• By Dartington SRU
  • Posted on Monday 16th March, 2009

Treating casualties in a war without end

Children living in urban areas are lucky if they never encounter community violence in some form. The most conservative estimates from previous research suggest 50% do, but the figure can be as high as 96%. Exposure to extreme violence such as street stabbings or shootings is still mercifully rare, but most urban children will have some contact with activity surrounding drug deals or robberies. Many researchers in the last 30 years have demonstrated that exposure to community violence does psychological harm to children and adolescents. But their uneven methods have resulted in what Patrick Fowler at Wayne State University, Michigan, describes as a confusing pattern of findings.Some researchers say that community violence is a factor in traumatic stress disorder (PTSD), some associate it with behavioral and emotional problems, but there is little consensus in the literature. Fowler and his colleagues attempt to bring some order in the form of a meta-analysis recently published in Development and Psychopathology.After synthesizing the results of 110 relevant studies, involving nearly 40,000 children, they have come to the conclusion that community violence is more strongly associated with PTSD symptoms than behavior or emotional problems.Communities with high levels of violence can be likened to “war zones in which there is no foreseeable end to the combat,” Fowler reports. Some children live in constant fear of robbery, fighting, gang activities, stabbings and shootings and continually hear of the victimization of friends, family and neighbors. The meta-analysis identified a weaker association with behavior problems. Exposure to community violence may alter how children think about what is normal and acceptable, Fowler concludes. Frequent exposure may in turn make children more likely to engage in violent acts. Effects associated with physical proximity to the violence also emerged. Being the victim of violence had a greater impact on children’s behavior than did witnessing it or hearing about it. The victims of violence were more likely to engage in violent behaviors themselves. Proximity did not seem to be a factor in the development of PTSD, however. Witnesses were as likely as victims to experience symptoms, a finding that may be explained by the phenomenon of collective traumatization, Fowler suggests. In that condition, children and young people continually fear for their safety and are always on guard. It perpetuates their PTSD symptoms regardless of their proximity to violent acts.In their reckoning of the implications for policy and practice, the researchers say that interventions should be aimed at witnesses and ordinary residents in violent communities, not just victims. At present very few such services exist and far fewer have been rigorously evaluated. They argue that preventions science could develop school-based programs to teach coping skills and train members of the community to identify and adequately respond to the symptoms of PTSD. The Wayne State review included studies published since 1993 based on a trawl of electronic databases, reference lists and contact with researchers. They stipulated the use of multiple item-self-report or objective measures of community violence and measures of PTSD symptoms or externalizing and internalizing behavior problems. See: Fowler, P J et al (2009) “Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents,” Development and Psychopathology, 21, pp 227-259

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