Children and the Cycle of Violence in Post-Conflict Settings : Mental Health, Aggression, and Interventions in Burundi

In this thesis I investigated the negative impact of maltreatment on the psychological wellbeing of children and adolescents who grew up in violent environments of the post-conflict country Burundi. Furthermore, the individual risk factors of these adolescents for engaging in everyday violence were assessed. Subsequently I evaluated the Forensic Offender Rehabilitation Narrative Exposure Therapy (FORNET) as a means of reducing violent behavior among adolescents.Research has demonstrated that trauma-related mental health disorders are common among war-affected populations. Children and adolescents growing up on the streets or in unstable family conditions in post-conflict settings are particularly vulnerable. Exposure to life-threatening situations, maltreatment and other forms of violence at early age most likely impede their development and exacerbate their risk to suffer from mental ill-health.Furthermore, violent environments also appear to foster aggressive behavior. A large number of studies have shown that posttraumatic stress disorder (PTSD) is associated with an increased likelihood of reactive aggressive responding. However, recent studies with serious offenders showed that violent behavior might also be perceived as appetitive, i.e., as exciting, fascinating and related to feelings of power. Appetitive aggression appears to be a useful adaption to adverse environments, which may also develop among children and adolescents. The mental health and the propensity to engage in violent behavior were investigated in 112 male children and adolescents. They were recruited from the streets (n = 15), families (n = 15), a residential center for former street children (n = 32) and other vulnerable children (n = 50) in Burundi. They were between 11 and 24 years old (mean = 15.9 years; SD = 3.0years). PTSD symptom severity was assessed with the University of California at Los Angeles PTSD Reaction Index (UCLA PTSD Index; Steinberg, Brymer, Decker, & Pynoos, 2004). The Minnesota International Neuropsychiatric Interview for Children and Adolescents (MINI-KID; Sheehan et al., 2010) was used to screen for depression, alcohol and substance dependence as well as for suicidal risk. In addition, physical health complaints were examined with a checklist. Aggression was assessed with an offense checklist, the Reactive Proactive Aggression Questionnaire (Raine et al., 2006) and the Appetitive Aggression Scale for Children (AAS-C). Among the adolescents in residential care, the 32 scoring highest in appetitive aggression were chosen to participate in an intervention study. Half of them received FORNET, the remaining 16 received treatment as usual. The follow-up assessment was conducted 4-7 months after completing treatment.Results showed that current street children were most affected by mental disorders. The children living in the residential center suffered more from PTSD symptoms than children who still lived with their families. In residential care, the current exposure to minor violence and neglect was positively associated with increased PTSD symptom severity. The latter impeded progress in school. Appetitive aggression was negatively related to PTSD symptoms. This indicates that appetitive aggression improves resilience against mental illhealth of adolescents who grew up in precarious conditions. Furthermore, appetitive aggression was a serious risk factor for current offenses. FORNET proved to be effective in reducing the involvement in everyday violence among adolescents (Hedges g =.62). In addition, the physical health of the FORNET treated participants improved (Hedges g =.56). The results disentangled different aspects of the cycle of violence: (1) Being a victim of even minor violent acts impairs mental health, which in turn impedes progress in school. Hence providing adolescents with a violence free environment is essential for successful integration into society. (2) Children and adolescents may develop appetitive aggression as an adaption to violent environments. While this protects their mental health in precarious conditions, it also increases their involvement in everyday violence. The FORNET is a promising approach to reducing violent behavior and to improving resilience against ill-health