title: Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system.
abstract: BACKGROUND
  The number of orphans in Sub-Saharan Africa is constantly rising. While it is known that family or community care is preferable over institutional care of African orphans, little is known about the quality of care in orphanages and possibilities of improvement. STUDY 1:
  
  
  METHODS
  Exposure to traumatic stress, experiences of violence in the home, school and orphanage, as well as mental ill-health and aggression of 38 children (mean age of M = 8.64 years) living in an orphanage in rural Tanzania were assessed at two time points. The severity of post-traumatic stress disorder symptoms (PTSD), depressive symptoms, and internalizing and externalizing problems were used as indicators of mental ill-health.
  
  
  RESULTS
  Violence experienced in the orphanage correlated more strongly with all indicators of mental ill-health than violence in the former home, school or neighborhood at time point 1. Additionally, violence experienced in the orphanage had a positive relationship with the aggressive behavior of the children at time point 2. STUDY 2:
  
  
  METHODS
  With the help of the pre-post assessment of Study 1, the implementation of a new instructional system and psychotherapeutic treatment (KIDNET) for trauma-related illness were evaluated.
  
  
  RESULTS
  In response to both, a change in the instructional system and psychotherapeutic treatment of PTSD, a massive decline in experienced violence and in the severity of PTSD-symptoms was found, whereas depressive symptoms and internalizing and externalizing problems exhibited little change.
  
  
  CONCLUSIONS
  These studies show that violence, especially in the orphanage, can severely contribute to mental ill-health in orphans and that mental health can be improved by implementing a new instructional system and psychotherapeutic treatment in an orphanage. Moreover, the results indicate that the experience of violence in an orphanage also plays a crucial role in aggressive behavior of the orphans.
authors.affiliation: Department of Psychology, University of Konstanz, Box 23/25, 78457 Konstanz, Germany. katharin.hermenau@uni-konstanz.de.
authors.forename: Katharin
authors.initials: K
authors.lastname: Hermenau
authors.forename: Tobias
authors.initials: T
authors.lastname: Hecker
authors.forename: Martina
authors.initials: M
authors.lastname: Ruf
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
authors.forename: Maggie
authors.initials: M
authors.lastname: Schauer