Abstract Background Asylum seekers who arrive in their host countries worldwide present with an alarming burden of trauma and distress. Related mental ill health is a matter of concern and hinders the mobilisation of resources necessary for successful social adaptation and integration into host communities, creating a vicious cycle. Although effective treatment is available, services are only accessible when conditions become chronic and/or life-threatening. To overcome the manifold barriers to care, we aim to implement a screen-to-counsel, stepped-care trauma rehabilitation programme for asylum seekers upon arrival in Germany. Individuals are invited to a personal interview at the end of which they are offered a specific intervention, depending on the severity of their symptoms and level of support needed: [s1] watchful waiting; [s2] Narrative Trauma Work (NAT), adapted from Narrative Exposure Therapy (NET; Schauer, Neuner, Elbert, 2025), delivered by peer migrant counsellors; or [s3] treatment by a licensed clinical psychological expert. This study is initiated to assess the effectiveness of the NAT intervention and the sustainability of the overall program within in the German health service setting. Methods To assess the effect of NAT, we will apply a quasi-experimental parallel group study with a natural waiting list control group (regression discontinuity design). Follow-up assessments will be conducted continuously up to 12 months later, in person and online. The outcomes of the study will include symptoms of depression, anxiety and posttraumatic stress, using the Refugee Health Screener (RHS-15, primary outcome). The study will also assess social and economic integration, and resilience, as well as successful application of the NAT counselling intervention, amongst other measures. Cost-effectiveness and sustainability will be assessed for the overall programme. Sustainability will be measured on the basis of counsellor participation and satisfaction using a mixed methods approach. The study will be conducted at various selected sites in southwest Germany. Discussion This study addresses a crucial gap in mental health care provision and integration support for refugees and strategic decisions for its implementation. Moreover, the programme builds on the work and evidence for trauma-focused treatment in refugee samples in low-income countries, but also from internally displaced persons and trauma-exposed individuals in post-conflict settings. Trial registration ClinicalTrials.gov Identifier: DRKS00033410, January 29, 2024. Trial status Protocol version: 1.0, Dec 13, 2024; Planned first recruitment: Apr 1st, 2024; Planned completion: unspecified.

Background: Mistreatment, abuse, or neglect during childbirth is known as obstetric violence (OV), which is increasingly recognized as a human rights issue with significant public health impacts. Research shows that traumatic childbirth can profoundly affect maternal psychological health and undermine positive parenting. This study provides primary evidence on the link between OV and postnatal depression (PND) among rural women in Jharkhand, a region marked by social and infrastructural disadvantage. Objectives: (1) Estimate the prevalence and examine the predictors of OV during facility-based childbirth in rural Jharkhand, India, and (2) assess the association between OV and PND. Design: A longitudinal community-based study was conducted in two phases (antenatal and postnatal follow-up). Methods: Pregnant women in their second or third trimester ( n = 246) were enrolled from the rural Chatra district employing a multistage sampling approach. Follow-up assessments were completed with the postpartum ( n = 189) women. OV was measured using a typology aligned with World Health Organization and Bowser and Hill’s framework. PND was assessed using a Hindi-translated and reliability-tested Four-Dimensional Symptom Questionnaire. Logistic regression models were used to predict OV and to examine the association between OV and PND, while adjusting for sociodemographic factors. Results: Over half of the women (56.1%) experienced at least one form of OV. Physical abuse (47.6%) and non-dignified care (33.9%) were most common. Bribery demands, delivery in government facilities, and deliveries attended by nurses or midwives were the strongest predictors of OV. The prevalence of PND was significantly higher among women exposed to OV (55.7%) than among those who were not exposed (28.9%). The adjusted analysis showed that OV increased the odds of PND by more than threefold (odds ratio = 3.11, p < 0.01). Neglected care, non-dignified care, physical abuse, and privacy violations were significant predictors of PND. Conclusion: OV is widespread in rural Jharkhand and strongly associated with PND. Integrating respectful maternity care standards, improving accountability in public facilities, and incorporating routine mental health screening into maternal healthcare are essential to reduce the burden of OV and PND.

Violence can have serious short- and long-term impacts on children and young people`s health, development and well-being. On a societal level, it represents a considerable obstacle to economic growth and advancement by lowering human and social capital. Since many children worldwide, especially in low- and middle-income countries, experience violence by teachers at school, there is an urgent need for efficacious and scalable interventions to prevent violence by teachers and improve teacher-student interactions. To this end, the present study examines the effectiveness of the intervention Interaction Competencies with Children – for Teachers (ICC-T) to reduce physical and emotional violence by teachers. The study adopts a cluster-randomized controlled trial design with schools (clusters) as level of randomization and three data assessment points: baseline assessment prior to the intervention, the first follow-up assessment 6 months after the intervention and the second follow-up assessment 18 months after the intervention. Across four different sites in Pakistan, a total number of 48 public single-gender high schools (24 girls’ and 24 boys’ schools) are randomly selected. After baseline assessment, half of the schools are randomly allocated to the intervention group, in which teachers at selected schools receive ICC-T, and the other half to the control group, in which teachers receive no intervention. At each school, 30 students in the sixth year of school and all teachers (expected average number: 15) are recruited. Thus, the final sample comprises at least 1300 students and 720 teachers. Data are collected through structured interviews, standardized cognitive tests and school records. Primary outcome measures are student- and teacher-reported physical and emotional violence by teachers in the past week. Secondary outcome measures include teachers’ attitudes towards violence and children’s mental health problems, quality of life and cognitive functioning. Other outcomes are students’ academic performance and peer violence. Data will be analyzed using multilevel analyses. This study aims to provide initial evidence of the effects of ICC-T on children’s exposure to violence at schools, their well-being and functioning in the context of Pakistan. The clinical trial was registered at ClinicalTrials.gov (ClinicalTrials.gov, 2024) under the identifier NCT06001554 (Preventing Physical and Emotional Violence by Teachers in Public Schools in Pakistan (ICC-T_Pak), 2023) on August 21st, 2023.

The international development community has identified armed conflict as an impediment to development and provides considerable resources to reduce armed conflicts. However, other forms of violence—such as suicide, homicide, and assault—are vastly more prevalent and far more widely distributed across countries than armed conflict. For some time, scholars in the field of public health have been arguing for putting self-directed and interpersonal violence higher on domestic and international policy agendas. When analysing the allocation of aid by purpose, it is obvious that donors and recipients have so far neither recognized self-directed nor interpersonal violence as a major development issue. Although promising violence-reduction interventions exist, almost no aid is targeted at suicide prevention and less than one per cent of total official development assistance is targeted at interpersonal violence.

Despite the recognized need to address the prevention of sexual violence against adolescents in Nigeria, significant research gaps persist in understanding the patterns, determinants, and impacts of such violence, particularly regarding regional variations and the specific developmental needs of adolescents across different stages. This study provides Nigerian regional prevalence estimates disaggregated by gender, rural/urban, and in/out-of-school populations, while also identifying socio-demographic and cultural determinants related to increased vulnerability. A cross-sectional survey was conducted in South-West Nigeria with a sample of 961 adolescents, targeting in- and out-of-school adolescents aged 13-17 years. Descriptive statistics and logistic regression analyses were performed.The prevalence of any form of SV since age 12 was 69.4%, with higher rates among out-of-school adolescents and boys. Non-contact abuse (63.2%), passive contact abuse (41.9%), and active contact abuse (28.7%) were the most common forms reported. Peers were the dominant perpetrators (77.1%), followed by other adults (27.9%). Being male (OR 2.033), older (OR 1.214 per year), involved in a romantic relationship (OR 2.731), and experiencing SV before age 12 (OR 4.622) were significant risk factors. Higher household wealth (OR 0.902 per asset) and emotional support from both parents (OR 0.413) were protective factors.This study highlights the high burden of SV against adolescents in Nigeria, with concerning patterns of male victimization and peer perpetration. The findings emphasize the need for comprehensive, evidence-based strategies addressing emotional support, social norms, power dynamics, and economic vulnerabilities to prevent and respond to this problem effectively.

In the highly competitive field of publishing in economics journals, methods often become fads sometimes to the detriment of framing meaningful research agendas and of research ethics. In recent times, empirical work based on primary data collection has gained traction. Randomized controlled trials entail not just primary data collection but also interventions involving human subjects. Field research involving data collection is also expensive, raising a number of concerns. In this special symposium we explore questions of research agendas and research ethics, and argue fo rthe acceptance of broader methodological approaches, greater inclusion in the publication process and for a reflection at the disciplinary level of practices related to field research.

Objective: Providing country-level estimates for prevalence rates of Generalized Anxiety Disorder (GAD), COVID-19 exposure and food insecurity (FI) and assessing the role of persistent threats to survival—exemplified by exposure to COVID-19 and FI—for the mental health crisis in Africa.Methods: Original phone-based survey data from Mozambique, Sierra Leone, Tanzania and Uganda (12 consecutive cross-sections in 2021; n = 23,943) were analyzed to estimate prevalence rates of GAD. Logistic regression models and mediation analysis using structural equation models identify risk and protective factors.Results: The overall prevalence of GAD in 2021 was 23.3%; 40.2% in Mozambique, 17.0% in Sierra Leone, 18.0% in Tanzania, and 19.1% in Uganda. Both COVID-19 exposure (ORadj. 1.4; CI 1.3–1.6) and FI (ORadj 3.2; CI 2.7–3.8) are independent and significant predictors of GAD. Thus, the impact of FI on GAD was considerably stronger than that of COVID-19 exposure.Conclusion: Persistent threats to survival play a substantial role for mental health, specifically GAD. High anxiety prevalence in the population requires programs to reduce violence and enhance social support. Even during a pandemic, addressing FI as a key driver of GAD should be prioritized by policymakers.

Aid is still an important feature of the development landscape.Fragile states, in particular, have the greatest development needs but due to their poor governance they are the least likely countries to use aid effectively to meet their development challenges.In this paper, we explore which fragile states receive most aid flows, which donors are particularly active in fragile states, and which type of projects are the focus of these aid flows to fragile states.Evidence so far suggests that the high number of donors and the volatility of ODA generate problems for recipients who are least able to deal with the issues of donor coordination and budget planning under uncertainty.Furthermore, despite different needs, aid spending patterns to fragile countries are not very different from the average recipient country, although extremely fragile countries benefit from aid targeted at humanitarian and peacebuilding needs.We suggest that aid in fragile states could be best allocated to address the specific needs of these countries, especially countries in the 'fragile' category that may be at risk of falling into the 'extremely fragile' category.Using specific aid flows to prevent such shifts could be a useful strategy for donors engaged in those countries.

Purpose Globally, many children are exposed to violent discipline in multiple settings. Interventions to prevent violent discipline are therefore highly needed. In the present study, the feasibility of the intervention Interaction Competencies with Children – for Parents (ICC-P), an additional module of a school-based intervention for teachers, was tested. The intervention aims to prevent violent discipline by changing attitudes towards such method and fostering supportive adult-child interaction through non-violent interaction skills. Methods In total, 164 parents ( M age = 39.55, range = 24 70, 72.3% female) from four public secondary schools in Tanzania participated in a four-day training conducted by six trainers ( M age = 44.67, range = 40–47, 50% female). Using a One-Group Pre-Post design, we measured the feasibility and preliminary effectiveness of the intervention qualitatively and quantitatively. Parents were assessed via self-administered questionnaires before and six weeks after the intervention. Trainers rated the implementation of every workshop session. Results Based on descriptive statistics and Classical Content Analysis, implementing trainers and participants rated ICC-P as feasible. Participants indicated a high need for such interventions and showed high acceptance. They were able to integrate core aspects of the intervention in their daily interactions with children. Using t-tests, ICC-P proved to be preliminarily effective; parents reported applying less violent discipline and holding more critical attitudes about such measures after the intervention. Conclusion ICC-P is feasible intervention that showed initial signs of effectiveness. We recommend combining the parents’ training module with the teachers’ module to prevent violence in multiple settings.

Background: Sexual violence is a public health issue among adolescents globally but remains understudied in Sub-Saharan Africa.Objective: The present study focused on the association of cumulative exposure to different types of sexual violence with mental and physical health problems and prosocial behaviour.Method: We conducted a survey with a regionally representative sample of both in-school and out-of-school adolescents, aged 13-17 years, living in south-western Nigeria. Self-reported exposure to sexual violence, behavioural problems, physical complaints, and prosocial behaviour were assessed.Results: About three quarters of the participants reported the experience of sexual violence (74.6%). Multiple regression models revealed that the more types of sexual violence an individual reported, the more mental and physical health problems, and the fewer prosocial behaviours they reported when controlling for other forms of violence exposure. Latent class analysis revealed three severity classes of sexual violence. Symptoms of mental and physical health indicators were significantly higher as exposure increased by group whereas prosocial behaviours were non-significantly fewer in the opposite direction.Conclusion: This study revealed a consistent and unique relation between sexual violence exposure and negative health outcomes among adolescents. Further research on sexual violence in Sub-Saharan Africa and its associations is needed.

We study how militant political factions use material aid to secure support. We focus on Hamas, a militant faction in the Palestinian Authority. We generate a unique dataset that includes the sources and extent of assistance received by Palestinian households, data on Israeli and Palestinian fatalities, and data on the level of support for particular Palestinian factions. We find that lower-income residents of districts that receive aid from religious charities are more likely to support Hamas. The support patterns identified partly align with the existing theory on armed religious groups as club good providers. We find no evidence that aid affects incumbent support or deters recipients from supporting militants. While it is possible that charities only target districts and households that support them, testing for reverse causality by regressing aid on lagged faction support yields no such evidence.

BackgroundAbuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana.MethodologyA facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15–45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills.FindingsWe find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2–2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4–4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5–4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant.ConclusionThe prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.

Background: Although the problem of obstetric violence (OV) is receiving increasing attention among academics and policy makers, the prevalence and associated factors of OV are still poorly understood. The fear of OV prevents women from giving birth in health facilities, which is crucial for the effectiveness of HIV prevention programs, such as the Prevention of Mother to Child Transmission (PMTCT) program. Objective: The aim of this paper is to determine the prevalence of OV, the comparative burden and associated predictors between HIV positive and negative women in Ghana. Methods: The present study is a facility-based cross-sectional study enrolling 2,142 women, of which 310 were HIV positive and 1,832 HIV negative with a birth history of 0-24 months. The women were enrolled consecutively using a two stage sampling technique from eight hospitals with antiretroviral clinics across two regions in Ghana. The primary outcome variable was the experience of OV and its various forms. Descriptive data is presented in tables and reported in frequencies. The inferential analysis has been performed by estimating the Adjusted Odds Ratios (AOR) using multivariate logistic regression. Results: Prevalence of OV was slightly lower among HIV positive women (61.0%) compared to HIV negative women (65.1%), though this was not statistically significant (χ2=1.99; p=0.158) . The most common sub-category of OV experienced by all women was non-confidential care (35.2%). HIV positive women experienced more abandoned care (32.6%) with non-consented care being the least prevalent form of OV. Experience of discrimination was higher among HIV positive women (13.5%) than HIV negative women (10.8%). The multivariate regression analysis of the predictors of OV suggests that HIV positive women are not more likely to experience OV. Instead, we find evidence that HIV positive women are less likely to be subjected to physical violence (AOR=0.512; CI: 0.369-0.710), non-consented care (AOR=0.457; CI: 0.244-0.859) and non-dignified care (AOR= 0.688; CI: 0.513-0.923). Conclusions: The study shows high rates of OV among all women. However, we found no evidence that HIV positive women were at higher risk to experience OV than HIV negative women. Evidence based interventions are required to address OV due to its threat to facility-based childbirth and the PMTCT cascade of care.

Although the provision of security to all their citizens is a state's fundamental duty, over 50 countries experienced armed conflict in 2021.The international development community has identified armed conflict as an impediment to development and provides considerable resources to reduce armed conflicts.However, other forms of violence, such as suicide, homicide, and assault, are vastly more prevalent and far more widely distributed across countries than armed conflict.For some time, scholars in the field of public health have been arguing for putting selfdirected and interpersonal violence higher on domestic and international policy agendas.When analysing the allocation of aid by purpose, it is obvious that donors and recipients have so far neither recognized self-directed nor interpersonal violence as a major development issue.Almost no aid is targeted at suicide prevention and less than one per cent of total official development assistance is targeted at interpersonal violence.

War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.

The COVID-19 pandemic is a global crisis affecting everyone. Yet, its challenges and countermeasures vary significantly over time and space. Individual experiences of the pandemic are highly heterogeneous and its impacts span and interlink multiple dimensions, such as health, economic, social and political impacts. Therefore, there is a need to disaggregate "the pandemic": analysing experiences, behaviours and impacts at the micro level and from multiple disciplinary perspectives. Such analyses require multi-topic pan-national survey data that are collected continuously and can be matched with other datasets, such as disease statistics or information on countermeasures. To this end, we introduce a new dataset that matches these desirable properties -the Life with Corona (LwC) survey -and perform illustrative analyses to show the importance of such micro data to understand how the pandemic and its countermeasures shape lives and societies over time.