Muller Brigitte, Munslow Barry, O'Dempsey Tim
Department of Health and Life Science, Liverpool School of Tropical Medicine, Liverpool, UK.
Int J Health Plann Manage. 2017 Jan;32(1):91-109. doi: 10.1002/hpm.2311. Epub 2015 Aug 26.
The magnitude of violence and human loss in conflict settings often exceeds the caring capacity of traditional support systems for orphans. The aim of this study is to understand the developmental context for children experiencing armed conflict, parental loss, extreme poverty, violence and social exclusion in a setting affected by interethnic violence. This article challenges the received wisdom that community reintegration is always better than institutional provision. Using a case study employing interviews, focus groups, workshops and observations, we examined how children's experiences of armed violence and parental loss affected their mental well-being, and their relationships within their community. Emerging findings such as experienced violence and psychological distress were further investigated using a cross-sectional survey design to explore the generalisability or transferability of theories or conclusions drawn from qualitative data. Findings showed that parental loss had a major impact on children's lives in the context of armed violence. Four main outcomes of orphanhood emerged: (i) facing the situation and evading harm (feelings of rejection and stigmatisation); (ii) trauma exposure and mental health effects (associations of orphanhood with adverse mental health outcomes and the number and type of experienced trauma); (iii) dealing with psychological distress (seeking caring connections and decreased feelings of isolation); and (iv) education and acceptance (increasing knowledge, skills and attitude and being respected in their community). We discuss the role that contexts such as armed violence, parental loss and social exclusion play for children's mental well-being and their implications for psychosocial interventions and orphan care in humanitarian settings. Copyright © 2015 John Wiley & Sons, Ltd.
冲突环境中的暴力程度和人员伤亡往往超出了传统孤儿支持系统的照料能力。本研究的目的是了解在一个受族裔间暴力影响的环境中，经历武装冲突、父母离世、极端贫困、暴力和社会排斥的儿童的成长背景。本文对那种认为社区重新融入总是优于机构照料的既定观念提出了质疑。通过一个采用访谈、焦点小组、工作坊和观察的案例研究，我们考察了儿童的武装暴力经历和父母离世如何影响他们的心理健康以及他们在社区中的人际关系。利用横断面调查设计对诸如经历的暴力和心理困扰等新出现的发现进行了进一步调查，以探究从定性数据得出的理论或结论的普遍性或可转移性。研究结果表明，在武装暴力背景下，父母离世对儿童的生活产生了重大影响。孤儿身份出现了四个主要结果：（i）面对处境并规避伤害（被拒绝和被污名化的感觉）；（ii）创伤暴露和心理健康影响（孤儿身份与不良心理健康结果以及经历的创伤的数量和类型之间的关联）；（iii）应对心理困扰（寻求关爱联系并减少孤独感）；以及（iv）教育与接纳（增加知识、技能和态度并在社区中受到尊重）。我们讨论了武装暴力、父母离世和社会排斥等背景因素对儿童心理健康所起的作用以及它们对人道主义环境中心理社会干预和孤儿照料的影响。版权所有© 2015约翰·威利父子有限公司。
