Decreasing Youth Involvement in Violence in Burundi
Condition: Posttraumatic Stress Disorder; Depression; Aggression
MeSH terms: Stress Disorders, Post-Traumatic; Aggression
Study type: Interventional

Summary: 
      The purpose of the current study is to examine the psychological well-being of youth within
      the context of participation in political violence during the 2015 election period in
      Burundi. In detail, the investigators are interested in fostering improved outcomes in a
      peace-building initiative aimed at youth in Burundi by reducing the mental health-related
      stress of the initiative's most severely affected participants. In addition, the
      investigators are interested in learning more about the youth experience of involvement in
      the Burundian political system in an effort to understand the links between youth engagement
      in political violence and past experiences of traumatic events.
    

Detailed description: 
      The African Great Lakes Region is marked by several countries which have been ravaged by
      violence for several years. One of these countries is Burundi, a small state bordered by
      Rwanda, Tanzania and the Democratic Republic of the Congo. This country has been stricken by
      more than a decade of civil war, which ended only in 2006.

      Today, many people still struggle in coping with the aftermath of the war. Political parties
      remain largely drawn along ethnic lines. These identities are often manipulated in order to
      incite violence and intimidation against opposing parties or groups. Violence between rival
      youth wings was a disturbing feature of the 2010 elections in Burundi, with similar
      conditions manifesting themselves in advance of the 2015 presidential election.

      Further complicating the situation in Burundi, one of the problems people in war-affected
      populations often face is the high impairment due to mental health problems. Studies in
      crisis regions have shown that multiple experiences of traumatic life events seriously
      damages mental health and can lead to disorders such as Posttraumatic Stress Disorder (PTSD)
      or depression. Further, the risk of developing PTSD rapidly increases with the number of
      traumatic events experienced, as the occurrence of PTSD is more likely when the accumulation
      of trauma exceeds a certain limit. This phenomenon has been described as the "building block
      effect". This means, people in the context of armed conflicts and war are especially at risk
      to develop PTSD, as the total load of perceived stress is much higher than anywhere else.
      Furthermore, recent studies have revealed that combatants and other populations living in
      violent and insecure circumstances may adapt to their environment by developing an attraction
      to perpetrating violence, i.e. appetitive aggression. While appetitive aggression helps
      individuals to survive in violent environments by reducing their likelihood of developing
      trauma-related symptoms, it increases the risk of getting involved in the perpetration of
      violence.

      In order to address the mental health needs of the participants in the present study, the
      investigators will be utilizing an intervention, Narrative Exposure Therapy for Forensic
      Offender Rehabilitation (FORNET), that has been demonstrated to reduce posttraumatic
      symptomology and readiness for aggressive behavior.

      Objectives:

      The aim of the present study is to investigate the intersection of politics and mental health
      within the context of Burundi. Specifically, the study will be seeking to answer the
      following research questions:

        1. Mental Health Barriers to Participation in Peace Building Initiatives: What, if any,
           role does the presence of mental health issues such as PTSD and depression play in
           effective participation in peace-building efforts? Can FORNET contribute to peace
           building programs?

        2. Links Between Mental Health Issues and Political Participation: What is the role of
           mental health issues in shaping the readiness to resort to violence as a result of
           political beliefs and attitudes toward members of other political parties in a
           post-conflict setting?

             1. Appetitive Aggression. Does the concept of appetitive aggression influence the
                manner of political participation? Does appetitive aggression have a relationship
                to the perpetration of politically-motivated violence?

             2. Trauma-related disorders. Do trauma-related disorders such as PTSD and depression
                influence the manner of political participation? Do they have a relationship to the
                perpetration of politically-motivated violence?
    

Intervention name(s): Narrative Exposure Therapy for Forensic Offender Rehab; Treatment as Usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): See arm description.; See arm description
Other intervention name(s): FORNET; TAU
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Appetitive Aggression