BackgroundResearch on the long-term mental health consequences of war and displacement among civilians who live in post-conflict countries is rare. The aim of this study was to examine the developmental trajectories and predictors of general psychological distress in three samples of Bosnian war survivors over an 11-year period.MethodsIn 1998/99, about three years after the war in Bosnia and Herzegovina, a representative sample of 299 adult Sarajevo citizens was examined in three subsamples: individuals who had stayed in Sarajevo throughout the siege, individuals who had been internally displaced, and refugees who had returned. Of the 138 study participants who could be located 11 years later, 100 were re-assessed (71%) using the Brief Symptom Inventory.ResultsOver time, psychological symptoms and general psychological distress decreased in those survivors who had stayed and increased in returnees. Former displaced persons did not show any significant changes. After controlling for other factors, cumulative trauma exposure before and during the war predicted general psychological distress at baseline. Eleven years later, higher trauma exposure during and after the war, returnee status, and more current stressors were all associated with higher levels of general psychological distress.ConclusionsLevels of psychological symptoms remained high in three subsamples of Bosnian war survivors. The differential symptom trajectories may correspond to distinct war experiences and contemporary stressors. Still, the cumulative effect of war traumata on mental distress persisted more than a decade after war and displacement, although the influence of current stressors seemed to increase over time.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1996-0) contains supplementary material, which is available to authorized users.

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The main objective of this review was to provide a quantitative and methodologically sound evaluation of existing treatments for bereavement and grief reactions in children and adolescents. Two meta-analyses were conducted: 1 on controlled studies and 1 on uncontrolled studies. The 2 meta-analyses were based on a total of 27 treatment studies published before June 2006. Hedges's g and Cohen's d were used as measures of effect size and a random-effects model was applied. Results yielded small to moderate effect sizes. Interventions for symptomatic or impaired participants tended to show larger effect sizes than interventions for bereaved children and adolescents without symptoms. Promising treatment models were music therapy and trauma/grief-focused school based brief psychotherapy.

IMPORTANCE Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. OBJECTIVE To examine whether developmentally adapted cognitive processing therapy (D-CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. DESIGN, SETTING, AND PARTICIPANTS This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. INTERVENTIONS Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. MAIN OUTCOMES AND MEASURES All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. RESULTS The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The D-CPT participants also showed greater and stable improvement in all secondary outcomes, with between-groups effect sizes ranging from 0.65 to 1.08 at the posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). CONCLUSIONS AND RELEVANCE Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. TRIAL REGISTRATION German Clinical Trials Register identifier: DRKS00004787

Medical hypnosis is a safe and effective complementary technique for use in medical procedures and in the treatment of irritable bowel syndrome. Waking suggestions can be a component of effective doctor-patient communication in routine clinical situations.