Boys who work on the streets of Iraq are exposed to more traumatic events such as torture than schoolboys of the same age.

AIM: Information is scarce about the issues faced by street working. This study examined traumatic events experienced by boys working on the streets of Iraq compared to schoolboys. METHODS: We compared 100 street working boys aged 8-16 years who were attending a drop-in centre for street working children in Duhok City, Kurdistan, Iraq, in 2004/2005 with 100 age-matched schoolboys randomly selected from six local schools. The instruments that were used included the Harvard-Uppsala Trauma Questionnaire for Children. RESULTS: Most of the street working boys were involved in activities such as selling goods or shoe shining, and some were stealing or begging. None were involved in drugs or prostitution. The street working boys showed a significantly higher rate of traumatic events than the control group (96% versus 64%, p < 0.001) and higher rates of moderate to severe trauma levels (78% versus 25%, p < 0.001). A varying degree of association was found for reporting different traumatic events. The largest effect size was found for torture, with an odds ratio of 28.4, and the smallest for maltreatment or assault (2.7). CONCLUSION: Street working boys in Iraq faced a higher risk of exposure to traumatic events than age-matched schoolboys.

Psychiatric morbidity among street children in duhok.

BACKGROUND: Due, in part, to family constraints in dealing with the economical burden of raising a family, a wave of street children is sweeping the developing world. Such children are prone to both somatic and mental illnesses. This is the first ever study that has been conducted to explore the psychopathology among street children in the Duhok Governorate. METHODS: The study was conducted between March 2004 and May 2005 in Duhok City among street children who attended the Zewa Center-the only center for street children in the region at the time of the study. Among a total of 107 eligible children, 100 agreed to participate (93% response rate). A modified family map (genogram) was used to obtain demographic data from the children and their caregivers through semi-structured interviews. In addition, the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) structured interviews were conducted with the children. RESULTS: The study found that 98% of children worked on the street because of the economic need and pressure on their families. There was high rate of parental illiteracy (90% of fathers and 95% of mothers), and 61% of respondents were shown to have at least one psychiatric disorder. A high percentage (57%) of these children suffered from anxiety disorders including posttraumatic stress disorders (29%). Ten percent had depression, and 5% had attention deficit hyperactivity disorder. CONCLUSION: Street children in Duhok seem to be working children due to their families' needs.

Corrected and republished: Suicide in the Kurdistan Region of Iraq, state of the art.

In recent years the, incidence of suicide in Kurdistan has been increasing, especially among females, to a degree it cannot be neglected. Consequently, attention was given to this phenomena and the aggressive method of suicide used by young peoples, especially females, in Kurdistan. In attempt to obtain an objective picture of the frequently media-reported suicide among youths and women in the Kurdistan Region of Iraq. The responsible authorities and medical service units in the region were visited to collect information, and the available data were explored to produce a state-of-the-art overview on the subject. Because of insufficient documentation and lack of systematic registration, the data on suicide were scattered and difficult to evaluate. However, the findings did confirm that suicide exists as a serious problem in the society in Kurdistan, particularly among females. Urgent attention is demanded from the responsible authorities and organizations concerned in the region. Further research is needed to investigate the exact extent of suicide and its correlates in the society in Kurdistan, in order to plan for effective preventive measures. Burn, Iraq, Kurdistan, Suicide, Young.

Suicide in the Kurdistan Region of Iraq, state of the art.

In recent years the, incidence of suicide in Kurdistan has been increasing, especially among females, to a degree it cannot be neglected. Consequently, attention was given to this phenomena and the aggressive method of suicide used by young peoples, especially females, in Kurdistan. In attempt to obtain an objective picture of the frequently media-reported suicide among youths and women in the Kurdistan Region of Iraq. The responsible authorities and medical service units in the region were visited to collect information, and the available data were explored to produce a state-of-the-art overview on the subject. Because of insufficient documentation and lack of systematic registration, the data on suicide were scattered and difficult to evaluate. However, the findings did confirm that suicide exists as a serious problem in the society in Kurdistan, particularly among females. Urgent attention is demanded from the responsible authorities and organizations concerned in the region. Further research is needed to investigate the exact extent of suicide and its correlates in the society in Kurdistan, in order to plan for effective preventive measures.

Traumatic experiences and post-traumatic stress disorder in Kurdistanian children and their parents in homeland and exile: an epidemiological approach.

The prevalence and correlates of post-traumatic stress disorder (PTSD) were assessed in random samples of school-aged Kurdistanian children and their parents in homeland and exile. Of the 376 eligible children at the two sites, 312 children and their parents (293 mothers and 248 fathers) completed the Harvard-Uppsala Trauma Questionnaire and Posttraumatic Stress Symptom interviews for children, and Harvard Trauma Questionnaire for parents. Unlike their children, fathers showed significantly higher PTSD frequencies in exile than in the homeland. The fathers' PTSD negatively correlated with the living standard and fathers' education, while child PTSD mostly correlated with maternal education and living in exile. Living in exile seems to have a negative impact on fathers' post-traumatic reactions, despite its positive influence on children. High drop-outs in exile limit the conclusions.

Traumatic Experiences and Post-traumatic Stress Symptoms in Kurdish Children in their Native Country and in Exile.

BACKGROUND: Traumatic experiences and post-traumatic stress symptoms were assessed in Kurdish children in their native country and in exile. METHOD: 312 randomly selected school-age children at two sites completed assessments of traumatic experiences and post-traumatic symptoms. RESULTS: Although traumatic experiences showed more similarities than differences between the two samples, the PTSD frequencies and post-traumatic stress symptom scores were higher in Kurdistan than in exile. Living in exile showed negative correlation with PTSD frequencies and post-traumatic stress symptom scores. CONCLUSIONS: Living in exile seems to have trauma healing effect on children of Kurdistan.

Applying EMDR on children with PTSD.

OBJECTIVE: To find out child-adjusted protocol for eye movement desensitization and reprocessing (EMDR). METHOD: Child-adjusted modification were made in the original adult-based protocol, and within-session measurements, when EMDR was used in a randomized controlled trial (RCT) on thirty-three 6-16-year-old children with post-traumatic stress disorder (PTSD). RESULTS: EMDR was applicable after certain modifications adjusted to the age and developmental level of the child. The average treatment effect size was largest on re-experiencing, and smallest on hyperarousal scale. The age of the child yielded no significant effects on the dependent variables in the study. CONCLUSIONS: A child-adjusted protocol for EMDR is suggested after being applied in a RCT for PTSD among traumatized and psychosocially exposed children.

EMDR treatment for children with PTSD: results of a randomized controlled trial.

The objective of the study was to examine the efficacy of EMDR treatment for children with post-traumatic stress disorder (PTSD) compared with untreated children in a waiting list control group (WLC) participating in a randomized controlled superiority trial (RCT). Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. The Posttraumatic Stress Symptom Scale for Children (PTSS-C scale) was used in interviews with children to evaluate their symptoms and outcome. Post-treatment scores of the EMDR group were significantly lower than the WLC indicating improvement in total PTSS-C scores, PTSD-related symptom scale, and the subscales re-experiencing and avoidance among subjects in the EMDR group, while untreated children improved in PTSD-non-related symptom scale. The improvement in re-experiencing symptoms proved to be the most significant between-group difference over time. The results of the present exploratory study including a limited number of children with PTSD are encouraging and warrant further controlled studies of larger samples of children suffering from PTSD.

Reporting questionnaire for children as a screening instrument for child mental health problems in Iraqi Kurdistan.

To identify child mental health problems in a mid-sized to large city in Iraqi Kurdistan, the Reporting Questionnaire for Children (RQC), followed by the Child Behaviour Checklist (CBCL) and the Post-traumatic Stress Symptom Checklist for Children (PTSS-C), were administered in interview form to the caregivers of 806 school-aged children. To cover different categories of children, four samples were randomly selected from among the general population (n = 201), orphans (n = 241), primary medical care patients (n = 199), and hospital patients (n = 165). The RQC revealed satisfactory validity against a deviant CBCL cut-off. The screening capacity of the RQC was further supported by its similarity to the CBCL in distribution of problem scores among the four samples and its positive correlation with the CBCL, but not with the trauma-related PTSS-C. Although the general population showed lower problem scores than the orphans and the two clinical samples, problem scores in all instruments were considerably higher than those reported from other societies. The RQC seems to be useful as a first-stage screening instrument for child mental health problems in Kurdistan.

Treatment of traumatized refugee children with Eye Movement Desensitization and Reprocessing in a psychodynamic context.

This study examines the effects of a psychodynamic approach of Eye Movement Desensitization and Reprocessing (EMDR) in treatment of traumatized refugee children. Among a child psychiatric outpatient refugee team, 13 children with post-traumatic stress disorder (PTSD), were treated by EMDR incorporated in a traditional psychodynamic therapeutic approach. The Posttraumatic Stress Symptom Scale for Children (PTSS-C) and the Global Assessment of Functioning (GAF) were administered before and after the treatment, to measure the effects. After treatment, a significant improvement was noticed in the functioning level and all PTSS-C scales, mostly in re-experiencing and least in the avoidance symptoms. The improvement in the functioning level was significantly correlated with the reduction of the PTSD-non-related and the depression, but not with that of the PTSD-related symptoms. Used in a psychodynamic context, EMDR is suggested to be effective treatment for traumatized refugee children. Our findings support the hypothesis of child-specific criteria for PTSD.

Do Kurdistanian and Swedish parents and children differ in their rating of competence and behavioural problems?

OBJECTIVE: This paper investigates child self-rating of behavioural problems and competence as compared with their parents' ratings, in comparative samples of Kurdistanian refugee children in Sweden and a group of Swedish children. METHOD: Kurdistanian and Swedish comparative samples composed of 32 children each matched in age, sex and trauma level, in the same community, and their parents. Among a large battery of instruments, the child behavioural checklist (CBCL) was used in separate interviews with parents and their children. RESULTS: When compared to the children's self-reported problems scores, the Swedish parents reported significantly lower scores than their children, compared to the Kurdistanian refugee parents. CONCLUSION: Regardless of cultural backgrounds, there were more similarities than differences in the children's reporting of their behavioural problems and competence. The discrepancy between the Swedish parents' estimation of their children's behavioural problems and the children's self-reported behavioural problems could be an effect of the individualistic nature of Swedish society compared with the more collective nature of Kurdistanian culture. However, the results should be considered hypothesis generating rather than conclusive.