[Assessment and therapy of suicidality in adolescence: the most important recommendations of the current guideline]. / Diagnostik und Therapie von Suizidalität im Jugendalter: Das Wichtigste in Kürze aus den aktuellen Leitlinien.

Due to the clinical relevance of suicidal risks, suicide attempts, and suicides in adolescence consensus-based guidelines with clinical recommendations were updated and summarized in this article. It should be considered that each indication has to be taken serious. Suicidality is an essential component of the psychopathological report and should be explored for the short- and long term risk. The clinical assessment of the acute suicidality results from a trustful anamnestic conversation, assessment of risk factors, mental disorders, and the use of alcohol and drugs. Acute suicidality is an indication for an inpatient treatment that for the protection of the patient has to be implemented also against his will. An adequate documentation is inevitable. After a suicide attempt, in addition to the initial medical treatment it has to be paid attention that the patient cannot harm himself any further and a rapid consultation in the responsible clinic takes place. First therapeutic goal is the reduction of suicidality and if necessary the re-achievement of the ability to negotiate a non-suicide agreement. For recurrent suicide thoughts an emergency plan has to be created. In addition to offer conversations, for a further relief a temporary sedated psychopharmacology can be necessary. In case of a suicide in a clinic, recommendations should be present that regulates responsibilities and procedures. Effective prevention methods are multiplier training, public education, restricted access to methods, and complying with media guidelines.

[The treatment needs of migrant children according to child and adolescent psychiatrists from medical clinics and in private practice]. / Anforderungen an die Behandlung von Migrantenkindern aus Sicht niedergelassener und leitender Ärzte für Kinder- und Jugendpsychiatrie.

OBJECTIVE: How does the German child and adolescent psychiatry system respond to the increasing number of migrant children and adolescents? METHOD: Senior doctors from German child and adolescent psychiatric hospitals (Association of Medical Hospital Directors in Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany, BAG) completed a specially constructed questionnaire about the treatment needs of migrant children, while a «random, representative¼ sample of child and adolescent psychiatrists in private practice (German Professional Association for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, BKJPP) was administered a slightly modified version. RESULTS: The 100 psychiatrists in private practice represented only about one-eighth of their group, whereas the 55 medical directors comprised a representative sample. One-third of the hospitals has treatments tailored to the specific needs of migrants. In both settings, however, competent interpreters were rarely found, despite the treatment problems arising from the understanding the illness by the parents, language problems, and the clinical knowledge of the patient. Cultural diversity is perceived as enriching. The migration background and the sex of child and adolescent psychiatrists influence the treatment of migrants. CONCLUSION: Facilitating the process of «cultural opening¼ in child and adolescent psychiatry involves enacting concrete steps, such as the funding of interpreter costs.

[Burden and capability of damaged parents--how refugee children can grow in exile]. / Last und Kraft beschädigter Eltern--Wie Flüchtlingskinder im Exil gesund wachsen können.

In trauma, dialectical tension arises between the inner perspective of the traumatized subject and the outside perspective (objective situation), between environmental stress and the subjective attribution of meaning, as well as between experience and behaviour. The traumatic process--the subject's endeavour to comprehend the overwhelming, often inconceivable experience and integrate it into its concepts of self and world--is understood against the backdrop of these interacting dimensions. The process phases "emerge from each other, run parallel, and permeate each other" (Fischer u. Riedesser, 2003). Problems that arise in the aftermath of trauma are rarely overcome by the victims alone. Attempts to process and self-heal have a social dimension, and family members are affected by war, persecution and flight in individual, varying ways. The impacts of violence experienced by parents from different crisis regions are examined in case studies with regard to the psychological development of indirectly impacted children growing up in exile.

[Guiltless guilty--trauma-related guilt and posttraumatic stress disorder in former Ugandan child soldiers]. / Schuldlos schuldig--Schuldempfinden und Posttraumatische Belastungsstörung bei ehemaligen Kindersoldaten in Uganda.

Despite international bans, more than 250,000 children and adolescents are exploited as soldiers worldwide, almost half of them in Africa. These children are exposed to a tremendous amount of violence and are often forced to commit atrocities themselves. In the present study, 330 former Ugandan child soldiers (age: 11-17, female: 48.5%) were interviewed regarding traumatic experiences, trauma-related guild, and posttraumatic stress disorder (PTSD). Affective and cognitive aspects of guilt were assessed with the Trauma-related Guilt Inventory (TRGI) and PTSD with a diagnostic interview (MINI-KID). Children had been abducted at a mean age of 10.75 years and served for an average period of 19.81 months. They were exposed to numerous traumatic experiences during abduction, e. g., 86.4% were exposed to killings, 87.9% were threatened with death, 52.6% were forced to kill another person, and 25.8% were raped. Diagnostic criteria for PTSD were fulfilled by 33% of the children. Higher guilt cognitions were significantly related to posttraumatic stress disorder. The current study has implications for the development of clinical interventions for war-affected children.

Multiple trauma and mental health in former Ugandan child soldiers.

The present study examines the effect of war and domestic violence on the mental health of child soldiers in a sample consisting of 330 former Ugandan child soldiers (age: 11-17 years, female: 49%). All children had experienced at least 1 war-related event and 78% were additionally exposed to at least 1 incident of domestic violence. Prevalences of posttraumatic stress disorder and major depressive disorder were 33%, and 36%, respectively. Behavioral and emotional problems above clinical cutoff were measured in 61%. No gender differences were found regarding mental health outcomes. War experience and domestic violence were significantly associated with all mental health outcomes. The authors' findings point to the detrimental effects of domestic violence in addition to traumatizing war experiences in child soldiers.

Posttraumatic resilience in former Ugandan child soldiers.

The present research examines posttraumatic resilience in extremely exposed children and adolescents based on interviews with 330 former Ugandan child soldiers (age = 11-17, female = 48.5%). Despite severe trauma exposure, 27.6% showed posttraumatic resilience as indicated by the absence of posttraumatic stress disorder, depression, and clinically significant behavioral and emotional problems. Among these former child soldiers, posttraumatic resilience was associated with lower exposure to domestic violence, lower guilt cognitions, less motivation to seek revenge, better socioeconomic situation in the family, and more perceived spiritual support. Among the youth with significant psychopathology, many of them had symptoms extending beyond the criteria for posttraumatic stress disorder, in keeping with the emerging concept of developmental trauma disorder. Implications for future research, intervention, and policy are discussed.

[Mental problems of migrant children and their families]. / Seelische Probleme von Migrantenkindern und ihren Familien.

Migration and flight often involve a change of culture and psychological traumatisation, but do not necessarily lead to psychological problems in children and their families. However, depending on additional psychic and social stressors, they are more vulnerable. When they seek counselling or treatment, cultural adjustment and trauma are usually the subject. Children born in the country of origin or growing up in the host country in the following generations are confronted with ambivalent feelings regarding their own past and that of their parents, and must deal with both their own and their parent's hopes and expectations for the future. Depending on individual resources and coping strategies, they may develop psychological problems. Counselling services, psychotherapeutic institutions and schools are seldom sufficiently prepared or equipped for dealing with these children and families' concerns. This article describes the challenges they face.

Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers.

CONTEXT: Tens of thousands of the estimated 250,000 child soldiers worldwide are abused or have been abused during the last decade in Africa's Great Lakes Region. In the process of rebuilding the war-torn societies, it is important to understand how psychological trauma may shape the former child soldiers' ability to reconcile. OBJECTIVE: To investigate the association of posttraumatic stress disorder (PTSD) symptoms and openness to reconciliation and feelings of revenge in former Ugandan and Congolese child soldiers. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional field study of 169 former child soldiers (aged 11-18 years) in rehabilitation centers in Uganda and the Democratic Republic of the Congo, conducted in 2005. MAIN OUTCOME MEASURES: Potentially traumatic war-related experiences assessed via a sample-specific events scale; PTSD symptoms assessed using the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI), with a score of 35 or higher indicating clinically important PTSD symptoms; and openness to reconciliation and feelings of revenge assessed via structured questionnaires. RESULTS: Children participating in this study were a mean of 15.3 years old. These former child soldiers reported that they had been (violently) recruited by armed forces at a young age (mean [SD], 12.1 [2] years), had served a mean of 38 months (SD, 24 months), and had been demobilized a mean of 2.3 months before data collection (SD, 2.4 months). The children were exposed to a high level of potentially traumatic events (mean [SD], 11.1 [2.99]). The most commonly reported traumatic experiences were having witnessed shooting (92.9%), having witnessed someone wounded (89.9%), and having been seriously beaten (84%). A total of 54.4% reported having killed someone, and 27.8% reported that they were forced to engage in sexual contact. Of the 169 interviewed, 59 (34.9%; 95% confidence interval, 34.4%-35.4%) had a PTSD symptom score higher than 35. Children who showed more PTSD symptoms had significantly less openness to reconciliation (rho= -0.34, P < .001) and more feelings of revenge (rho= 0.29, P < .001). CONCLUSIONS: PTSD symptoms are associated with less openness to reconciliation and more feelings of revenge among former Ugandan and Congolese child soldiers. The effect of psychological trauma should be considered when these children are rehabilitated and reintegrated into civilian society.