Can we challenge attention and interpretation threat biases in rescued child labourers with a history of physical abuse using a computerised cognitive training task? Data on feasibility, acceptability and target engagement.

Child labourers are more likely to have experienced physical victimisation, which may increase risk for anxiety/depression, by shaping threat biases in information-processing. To target threat biases and vulnerability for anxiety/depression, we evaluated whether Cognitive Bias Modification (CBM) training could be feasibly and acceptably delivered to rescued youth labourers. Seventy-six physically abused rescued labourers aged 14-17 (40 from Nepal, 36 from India) in out-of-home care institutions received either multi-session computerised CBM or control training. Training targeted attention away from threat to positive cues and the endorsement of benign over threat interpretations. Feasibility and acceptability data were gathered along with pre and post intervention measures of attention and interpretation bias and emotional and behavioural symptoms. In terms of feasibility, uptake (proportion of those who completed the pre-intervention assessment from those who consented) and retention (proportion of those who completed the post-intervention assessment from those who completed the pre-intervention assessment) were above 75% in both countries. Average acceptability ratings were mostly 'moderate' on most indices for both countries, and none of the participants reported experiencing serious adverse events or reactions in response to or during the trial. Secondarily, CBM participants showed increased attention to positive and decreased attention to threatening stimuli, as well as increased endorsement of benign interpretation and decreased endorsement in negative interpretations of ambiguous social situations. Symptom changes were less clear. Delivering CBM to former child labourers in out-of-home care institutions has interventive potential. ClinicalTrials.gov Identifier: NCT03625206, Date of registration: August 10, 2018.

Threat biases associate with anxiety and depression in physically-abused young people with a history of child labour.

BACKGROUND AND OBJECTIVES: Young people who have experienced early-life maltreatment preferentially attend to threat and draw more threatening interpretations. In turn, these threat biases may explain elevated risk for lifelong anxiety and/or depression. We investigated whether adolescent labourers with a history of physical abuse showed threat biases relative to non-abused labourers, and whether these threat biases associated with anxiety and depression. METHODS: 100 young people (aged 13-18 years, 64% female) from Nepal rescued from illegal child work were assessed for childhood maltreatment and anxiety and/or depression disorders. Participants completed an emotional visual search task (to measure attention engagement of positive versus negative faces) and an ambiguous scenarios questionnaire (to measure the endorsement of negative versus benign interpretations). RESULTS: Seventy young people reported a history of physical (and emotional) abuse. They were more likely to meet symptom thresholds for depression, and marginally, for anxiety disorders than non-physically abused participants. Abused and non-abused participants did not differ on attention engagement/disengagement of threat or on interpretational style. Abused participants with anxiety were slower to disengage from negative faces to engage with a positive face than non-anxious abused participants. Abused participants with depression endorsed more negative interpretations of ambiguous situations than those without depression. LIMITATIONS: The cross-sectional design limits our ability to infer whether threat biases reflect risk markers of psychopathology. CONCLUSIONS: If threat biases are shown to confer risk for anxiety and depression in future studies, they could be targeted in mental health prevention programs for these vulnerable young people.

Acceptability of a brief training programme targeting attention and interpretation biases for threat in youth with a history of maltreatment.

BACKGROUND: Tendencies to attend to threatening cues in the environment and to interpret ambiguous situations with negative/hostile intent maintain and may even precipitate internalizing and externalizing problems in young people with a history of maltreatment. Challenging maladaptive information-processing styles using cognitive bias modification (CBM) training may reduce symptoms. AIMS: To investigate the acceptability of CBM training in nine young people attending alternate education provision units in the UK, and 10 young people living in out-of-home care institutions in Nepal with a history of maltreatment. METHOD: CBM training consisted of five sessions of training over a 2-week period; each training session consisted of one module targeting attention biases and one module targeting interpretation biases for threat. A feedback form administered after training measured acceptability. Pre- and post-intervention measures of internalizing and externalizing symptoms were also taken. RESULTS: Most young people (89%) found the training helpful and 84% found the training materials realistic. There were reductions in many symptom domains, but with individual variation. Although limited by the lack of a control condition, we established generalizability of acceptability across participants from two cultural settings. CONCLUSIONS: Replication of these findings in larger feasibility randomized controlled trials with measures of attention and interpretation bias before and after intervention, are needed to assess the potential of CBM in reducing anxiety symptoms and its capacity to engage targeted mechanisms.

History of abuse and neglect and their associations with mental health in rescued child labourers in Nepal.

OBJECTIVES: Little is known about rates of childhood maltreatment in low-income countries, particularly among marginalised sectors of society. Economic hardships mean that in such countries, many children and young people are exploited in the labour force and/or are trafficked, placing them at greater risk for being exposed to other forms of maltreatment. Cultural norms endorsing the use of physical and emotional acts to discipline children further exacerbate this risk. Here, we assessed the rates of childhood victimisation experiences and associated mental health problems in Nepalese youth rescued from illegal child labour including trafficking. METHODS: One hundred and three young people aged 12-18 years living in out-of-home care institutions and rescued from child labour/trafficking completed translated versions of selected modules from the Juvenile Victimisation Questionnaire, the Youth Inventory and the Strength and Difficulties Questionnaire. Care-home employees responsible for looking after the young people completed the Adolescent Symptom Inventory and the Strength and Difficulties Questionnaire. Analysis described maltreatment frequencies and compared individuals who had and had not experienced any form of maltreatment on the presence/absence of psychiatric diagnoses. RESULTS: Seventy-two percent of participants experienced some form of maltreatment in their lifetime. Rates for each maltreatment type were 46.6% for physical abuse, 40.77% for emotional abuse, 27.2% for sexual abuse and 33% for neglect. Symptoms indicative of anxiety disorders and trauma were commonly reported especially in victims of childhood maltreatment. CONCLUSIONS: Our estimates of physical abuse in this at-risk juvenile sample were commensurate to those reported in general-population youth samples in Nepal, but sexual and emotional abuse rates were somewhat lower. The potential presence of anxiety and trauma in this sample that may result from maltreatment requires replication, but underscores an urgent need for routine mental health screening in rescued child labourers during rehabilitation efforts.

Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal: Gender-Specific Patterns.

This study describes the epidemiology of unintentional adult burn injury admissions in a tertiary hospital in Nepal, from 2002 to 2013, focusing on gender-specific patterns. Chi-square tests and Wilcoxon Rank Sum tests were performed. There were 819 unintentional burn admissions: 52% were male and 58% younger than 35 years. The median percentage total body surface area burned (interquartile range) was greater in females than in males (P < .001): 28% (17-40) versus 20% (12-35), and female mortality was higher (32% vs 11%). A higher proportion females were illiterate than males (48% vs 17%). Burns occurred at home (67%), work (28%), and public places (5%); gender-specific patterns were observed. Flame burns accounted for 77%, electricity 13%, and scalds 8%. Kerosene (31%) and biomass (27%) were the major fuels. Cooking, heating, and lighting were the main activities associated with burn injury. Results support interventions to reduce the use of open fires and kerosene and to promote electrical safety.

Intentional burns in Nepal: a comparative study.

AIMS: Intentional burns injuries are associated with high mortality rates, and for survivors, high levels of physical and psychological morbidity. This study provides a comprehensive assessment of intentional burn admissions to the adult Burns Unit at Bir Hospital, Kathmandu, Nepal, during the period 2002-2013. METHODS: A secondary data analysis of de-identified data of patients hospitalized at Bir Hospital, Kathmandu, with a burn during the period of 1 January 2002 to 31 August 2013. Socio-demographic, injury and psychosocial factors of patients with intentional and unintentional burns are described and compared. Chi-square tests, Fisher's exact test and Wilcoxon rank sum tests were used to determine statistical significance. RESULTS: There were a total of 1148 burn admissions of which 329 (29%) were for intentional burn, 293 (26%) were self-inflicted and 36 (3%) were due to assault. Mortality rates for intentional burns were approximately three times those for unintentional burns (60 vs. 22%). When compared to unintentional burns, patients with intentional burns were more likely to be female (79 vs. 48%), married (84 vs. 67%), younger (25 vs. 30 years), have more extensive burns (total body surface area, %: 55 vs. 25) and higher mortality (60 vs. 22%). Intentional burns were more likely to occur at home (95 vs. 67%), be caused by fire (96 vs. 77%), and kerosene was the most common accelerant (91 vs. 31%). A primary psychosocial risk factor was identified in the majority of intentional burn cases, with 60% experiencing adjustment problems/interpersonal conflict and 32% with evidence of a pre-existing psychological condition. A record of alcohol/substance abuse related to the patient or other was associated with a greater proportion of intentional burns when compared with unintentional burns (17 vs. 4%). CONCLUSIONS: The majority of intentional burn patients were female. Almost all intentional burns occurred in the home and were caused by fire, with kerosene the most common accelerant used. Underlying psychosocial risk factors were identified in most cases. Intentional burns resulted in severe burns with high mortality. Intentional burns are not only a serious medical issue; they represent significant public health and gender issues in Nepal.