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Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.

Publication ,  Journal Article
Gray, CL; Pence, BW; Ostermann, J; Whetten, RA; O'Donnell, K; Thielman, NM; Whetten, K
Published in: Glob Health Sci Pract
August 25, 2015

BACKGROUND: Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care settings. METHODS: The Positive Outcomes for Orphans study used a 2-stage, cluster-randomized sampling design to identify 1,357 institution-dwelling and 1,480 family-dwelling orphaned and separated children in 5 low- and middle-income countries (LMICs) in sub-Saharan Africa and Asia. We used the Life Events Checklist developed by the National Center for Posttraumatic Stress Disorder to examine self-reported PTEs among 2,235 OSC ages 10-13 at baseline. We estimated prevalence and incidence during 36-months of follow-up and compared the risk of PTEs across care settings. Data collection began between May 2006 and February 2008, depending on the site. RESULTS: Lifetime prevalence by age 13 of any PTE, excluding loss of a parent, was 91.0% (95% confidence interval (CI) = 85.6, 94.5) in institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0) in family-dwelling OSC; annual incidence of any PTE was lower in institution-dwelling (23.6% [95% CI = 19.4, 28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1, 32.2]). More than half of children in institutions (50.3% [95% CI = 42.5, 58.0]) and in family-based care (54.0% [95% CI = 50.2, 57.7]) had experienced physical or sexual abuse by age 13. Annual incidence of physical or sexual abuse was lower in institution-dwelling (12.9% [95% CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95% CI = 17.7, 21.3]), indicating statistically lower risk in institution-dwelling OSC (risk difference = 6.5% [95% CI = 1.4, 11.7]). CONCLUSION: Prevalence and incidence of PTEs were high among OSC, but contrary to common assumptions, OSC living in institutions did not report more PTEs or more abuse than OSC living with families. Current efforts to reduce the number of institution-dwelling OSC may not reduce incidence of PTEs in this vulnerable population. Protection of children from PTEs should be a primary consideration, regardless of the care setting.

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Published In

Glob Health Sci Pract

DOI

EISSN

2169-575X

Publication Date

August 25, 2015

Volume

3

Issue

3

Start / End Page

395 / 404

Location

United States

Related Subject Headings

  • Stress, Psychological
  • Prevalence
  • Poverty
  • Orphanages
  • Male
  • Longitudinal Studies
  • Life Change Events
  • Incidence
  • Humans
  • Follow-Up Studies
 

Citation

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Gray, C. L., Pence, B. W., Ostermann, J., Whetten, R. A., O’Donnell, K., Thielman, N. M., & Whetten, K. (2015). Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study. Glob Health Sci Pract, 3(3), 395–404. https://doi.org/10.9745/GHSP-D-15-00093
Gray, Christine L., Brian W. Pence, Jan Ostermann, Rachel A. Whetten, Karen O’Donnell, Nathan M. Thielman, and Kathryn Whetten. “Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.Glob Health Sci Pract 3, no. 3 (August 25, 2015): 395–404. https://doi.org/10.9745/GHSP-D-15-00093.
Gray CL, Pence BW, Ostermann J, Whetten RA, O’Donnell K, Thielman NM, et al. Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study. Glob Health Sci Pract. 2015 Aug 25;3(3):395–404.
Gray, Christine L., et al. “Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.Glob Health Sci Pract, vol. 3, no. 3, Aug. 2015, pp. 395–404. Pubmed, doi:10.9745/GHSP-D-15-00093.
Gray CL, Pence BW, Ostermann J, Whetten RA, O’Donnell K, Thielman NM, Whetten K. Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study. Glob Health Sci Pract. 2015 Aug 25;3(3):395–404.

Published In

Glob Health Sci Pract

DOI

EISSN

2169-575X

Publication Date

August 25, 2015

Volume

3

Issue

3

Start / End Page

395 / 404

Location

United States

Related Subject Headings

  • Stress, Psychological
  • Prevalence
  • Poverty
  • Orphanages
  • Male
  • Longitudinal Studies
  • Life Change Events
  • Incidence
  • Humans
  • Follow-Up Studies