6.2 Implications for the future
6.2.1 Future research
General discussion 92 6.1.4 Resume
The present work investigated the predictors of violence against children in the aftermath of mass trauma as well as the effects of positive parenting on children’s mental health. The presented results not only corroborate previous findings, but also provide further information on the development and continuation of violence against children in the aftermath of mass trauma. The result of the first and second study strengthen both pathways suggested by Catani (2010, 2018): Firstly, parents living in the context of mass trauma may subsequently suffer from psychological impairment and dysfunctional coping strategies such as substance abuse which may increase the likelihood of perpetrating violence against their children. Secondly, children affected by mass trauma may suffer from psychological impairments which may make them more vulnerable to experience violence. The results of the second study further indicate that the second pathway as suggested by Catani (2010, 2018) may not only apply to violence within the family but also to violence in other relationships. Through these two pathways, violence may find its way from community to interpersonal level. Interpersonal violence may further affect children’s mental health which, in turn, may lead to a vicious cycle of increasing violence and additional mental health problems. Therefore, protecting the mental health of children in the context of mass trauma seems to be crucial. In this regard, the third study revealed parental care as a powerful factor that may even buffer the detrimental effects of war and natural disaster on children’s mental health giving parenting behavior an essential role in the context of mass trauma.
General discussion 93 health problems even in the context of mass trauma need further support from future research.
Our samples were not representative for the whole community of Sri Lankan Tamils, so that future studies should concentrate on epidemiological studies with a randomly selected sample. Future studies should also focus on longitudinal studies in order to investigate the cause-effect relationship between exposure to mass trauma, psychopathology of family members and violence against children and the moderating effect of parental care on the relationship between mass trauma and children’s mental health. Longitudinal studies would be also helpful to eliminate potential reporting bias with respect to retrospective events.
Some of the effects, such as an independent effect of parents own experience of family violence on parental perpetration, may have reached significance in a larger sample that exhibits a greater variance in the level of parents' exposure to family violence. Future studies with institutionalized children in post-conflict settings should also include the assessment of guardians’ mental health and prior adverse experience in order to eliminate the possibility of their mental health playing a role in the perpetration of violence against the institutionalized children. It would be also helpful to include more extensive diagnostic interviews that allow for the diagnosis of a broader range of psychological disorders besides PTSD and major depression. Future studies should add behavioral observations as independent and additional measures of parenting behavior.
Future research should also develop and test family-level interventions that may be effective and sustainable in promoting resilience in children in post-disaster contexts. Some family-based interventions have been already developed and adapted to post-war communities (Betancourt et al., 2013; Wieling et al., 2015), but the empirical evidence regarding their long-term efficacy is still not proven. Future research should aim at filling this research gap and further develop and test intervention programs that include culturally sensitive family-based approaches and parenting trainings for families in the aftermath of mass trauma.
General discussion 94 6.2.2 Clinical implications
It is hoped that the finding of the studies may stimulate debate about adequate interventions for children affected by mass trauma. The high level of violence against children indicates the necessity of adequate interventions to promote nonviolent parenting and to protect children living in the aftermath of war and natural disaster. The findings denote that interventions aiming at reducing family violence in post-conflict settings should consider both child and parent characteristics. Therefore, intervention programs should include culturally sensitive family-based approaches and parenting trainings that meet the specific needs of families and children in post-war communities. However, it is not sufficient to focus only on highlighting alternative parenting styles and disciplinary measures, but also to include the promotion of responsible handling of alcohol and if applicable the individual treatment of parental alcohol addiction. A study found a reduction of intrafamilial violence after engaging the integrated cognitive–behavioral intervention (ICBI) among Indian men with substance use disorder (Satyanarayana et al., 2016). At child level, intervention programs should not only include the treatment of children’s mental impairments but also provide training to nourish their social skills and to establish healthy, non-violent relationships with peers. For example, the narrative exposition therapy (NET) has been successfully used to treat posttraumatic stress disorder and to restore functioning in traumatized children (Catani et al., 2009; Ruf et al., 2010). Institutionalized children in the aftermath of mass trauma are, in particular, vulnerable to experience further violence, so that they require more care and attention. Intervention programs in residential care institutions should provide training in nonviolent behavioral management strategies for guardians in order to promote positive disciplinary measures. A promising intervention approach that aims to prevent maltreatment in institutional care, Interaction Competencies with Children – for Caregivers (ICC-C), was already successfully implemented in Sub-Saharan Africa (Hecker et al., 2017), but needs to be validated across other countries.
6.3 Overall conclusion
The findings of the three studies suggest that the experience of mass trauma may contribute to violence against children in a post-conflict setting. The present studies are
General discussion 95 furthermore an attempt to illuminate the underlying mechanisms of this relationship: In accordance with Catani’s framework (2010, 2018), traumatization of all family members, child psychopathology, and perpetrators’ alcohol use seem to reinforce guardians’ and peers’ aggressive and violent behavior towards the children. Additionally, the results indicate that parenting practices play a major role for the wellbeing of children in the aftermath of mass trauma. Parenting practices should not only be seen as potential risk factors for children’s mental health but also as a variable that can have a strong protective impact since high parental care seem to alleviate the negative effect of mass trauma on children’s mental wellbeing.
The findings on the complex interplay of mass trauma, interpersonal violence, psychological impairment, and parenting behavior are important for understanding the needs and difficulties of children and their parents in the aftermath of war and natural disaster.
Thus, the present work paves the way for the development of appropriate interventions and thereby contributes to improving the living conditions of children affected by mass trauma.
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