The network structure of posttraumatic stress symptoms in war-affected children and adolescents.

Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results: In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion: The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

The role of violence perpetration in driving externalizing problems and offending behavior among youth from eastern Democratic Republic of Congo.

Youth in conflict-affected regions are exposed to a multitude of traumatic events. These individuals often witness violence; experience it firsthand; and, in some cases, become perpetrators. The interplay of events shapes systematic trauma histories that may have unique implications for youths' mental health. In a cross-sectional study conducted in eastern Democratic Republic of Congo (DRC), we interviewed 295 war-affected youth (63.4% boys, Mage = 16.70 years), including former child soldiers (n = 171), regarding their traumatic experiences and mental health. Using latent class analysis, we identified four common trauma history classes categorized by (a) low exposure, (b) medium exposure, (c) high exposure, and (d) high exposure/perpetration. Across the sample, gradual increases in trauma load corresponded with increased vulnerability to posttraumatic stress disorder (PTSD) symptoms, ηp 2 = .36, and internalizing problems, ηp 2 = .12; however, only youth from the high exposure/perpetration class differed significantly from other youth in their levels of externalizing problems, ηp 2 = .13, and offending behaviors, ηp 2 = .17. A longer time in armed groups was related to a higher risk of both experiencing and perpetrating violence. The results indicate that it is not child soldier status, per se, but the perpetration of violence that reinforces a cycle of violence in conflict-affected societies by contributing to increased externalizing problems and offending behaviors. In conflict regions, integrated approaches are needed to address both trauma and externalizing problems of war-affected youth.

The role of intrinsic and extrinsic rewards in committing violence during combat: A cross-sectional study with former combatants in the DR Congo.

It has been postulated that the violent behavior that characterizes armed conflict is reinforced by the possibility of receiving rewards. The present study examined the potential influence of two types of rewards in an ongoing setting of conflict: extrinsic and intrinsic rewards. Former combatants active in the Democratic Republic of the Congo (N = 198) were interviewed and questioned about the way they were recruited, the offenses they committed during combat, their level of perceived intrinsic rewards (i.e., appetitive perception of violence), and the number of received extrinsic rewards during their time in the armed group (e.g., money, extra food, alcohol, or drugs). A moderated multiple regression analysis showed that the number of received extrinsic rewards and the level of intrinsic rewards were significantly positively related to the number of different types of offenses committed. In contrast to our expectations and previous findings, the recruitment type (forced conscription vs. voluntary enlistment) did not moderate this relation. Our findings suggest that both types of rewards play a role in committing violence during combat. We suggest, therefore, that reintegration programs should not only consider the influence of extrinsic rewards, but also need to address the influence of intrinsic rewards to counter violent behavior among former combatants. Aggr. Behav. 43:241-250, 2017. © 2016 Wiley Periodicals, Inc.

Analyzing the microfoundations of human violence in the DRC - intrinsic and extrinsic rewards and the prediction of appetitive aggression.

BACKGROUND: Civil wars are characterized by intense forms of violence, such as torture, maiming and rape. Political scientists suggest that this form of political violence is fostered through the provision of particular intrinsic and extrinsic rewards to combatants. In the field of psychology, the perpetration of this kind of cruelty is observed to be positively linked to appetitive aggression. Over time, combatants start to enjoy the fights and even the perpetration of atrocities. In this study, we examine how receiving rewards (intrinsic versus extrinsic) influence the level of appetitive aggression exhibited by former combatants. METHOD: We surveyed 95 former combatants in the eastern provinces of the Democratic Republic of the Congo. RESULTS: Linear regression analyses reveal that intrinsic as well as extrinsic rewards are linked to the former combatants' Appetitive Aggression score. However, this relationship is partly determined by the way in which combatants are recruited: While abducted combatants seem to react more strongly to extrinsic rewards, the score of those that joined voluntarily is primarily determined by intrinsic rewards. CONCLUSIONS: We conclude that receiving rewards influence the level of appetitive aggression. However, which type of rewards (intrinsic versus extrinsic) is of most importance is determined by the way combatants are recruited.