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- If interested in the treatment of veterans and refugees, go to our research area of rehabilitation here.
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Projects related to the refugees:
Ongoing projects
In collaboration with the Rehabilitation Centre for Torture Victims Jutland (RCT-Jutland), the National Centre for Psychotraumatology has helped introduce a systematic evaluation of traumatized and tortured refugees treated at the center. Data collection has so far led to research on the severity of traumatization and functional impairment among refugees. In the longer term, the data collection will lead to a larger impact study of the treatment programmes and techniques offered at the center. We are currently investigating the impact of cultural differences in trauma testing.
Publications:
Karatzias, T., Shevlin, M., Ben-Ezra, M., McElroy, E., Redican, E., Vang, M. L., Cloitre, M., Ho, G. W. K., Lorberg, B., Martsenkovskyi, D., & Hyland, P. (2023). War exposure, posttraumatic stress disorder, and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war. Acta Psychiatrica Scandinavica, 147(3), 276–285. Doi: 10.1111/acps.13529
Completed projects related to refugees
Publications:
Vang, M.L., Jørgensen, S., Auning-Hansen, M. & Elklit, A. (2019). Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis. Torture, 29(3), 27-45. Doi: 10.7146/torture.v29i3.115367
Nielsen, T., Elklit, A., Vang, M. L., Nielsen, S. B., Auning-Hansen, M., & Palic, S. (2023). Cross-cultural validity and psychometric properties of the international trauma questionnaire in a clinical refugee sample. European Journal of Psychotraumatology, 14(1). Doi: 10.1080/20008066.2023.2172256.
Publications:
Friis Jørgensen, S., Auning-Hansen, M. A., & Elklit, A. (2017). Can disability predict treatment outcome among traumatized refugees? Torture, 27(2), 12-26. Doi: 10.7146/torture.v27i2.97208
The project in Avnstrup and Sandholm examined symptoms of anxiety, depression and PTSD in a group of 53 rejected asylum seekers from Iraq selected from two Red Cross centres. The length of stay in an asylum centre and the number of traumatic events were considered risk factors associated with the degree of mental disorder.
94% of the participants showed symptoms of anxiety, 100% had depressive symptoms, and 77% showed symptoms of PTSD. Participants had experienced or witnessed an average of 8.5 traumatic events prior to their arrival in Denmark. The study shows no significant correlation between the number of traumatic events and PTSD symptoms. The same applies to the correlation between the length of stay and the various symptoms.
The project was carried out in collaboration with the Danish Red Cross.
Publications:
Schwarz-Nielsen, K. H. & Elklit, A.(2009). An evaluation of the mental status of rejected asylum seekers in two Danish asylum centers. Torture, 19 (1), 51-59.
Publications:
Elklit. A., Palic, S., Lasgaard, M. & Kjær, K. (2012). Social Support, Coping and Posttraumatic Stress Symptoms in Young Refugees. Torture, 22(1), 11-23.
Elklit, A. (2006). Psychological Assessment and Diagnosing of Traumatized Refugees. Århus: Psykologisk Institut, Aarhus Universitet.
Elklit, A., Nørregaard, J. & Tibor, B. (1998). Forekomst og art af traumatiserende begivenheder hos unge bosniske flygtninge i Danmark. Ugeskrift for læger, 160 (29), 4310-4314.
Elklit, A. (1998). Hvor omfattende er traumatiseringen af de unge bosniske flygtninge i Danmark? Forskningsnyt fra Psykologien, 7 (5), 6-7.
Elklit, A., Nørregaard, J., Tibor, B. (1997). Traumatisering hos unge bosniske flygtninge i Danmark. Psykologisk Pædagogisk Rådgivning, 34, 3-18.
This project was conducted in close collaboration with Professor Kennedy Amone-P'Olak. We investigated whether emotions such as shame, guilt and anger mediated the effects of war experiences and PTSD in former child soldiers from northern Uganda. It turned out that just under 36% met the then proposed ICD-11 criteria for PTSD. The results directly indicated that previous war experiences were directly associated with PTSD. In addition, anger and guilt were found to be significant mediators of this effect.
Publications:
Amone-P’Olak, K. & Elklit, A.(2018) The role of Interpersonal Sensitivity as mediator of the relations between War Experiences and mental illness in War-affected Youth in Northern Uganda: Findings from the WAYS study. Traumatology. Doi: 10.1073/trm0000145
Amone-P’Olak, K., Dokkedahl, S. & Elklit, A.(2017): Post-traumatic Stress Disorder among child perpetrators and victims of violence from the Northern Uganda civil war: Findings from the WAYS study. Journal of Psychology in Africa, 27(3), 235-242. Doi: 10.1080/14330237.2017.1321849
Amone-P’Olak, K., Elklit, A. & Dokkedahl, S. (2017): PTSD, Mental Illness, and Care Among Survivors of Sexual Violence in Northern Uganda: Findings from the WAYS study. Psychological Trauma: Theory, Research, Practice, and Policy. Doi: 10.1037/tra0000295
Murphy, S., Elklit, A., Dokkedahl, S. & Shevlin, M. (2016). Anger, Guilt and Shame as Mediators in the Relationship Between war Experiences and PTSD: Testing the Moderating Role of Child Soldier Status. Journal of Child & Adolescent Trauma. Doi: 10.1007/s40653-016-0124-x
Dokkedahl, S. B., Oboke, H., Ovuga, E., & Elklit, A. (2015). The Psychological Impact of War and Abduction on Children in Northern Uganda: A Review. International Journal of Mental Health & Psychiatry, 1(2). Doi: 10.4172/2471-4372.1000109
Dokkedahl, S. B., Oboke, H., Ovuga, E., & Elklit, A. (2015). ICD-11 trauma questionnaires for PTSD and complex PTSD: Validation among civilians and former abducted children in Northern Uganda. Journal of Psychiatry, 18(6). Doi: 10.4172/2378-5756.1000335
The project was supported by Danida.
Publications:
Oboke, H. & Whyte, S.R. (2019) Anger and Bitter Hearts: The Spread of Suicide in Northern Ugandan Families. Ethnos - Journal of Anthropology. Doi: 10.1080/00141844.2019.1629982.
Oboke, H., Abio, A., Ocaka, F. K., Sodeman, M., Elklit, A. & Ovuga, E. (2017) Impact of mental health training on the mental well-being of lay counselors in Northern Uganda. Jacobs Journal of Community Medicine, 3(1), 31.
Oboke, H., Elklit, A., Ovuga, E., & Sodemann, M. (2020). Preventing Suicide Behavior using Village Helpers in post-conflict Northern Uganda. African Journal of Traumatic Stress. (5)1.
Is suicide preventable in Gulu District ? Oboke, E. H. 2021, Gulu University i Uganda.
Publikation: Afhandling › Ph.d.-afhandling.
The HoNOS (Health of Nation Outcome Scales) rating scale is an instrument used to determine which problems have led to a person coming into contact with the psychiatric healthcare system and whether these problems have improved during the course of treatment.
The National Centre for Psychotraumatology has collaborated with the Clinic for PTSD and Transcultural Psychiatry (KPTP) in the Central Denmark Region. The project aimed to investigate the overall psychiatric level of functioning (HoNOS) in traumatized refugees undergoing psychiatric treatment. Before and after treatment, refugees were measured and compared to Danish psychiatric patients, the Danish patients experienced the greatest improvement.
The project shows that there is a need for the development of better and broader measurements of complex psychiatric phenomena in refugees, which can be achieved by an increased focus on cross-cultural measurements.
Publications:
Palic, S., Kappel, M. L., Nielsen, M. S., Carlsson, J. & Bech, P. (2014). Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients. BMC Psychiatry, 14, 330.
The project investigated complex traumatization in refugees seeking treatment and how it can be measured in clinical practice. The project includes two studies with different patient groups. The first study examines complex traumatization via the concept of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) in a clinical group of 116 Bosnian refugees. The second study investigates the claim of the presence of highly diverse psychiatric morbidity in complex PTSD through a measure of global psychiatric dysfunction, the Health of Nation Outcome Scales (HoNOS). The project was part of Sabina Palic's PhD thesis.
Publications:
Palic, S., Carlsson, J., Armour, C. & Elklit A.: (2015). Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark. Nordic Journal of Psychiatry, 69, 307-314.
Palic, S. & Elklit, A. (2014). Personality Dysfunction and Complex Posttraumatic Stress Disorder Among Chronically Traumatized Bosnian Refugees. Journal of Nervous and Mental Disease, 202, 111-118.
The project investigated the medical treatment of PTSD in refugees.
Among other, the project resulted in the publication of Sonne, C., Carlsson, J., Ekstrøm, M., Elklit, A. & Mortensen, E. L. (2013), which investigated whether treatment with antidepressants had an effect on PTSD symptoms in refugees. The treatment period with antidepressant medication lasted approximately 7 months, after which PTSD symptoms, social functioning and depressive symptoms were assessed using validated scales.
Publications:
Sonne, C., Carlsson, J., Ekstrøm, M., Elklit, A. & Mortensen, E. L. (2013). Treatment of traumatized refugees with Sertraline versus Venlafaxine in combination with psychotherapy – a randomized clinical study. Trials, 14, 1-7. Doi:10.1186/1745-6215-14-137.
Sonne, C.; Carlsson, J.; Bech, P.; Elklit, A. & Mortensen, E.L.(2016). Treatment of trauma-affected refugees with Venlafaxine versus Sertraline combined with psychotherapy - a randomized study. BMC Psychiatry, 16. Doi: 10.1186/s12888-016-1081-5.
Sonne, C., Mortensen, E.L., Carlsson, J., Elklit, A., Bech, P & Vindbjerg, E. (2016). Psychosocial predictors of treatment outcome for trauma-affected refugees. European Journal of Psychotraumatology, 7. Doi: 10.3402/ejpt.v7.30907
There is a lack of research examining secondary stalking and its effect on children who, in many cases, can be direct targets, or secondary survivors, of the stalking of their parent. The present study examines trauma reactions in children of stalking survivors in a Danish sample. It investigates the differences and similarities of such reactions across three age groups. 57 children were divided into groups depending on their age. The symptoms of the youngest group, 0–6-year-olds, were investigated by way of a maternal diagnostic interview. The two older groups, 7–11- and 12–19-year-olds completed the age-appropriate questionnaires, “Darryl” and “HTQ”, respectively, online. 22 % of the youngest group met the criteria for Post-Traumatic Stress Disorder (PTSD). 85 % of the middle age group and 58% of the older age group met PTSD diagnostic criteria. The findings illustrate that reactions to secondary stalking were predominantly within the arousal cluster of PTSD symptomology, with sleep disturbances and irritability commonly reported. The overall prevalence of children meeting PTSD diagnostic criteria in the sample was 56%. Future studies will benefit from larger samples and from knowledge of any pre-existing relationship between parent and stalker.
Publications:
Sørensen, S. D. & Elklit, A. (2003). De glemte generationer-perspektiver på tværgenerationel traumetransmission. Psyke & Logos, 24, (1): 162-195
The National Test Bank mapped which tests the centres of treatment use and which translations the tests used are available in. This process has now been completed and it has been confirmed that there is a great deal of diversity between the tests used by the centres of treatment.
Publications:
Johannsen, M. (2011). Testbank for traumatiserede flygtninge. Psykolog Nyt nr. 15.
Publications:
Andersen, S.A. & Elklit, A. (2016) Den psykiske tilstand blandt flygtninge i Danmark og effektevaluering af behandlings- og rehabiliteringscentret OASIS. Odense: Videnscenter for Psykotraumatologi, 1-18.
Publications:
Stæhr, M. & Elklit, A.(2001).Psykoedukation – en effektundersøgelse af et program for flygtningebørn. København: Dansk Røde Kors og Psykologisk Institut, Aarhus Universitet.
Elklit, A.(2011) Psykoedukation – 5 aktørgruppers evaluering af et program til forebyggelse af alvorlige psykiske skader hos børn og unge fra Kosovo. Psykologisk Pædagogisk Rådgivning, 38(5), 365-390.
Elklit, A.(2011) Psykoedukation med flygtninge. Psykologisk Pædagogisk Rådgivning, 38(5), 349-364
Abdalla, K & Elklit, A.(2001). En landsdækkende screeningundersøgelse af flygtningebørn fra Kosovo. Psykologisk Pædagogisk Rådgivning, 38(5), 339-348.
Elklit, A.(2001) Psykologisk undersøgelse og diagnostik af traumatiserede flygtninge. Psykologisk Pædagogisk Rådgivning, 38(5), 331-338.
Elklit, A.(2001) Psykoedukation med flygtninge – en ny arbejdsform. Psykologisk Pædagogisk Rådgivning, 38(5), 327-329.
Abdalla, K. & Elklit, A.(2001) A Nationwide Screening Survey of Refugee Children from Kosovo. Torture, 11, 45-49.
Abdalla, K & Elklit, A.(2001) En landsdækkende screeningundersøgelse af flygtningebørn fra Kosovo. Psykologisk Pædagogisk Rådgivning, 38(5), 339-348.
Elklit, A. (2001). Psycho-education with refugee children. Torture, 11, (3), 68-74.
A project in Holstebro with therapy for victims of torture in collaboration with Holstebro Psychiatry and the Clinic for PTSD and Transcultural Psychiatry. The project was published in 2009 and was led by Ask Elklit and Sabina Palic. The study included 26 severely traumatized refugees with different cultural backgrounds who received treatment for their trauma at Holstebro Psychiatry. The participants' symptoms of PTSD and other measures of general functioning were screened at the start, the end and 6 months after treatment. The results indicated a very high severity of PTSD symptoms, emphasizing the need for treatment in this population. The effectiveness of the multidisciplinary treatment programme (physiotherapy, psychotherapy, social counselling and pharmacological treatment) was supported by small to medium effect sizes. The clinical implications of these improvements were smaller and much less clear.
High levels of PTSD, depression and anxiety symptoms persisted in the traumatized refugees for up to 24 years after immigration to Denmark. The long duration of psychological after-effects makes it necessary to emphasize that receiving countries are subject to UN treaties that obligate receiving countries to rehabilitate victims of torture and mass violence. Numerous studies show that providing these people with a safe environment and reassurance of basic needs is not enough to reduce the psychological impact of their traumatic experiences. Effective and national guidelines for the rehabilitation of traumatized refugees are therefore necessary to ensure successful integration and help these traumatized people to reduce the extent of their psychological distress.
Publications:
Palic, S. & Elklit, A. (2011). Psychosocial Treatment of Posttraumatic Stress Disorder in Adult Refugees: A Systematic Review of Prospective Treatment Outcome Studies and a Critique. Journal of Affective Disorders, 131, 8-23. Doi: 10.1016/j.jad.2010.07.005
Palic, S. & Elklit, A. (2009). An explorative outcome study of CBT-based multidisciplinary treatment in a diverse group of refugees from a Danish treatment centre for rehabili-tation of traumatized refugees. Torture, 19 (3), 248-270.
Elklit, A. & Einarsdóttir, T. (2003). PTSD og sociale problemer hos torturerede flygtninge i Danmark. Psykolog Nyt, 57, (8), 22-25.
This project was perfomed in cooperation with professor Henry Oboke, professor from Northern Uganda. The National Center for Psychotraumatology’s Ph.d. student Sarah Dokkedahl was in Northern Uganda over a period of time, which resulted in the projects underlined below.
The Northern Uganda-project encompasses both child soldiers, young victims, abducted children, victims of sexual abuse and the impact of war on the civil society.
Related publications:
Oboke, H., Abio, A., Ocaka, F. K., Sodeman, M., Elklit, A. & Ovuga, E. (2017) Impact of mental health training on the mental well-being of lay counselors in Northern Uganda. Jacobs Journal of Community Medicine, 3(1).
Dokkedahl, S., Oboke, H., Ovuga, E. & Elklit, A. (2015). ICD-11 Trauma Questionnaires for PTSD and Complex PTSD: Validation among Civilians and Former Abducted Children in Northern Uganda. Journal of Psychiatry, 18(6). Doi: 2378-5756.1000335
Dokkedahl, S., Oboke, H., Ovuga, E. & Elklit, A. (2015). The Psychological Impact of War and Abduction on Children in Northern Uganda: A Review. International Journal of Mental Health & Psychiatry, 1(2). Doi: 10.4172/ijmhp.1000109
Unaccompanied Afhgan children who make the long trip to Europe are deeply and negatively affected by their experience. As well as the hardship and abuses of the journey, after arrival the are confronted with the prospect of forces return to Afghanistan, coupled with contining pressure from family members to send remittances home, so that debts incurred to pas for the journey can be paid off.
This project was lead by the National Center for Pychotraumatology´s former Ph.D.-student Karen -Inge Karstoft
Publications:
Karstoft, Kl. (2011). Uledsagede afghanske flygtningebørn. Odense: Videnscenter for Psykotraumatologi.
Karstoft, Kl. (2011). Børn uden ledsager. Psykolog Nyt nr.10, 2011, 20-2
Projects related to veterans:
Ongoing projects related to veterans
Completed projects
Publications:
A. F. Elrond., A. B. Nielsen., B.W. Schmidt., K. Eskelund., L. Nissen., M. S. Vedtofte., R. H. Haugbølle., S. B. Andersen., & A. Elklit (2021). Introduction and summaries of findings in: Comprehensive study to develop a PTSD framework. The Danish Veterans Centre & Centre for Psycho Traumatology.
A. F. Elrond., A. B. Nielsen., B.W. Schmidt., K. Eskelund., L. Nissen., M. S. Ved-tofte., R. H. Haugbølle., S. B. Andersen., & A. Elklit (2021). Gender perspectives in: Comprehensive study to develop a PTSD framework. The Danish Veterans Centre & Centre for Psycho Traumatology
A. F. Elrond., A. B. Nielsen., B- W. Schmidt., K. Eskelund., L. Nissen., M. S. Ved-tofte., R. H. Haugbølle., S. B. Andersen., & A. Elklit (2021). Best Practices for prevention and mitigation in: Comprehensive study to develop a PTSD framework. The Danish Veterans Centre & Centre for Psycho Traumatology
For 54%, the worst experience was a life-threatening situation, 62% describe the transition as difficult, 33% feel an inner sense of emptiness. A quarter have increased their alcohol consumption. The most common symptoms after deployment are: restlessness (55%), increased alertness (53%), irritability (34%), sleep problems (30%), nightmares (26%), fatigue (26%), depression (21%). Three quarters feel partially to not at all understood by those around them. Only a third knew that they could get emergency crisis help in Croatia or Bosnia.
Publications:
Elklit, A. (1998). UN-soldiers serving in peacekeeping missions. A review of the psychological aftereffects. International Review of the Armed Forces Medical Services, 71, (7/8/9), 197-208.
Elklit, A., Knudsen, H. (1996). Sygeliggørelsen af den danske FN-soldat - en defensiv strategi. Psykolog Nyt, 50 (8), 27.
Knudsen, H., Elklit, A. (1996). Danske FN-soldater i Kroatien. Psykolog Nyt, 50 (4), 3-6.
Elklit, A., Knudsen, H. (1995). Danske FN-soldater i fredsbevarende mission - belastninger og efterreaktioner. Psykologisk Skriftserie, 20 (5).
Elklit, A. (1995). Danske FN-soldater i Kroatien og Bosnien. Forskningsnyt fra Psykologien, 4 (6), 1-3.
This project was conducted by Beatrice Ponce de Leon in collaboration with the Veteran Centre in Ringsted.
Publications:
Ponce de Leon, B., Andersen, S. Karstoft, K. & Elklit, A. (2017). Pre-deployment dissociation and personality as risk factors for post-deployment PTSD in Danish soldiers deployed to Afghanistan. European Journal of Psychotraumatology, 9 (1), 1443672. Doi: 10.1080/20008198.2018.1443672
The project examined whether locus of control (LOC) and coping styles are associated with long-term developmental trajectories of PTSD after exposure to combat. 675 Israeli soldiers with or without combat stress reactions (CSR) from the Lebanon War were assessed 1, 2 and 20 years after the war. Combat exposure, LOC and coping style were then examined as covariate factors for the developmental pathways of resilience, recovery, delayed onset and chronicity. Symptomatic trajectories in the CSR and non-CSR group were significantly associated to varying degrees with perceived life threat during combat (ORs: 1.76-2.53), internal LOC (ORs: 0.77-0.87), emotional coping style (ORs: 0.28-0.34) and low use of problem-focused coping (ORs: 2.12-3.11). Assessment of LOC and coping can be used to predict chronic PTSD after combat exposure.
The project was conducted by Karen-Inge Karstoft in collaboration with Yael Lahaev, Yaniv Kanat-Mayman and Zahava Solomon from Tel Aviv University.
Publications:
Lahav, Y., Kanat-Maymon, Y. & Solomon, Z. (2017) Posttraumatic Growth and Dyadic Adjustment among War Veterans and their Wives. Front Psychol, 8. Doi: 10.3389/fpsyg.2017.01102
Publications:
Karstoft, K.-I., Armour, C., Elklit, A. & Solomon, Z. (2013): Long-term trajectories of PTSD in veterans: the role of social resources. Journal of Clinical Psychiatry, 74 (12), e1163–e1168. Doi: 10.4088/JCP.13m08428
This project was conducted in collaboration with the Danish Veteran Centre.
Publications:
Ponce de León, B., Andersen, S. Karstoft, K. & Elklit, A. (2018). Sensation Seeking as a Predictor of Psychopathology in Danish Soldiers Deployed to Afghanistan. Military Psychology,30(5), 381-389