Trauma-related impairment in children—A survey in Sri Lankan provinces affected by armed conflict
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Objectives The present study examined traumatic experiences, PTSD, and co-morbid symptoms in relation to neuropsychological and school performance in school children affected by two decades of civil war and unrest.Method The epidemiological survey of children's mental health included a representative sample of 420 school children. Local teachers were trained to administer a translation of the UCLA-PTSD Index Form. The instrument and the epidemiological findings were validated by assessment through clinical expert interview, school grades, and neuropsychological testing in a subsample (N=67).Results Ninety-two percent of the children surveyed had experienced severely traumatizing events such as combat, bombing, shelling, or witnessing the death of a loved one. Twenty-five percent met the criteria for a diagnosis of PTSD. Traumatized children reported lasting interference of experiences with their daily life, which was corroborated by memory testing, scores in school performance and ratings of social withdrawal. Depressive symptoms and poor physical health were frequent in these children. The majority of trained teachers achieved valid results in the structured interviews.Conclusion Performance and functioning in children are related to the total load of traumatic events experienced. An important component of psychosocial programs in post-conflict areas should include increasing community-based awareness of the consequences of traumatic stress, both as a preventative measure and as a way of decreasing stigmatization of affected individuals.
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High levels of lasting mental disorders, including PTSD, had been found among war-affected Tamil school children already before the Tsunami.
“and high levels of lasting mental disorders, including PTSD, had been found among war-affected Tamil school children already before the Tsunami [28].”
From Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka (2009) · cites this paper as [28]
The UPID had been translated into Tamil following standard principles of instrument translation and validation.
“In a previous study, this instrument had been translated into Tamil following standard principles of instrument translation and validation [28].”
From Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka (2009) · cites this paper as [28]
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Saile, R., Ertl, V., Neuner, F., & Catani, C. (2015) · Development and Psychopathology · doi:10.1017/s0954579415001066 · Cited by 31 · see citing works
“…diagnoses based on the Mini International Neuropsychiatric Interview for children and adolescents (Sheehan et al., 1998) in Sri Lanka (k ¼ 0.80; Elbert et al., 2009) and the clinician-administered PTSD Scale for Children and Adolescents (Nader et al., 2004) in Afghanistan (k ¼ 0.56; Catani…”
BackgroundMethodInfluentialSelf-citationYoon, S., Quinn, C. R., McCarthy, K. S., & Robertson, A. A. (2019) · Youth & Society · doi:10.1177/0044118x19844392 · Cited by 30 · see citing works
From War to Classroom: PTSD and Depression in Formerly Abducted Youth in Uganda
Winkler, N., Ruf‐Leuschner, M., Ertl, V., Pfeiffer, A., Schalinski, I., Ovuga, E., Neuner, F., & Elbert, T. R. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00002 · Cited by 29 · see citing works
“On the other hand, PTSD symptoms interfere with scholastic achievement and may ultimately lead to unacceptably high drop-out rates (6, 7).”
BackgroundSelf-citationFasfous, A. F., Peralta-Ramírez, I., & Pérez-García, M. (2013) · Journal of Muslim Mental Health · doi:10.3998/jmmh.10381607.0007.203 · Cited by 27 · see citing works
“…zones indicate that exposure to the traumatic event leads to the development of PTSD in childhood and adulthood (Attari, Dashty, & Mahmoodi, 2006; Elbert et al., 2009; Carlson & RosserHogan, 1994; Nader, Pynoos, Fairbanks, Al- Ajeel, & Al- Asfour, 1993; Qouta, Punamaki, & El Sarraj, 2003; Thabet…”
BackgroundDevelopment of mental health care in Sri Lanka: Lessons learned
Kathriarachchi, S., Seneviratne, V., & Amarakoon, L. (2019) · Taiwanese Journal of Psychiatry · doi:10.4103/tpsy.tpsy_15_19 · Cited by 27 · see citing works
“In a survey of children in north eastern Sri Lanka, 92% stated that they had experienced severely traumatizing events during the internal armed conflict, such as combat, shelling, bombing, and witnessing the death of loved ones, and 25% had symptoms of post-traumatic stress disorder [10].”
BackgroundNasie, M., Tagar, M. R., & Bar‐Tal, D. (2021) · Journal of Social Issues · doi:10.1111/josi.12479 · Cited by 27 · see citing works
Crombach, A., Bambonye, M., & Elbert, T. R. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01441 · Cited by 27 · see citing works
Self-citationWilker, S., Kolassa, S., Vogler, C., Lingenfelder, B., Elbert, T. R., Papassotiropoulos, A., de Quervain, D. J. ‐., & Kolassa, I. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.02.022 · Cited by 26 · see citing works
Self-citationJeharsae, R., Sangthong, R., Wichaidit, W., & Chongsuvivatwong, V. (2013) · Conflict and Health · doi:10.1186/1752-1505-7-8 · Cited by 24 · see citing works
“Exposure to armed conflict was found to have a linkage to delayed linguistic development among preschoolers and to be associated with psychological disturbance and poor school achievement among school children [5,9,10].”
BackgroundStudying Stress in the Twenty-First-Century: An Update of Stress Concepts and Research
Wheaton, B., & Montazer, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.013 · Cited by 24 · see citing works
Bowman, S., McKinstry, C., Howie, L., & McGorry, P. D. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.12928 · Cited by 23 · see citing works
“…comprehension problems in high school stu- dents who have been exposed to childhood trauma (De Bellis & Zisk, 2014; DePrince, Weinzierl, & Combs, 2009; Elbert et al., 2009; Husain, Allwood, & Bell, 2016; Kira et al., 2014; Kira, Lewandowski, Somers, Yoon, & Chiodo, 2012; Schoeman, Carey, &…”
Nyarko, F., & Punamäki, R. (2020) · Transcultural Psychiatry · doi:10.1177/1363461520901636 · Cited by 23 · see citing works
“These findings are important because intrusive symptoms can interfere with young adults’ social and intimate relationships, learning, and general wellbeing (Elbert et al., 2009; Yoder, Tol, Reis, & de Jong, 2016).”
Bensimon, M. (2020) · Nordic Journal of Music Therapy · doi:10.1080/08098131.2019.1703210 · Cited by 23 · see citing works
“…to war, showing correlation with acute stress disorder, PTSD, anxiety, depression, regressive behaviors, separation problems, sleep difficulties, and behavioral problems (Chemtob et al., 2008; Elbert et al., 2009; Fremont, 2004; PatHorenczyk et al., 2007; Pine et al., 2005; Sagi-Schwartz, 2008).”
BackgroundEckart, C., Kaufmann, J., Kanowski, M., Tempelmann, C., Hinrichs, H., Elbert, T. R., Heinze, H., & Kolassa, I. (2011) · Psychophysiology · doi:10.1111/j.1469-8986.2011.01303.x · Cited by 22 · see citing works
Self-citationExposure of Children to War and Terrorism: A Review
Yahav, R. (2011) · Journal of Child & Adolescent Trauma · doi:10.1080/19361521.2011.577395 · Cited by 24 · see citing works
“To name a few examples, the ongoing war in Sri Lanka has resulted in the death and displacement of thousands of civilians (eg, Elbert et al, 2009 ; see Ellis, Miller, Baldwin, & Abdi, 2011 , for research on refugee youth).”
BackgroundSchool hazard vulnerability and student learning
David, C. C., Monterola, S. L. C., Paguirigan, A. A., Legara, E. F., Tarun, A., Batac, R. C., & Osorio, J. P. (2018) · International Journal of Educational Research · doi:10.1016/j.ijer.2018.07.005 · Cited by 22 · see citing works
Chandradasa, M., & Champika, L. (2018) · Academic Psychiatry · doi:10.1007/s40596-018-0920-8 · Cited by 21 · see citing works
The Measurement of Mental Disorder
Wakefield, J. C., & Schmitz, M. F. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.005 · Cited by 20 · see citing works
Wilker, S., Catani, C., Wittmann, J., Preuße, M., Schmidt, T. L., May, T., Ertl, V., Doering, B. K., Rosner, R., Zindler, A., et al. (2020) · Trials · doi:10.1186/s13063-020-4127-4 · Cited by 20 · see citing works
Self-citationGiebel, G., Weierstall, R., Schauer, M., & Elbert, T. R. (2013) · Evolutionary Psychology · doi:10.1177/147470491301100122 · Cited by 19 · see citing works
“…vulnerable to developing posttraumatic stress disorder (PTSD; Elbert, Rockstroh, Kolassa, Schauer, and Neuner, 2006) and other forms of psychopathology (Allwood et al., 2002; Elbert et al., 2009; Kolassa and Elbert, 2007; Schaal and Elbert, 2006; Schaal, Jacob, Dusingizemungu, and Elbert, 2010).”
BackgroundSelf-citationThe Dual Continua Model: The Foundation of the Sociology of Mental Health and Mental Illness
Keyes, C. L. M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.007 · Cited by 21 · see citing works
Bhutta, Z. A., Yousafzai, A. K., & Zipursky, A. (2010) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2009.12.004 · Cited by 18 · see citing works
Johnson, R. J., & Hobfoll, S. E. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.024 · Cited by 17 · see citing works
Impact of the Boko Haram Insurgency on the Child's Right to Education in Nigeria
Isokpan, A. J., & Durojaye, E. (2016) · Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad · doi:10.17159/1727-3781/2016/v19i0a1299 · Cited by 17 · see citing works
Socioeconomic Stratification and Mental Disorder
Eaton, W. W., & Muntaner, C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.016 · Cited by 18 · see citing works
Løkkegaard, S. S., Egebæk, S. A. B., & Elklit, A. (2017) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-017-0146-z · Cited by 15 · see citing works
Marquer, C., Barry, C., Mouchenik, Y., Hustache, S., Djibo, D. M., Manzo, M. L., Falissard, B., Révah‐Levy, A., Grais, R. F., & Moro, M. R. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-170 · Cited by 15 · see citing works
“The clinician also completed a semi-structured clinical interview, and performed a diagnosis based on ICD-10 classification [33,57].”
BackgroundMethodKeith, V. M., & Brown, D. R. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.019 · Cited by 16 · see citing works
Understanding the Connection between Social Support and Mental Health
Brown, R. L., & Ciciurkaite, G. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.014 · Cited by 15 · see citing works
Impacts of Wildfires on School Children: A Case Study of Slave Lake, Alberta, Canada
Townshend, I. J., Awosoga, O., Kulig, J. C., Botey, A. P., Shepard, B., & McFarlane, B. L. (2015) · International Journal of Mass Emergencies & Disasters · doi:10.1177/028072701503300202 · Cited by 15 · see citing works
Diab, S. Y., Guillaume, M., & Punamäki, R. (2018) · The Elementary School Journal · doi:10.1086/698730 · Cited by 14 · see citing works
“Furthermore, war-affected Sri Lankan children suffering from PTSD attained lower grades in language, but not in math, than those without PTSD (Elbert et al., 2009).”
BackgroundInfluentialIto, T., Li, J., Usoof-Thowfeek, R., & Yamazaki, K. (2024) · World Development · doi:10.1016/j.worlddev.2023.106430 · Cited by 11 · see citing works
Functional impairment and mental health functioning among Vietnamese children
Dang, H., Weiss, B., & Trung, L. T. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1114-2 · Cited by 13 · see citing works
“Researchers have assessed functional impairment in relation to specific disorders in other Asian countries (e.g., ADHD in Taiwan [19]; war-related PTSD in Sri Lanka [20]), but not global functional impairment.”
Mental health screening and assessment tools for forcibly displaced children: a systematic review
Verhagen, I. L., Noom, M. J., Lindauer, R., Daams, J. G., & Hein, I. M. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2126468 · Cited by 17 · see citing works
“…AUC = 0.79 (+) 82% (7) 70% (7) 504 Adequate Results in line with 2 hypotheses (2+), results not in line with 1 hypothesis (1–) IES (Dyregrov et al., 1996) – – – – – – 1787 Adequate Results not in line with 1 hypothesis (1–) IES (Sack et al., 1998) 180 Very good DICA 19 AUC = 0.69 (–) 66% 63% – –…”
BackgroundInfluentialTrauma as a Public Health Issue: Epidemiology of Trauma and Trauma-Related Disorders
Mew, E. J., Koenen, K. C., & Lowe, S. R. (2022) · Springer eBooks · doi:10.1007/978-3-030-97802-0_2 · Cited by 9 · see citing works
Mental Health Enables Integration: Re-thinking Treatment Approaches for Refugees
Hecker, T., & Neuner, F. (2018) · Migration, minorities and modernity · doi:10.1007/978-3-030-03155-8_5 · Cited by 9 · see citing works
Self-citationLink, B. G., & Phelan, J. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.024 · Cited by 9 · see citing works
Rosenfield, S., Kato, K., & Smith, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.017 · Cited by 9 · see citing works
Rajan, V., Neuner, F., & Catani, C. (2021) · Development and Psychopathology · doi:10.1017/s0954579420001078 · Cited by 8 · see citing works
“…exposure to mass trauma For the assessment of sociodemographic characteristics, we adopted a questionnaire that had previously been used with Tamil schoolchildren (Catani et al., 2008a; Elbert et al., 2009) and included additional questions regarding their stay in the residential care institution.”
MethodSelf-citationPsychopathology mediates between maltreatment and memory functioning in Burundian refugee youth
Scharpf, F., Mueller, S. C., Masath, F. B., Nkuba, M. G., & Hecker, T. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105165 · Cited by 8 · see citing works
- Authors
- Elbert, T., Schauer, M., Schauer, E., Huschka, B., Hirth, M., & Neuner, F.
- Affiliations
- University of Konstanz (DE)
- Bielefeld University (DE)
- Corresponding author
- Elbert, Thomas
- Venue
- Child Abuse & Neglect
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 33
- Issue
- 4
- Pages
- 238-246
- ISSN
- 0145-2134 (ISSN-L)
- OpenAlex
- W2117241046
- Cited by
- 167
- References
- 32
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 42 · 2016: 12 · 2015: 10 · 2014: 10 · 2013: 11 · 2012: 6
- FWCI
- 13.42
- Type
- journal article
- Language
- en
- Open access
- green
- nbn-resolving.de
- Locations
- Child Abuse & Neglect (publishedVersion)
- PubMed (publishedVersion)
- KOPS (University of Konstanz) (submittedVersion)
- PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- childhood trauma, post-traumatic stress disorder, armed conflict, civil war, Sri Lanka, elementary school students, neuropsychological performance, academic performance, depressive symptoms, physical health, social withdrawal, psychosocial interventions, post-conflict mental health
- MeSH terms
- Adolescent, Child, Educational Measurement, Female, Humans, Interpersonal Relations, Male, Memory, Quality of Life, Sri Lanka, Warfare, Wounds and Injuries, Comorbidity, Epidemiologic Studies, Young Adult
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