Our research within the area of war covers both projects related to veterans and projects related to refugees. Even though both of these groups might have experienced traumatic events in relation to war, distinctions in additional factors present during the traumatic experience exists.Veterans will, to illustrate this, often have experienced his trauma in his profession while this is not necessarily the case for the refugee. Therefor we have decided to subdivide the area of research for a simpler overview.
In particular we focus our research on assessment and treatment of veterans and refugees.
You will find a list of our ongoing and completed projects below.
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If interested in the treatment of veterans and refugees, go to our research area of rehabilitation here.
You will find a list of all our publications within the research field of War here
Projects related to the refugees:
Ongoing projects related to refugees
The aim of the present study was to examine the influence of disability on changes in symptoms of PTSD, anxiety, and depression among treatment-seeking traumatized refugees. Eighty-one refugees participated in different rehabilitation programs. PTSD symptomatology was assessed by the HTQ-IV and symptoms of depression and anxiety were assessed by the HSCL-25. Disability was assessed by the WHODAS 2.0 before treatment. Following treatment, no statistically significant changes in PTSD, depression, and anxiety symptom scores were observed. Disability in the domain 'getting along' was a significant predictor of PTSD scores following treatment, when controlling for baseline scores. Neither total disability nor individual disability domains predicted any other symptom changes. Living with one's partner did, however, seem to be a consistent and significant predictor of treatment outcome. The results are discussed in terms of clinical implications and future research needs.
Current issue:
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
Completed projects related to refugees
International studies have shown high incidences of symptoms regarding anxiety, depression, and post traumatic stress disorder (PTSD) among asylum seekers of different ethnicities. The aim of the present study was to investigate the presence of symptoms of anxiety, depression, and PTSD among rejected Iraqi asylum seekers in two Danish Red Cross asylum centers. Factors such as the length of stay in an asylum center and the number of traumatic events were considered as risk factors associated with the degree of psychological morbidity. METHOD: In 2007, 53 rejected Iraqi asylum seekers from two Danish Red Cross centers completed a survey based on the Harvard Trauma Questionnaire-IV (HTQ) and the Hopkins Symptom Checklist 25 (HSCL-25). The response rate was 36%. The analyses focused on the impact of gender, age, marriage, religion, the length of stay at the asylum center, and the number of traumatic events on the severity of symptoms of anxiety, depression, and PTSD. FINDINGS: Of all participants, 94% were found to have symptoms of anxiety, 100% had symptoms of depression, and 77% had symptoms of PTSD. The participants had experienced or witnessed an average of 8.5 traumatic events before their arrival in Denmark. There was no significant association between the number of traumatic events, and the symptoms of PTSD. In addition, there was no significant difference in the length of stay and symptoms of anxiety, depression, and PTSD despite the fact that 79% of the participants had stayed in an asylum center for 5-10 years or more. CONCLUSION: Despite the limitations of the data, such as the small sample, this study showed that the prevalence rates of psychopathology in Iraqi asylum seekers in Denmark were alarmingly high. Therefore, it is recommended that systematic screening of all detained asylum seekers in Denmark is introduced. Given the degree of mental health problems it is also recommended that procedures be changed and that treatment should be offered to asylum seekers who are detained in Danish asylum centers.
Current issue:
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.
Related publications
Elklit, A., Nørregaard, J., Tibor, B. (1997). Traumatisering hos unge bosniske flygtninge i Danmark. Psykologisk Pædagogisk Rådgivning, 34, 3-18.
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. (2006). Psychological Assessment and Diagnosing of Traumatized Refugees. Århus: Psykologisk Institut, Aarhus Universitet.
Elklit. A., Palic, S., Lasgaard, M. & Kjær, K. (2012). Social Support, Coping and Posttraumatic Stress Symptoms in Young Refugees. Torture, 22(1), 11-23.
Previous research has identified strong associations between war experiences and posttraumatic stress disorder (PTSD). Few studies, however, have explored the underlying mechanisms of these associations in an integrated model. This study explored whether feelings of anger, shame, and guilt mediated the effects of war experiences and PTSD and if this association is heightened in former child soldiers from Northern Uganda. Nearly 40% of the sample were former child soldiers (N = 122), and 189 were civilians. A total of 35.5% met the proposed ICD-11 criteria for PTSD. Findings indicated previous war experiences were directly associated with PTSD. Anger and guilt were significant mediators of this effect, child soldier status did not moderate the mediated effects. This study provides an alternative framework of assessing the association between trauma and PTSD using a sample of young adults exposed to mass conflict.
Current issue:
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
Related 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
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
Currently, the mental health issues of traumatized refugees are mainly documented in terms of posttraumatic stress disorder, depression, and anxiety. Importantly, there are no reports of the level of psychiatric disability in treatment seeking traumatized refugees resettled in the West. Insufficient acknowledgment of the collective load of bio-psycho-social problems in this patient group hinders effective psychiatric and social service utilization outside the specialized clinics for traumatized refugees. Methods: The level of psychiatric disability in traumatized refugees from Danish specialized clinics (N = 448) is documented using routine monitoring data from pre-and post-treatment on the Health of Nation Outcome Scales (HoNOS). Furthermore, the HoNOS ratings are compared with routine monitoring data from Danish inpatients with different diagnoses (N = 10.911). Results: The routinely collected data indicated that despite their outpatient status, traumatized refugees had higher levels of psychiatric disability at pre-treatment compared to most inpatients. Moreover, the traumatized refugees had a HoNOS profile characterized by an overall high problem level in various psychiatric and social domains. The rate of pre-to post-treatment improvement on the HoNOS was smaller for the traumatized refugees than it was for the psychiatric inpatients. Conclusions: The level, and the versatile profile, of psychiatric disability on the HoNOS point to complex bio-psycho-social problems in resettled treatment seeking traumatized refugees. Thus, a broader assessment of symptoms and better cooperation between psychiatric, health care, and social systems is necessary in order to meet the treatment needs of this group.
Current issue:
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.
A proposal for the inclusion of complex posttraumatic stress disorder (CPTSD) in the upcoming ICD-11 has been put forward. Using self-report, we investigated the resemblance between disorders of extreme stress not otherwise specified (DESNOS) and both axis I and II syndromes among 116 treatment-seeking Bosnian refugees. In this sample, the prevalence of DESNOS overlapped to a large degree with the prevalence of schizotypal and paranoid personality disorders (PDs). There was, however, also a large prevalence of axis I syndromes in the group. Thus, DESNOS in the refugees can be categorized as an axis I or II disorder depending on the chronicity and the severity of functional impairment. DESNOS and PD-like states were even observed among the refugees with no history of childhood maltreatment. No large differences were observed between DESNOS and PD regarding sex. The symptom constellation of CPTSD in the ICD-11 is partially supported. However, CPTSD might resemble PD to a considerable degree.
Current issue:
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.
Related 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.
The prevalence of trauma-related psychiatric disorders is high among refugees. Despite this, little is known about the effect of pharmacological treatment for this patient group. The objective of the present study was therefore to examine differences in the effects of venlafaxine and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees.The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard Trauma Questionnaire – part IV, which was the primary outcome measure. Other outcome measures included: Hopkins Symptom Check List-25 (depression and anxiety), Social Adjustment Scale – short version (social functioning), WHO-5 Well-being Index (quality of life), Crisis Support Scale (support from social network), Sheehan Disability Scale (disability in three areas of functioning), Hamilton Depression and Anxiety scale, the somatisation items of the Symptoms Checklist-90, Global Assessment of Functioning scales and the summarised score of pain in four body areas rated on visual analogue scales.
Results: Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma Questionnaire and a number of other ratings in both groups. On the primary outcome measure, no difference was found in treatment effect between the sertraline and venlafaxine group. A significant group difference was found in favour of sertraline on the Sheehan Disability Scale.
Conclusion: Sertraline had a slightly better outcome than venlafaxine on some of the secondary outcome measures, but not on the primary outcome measure. Furthermore, a higher percentage of dropouts was found in the venlafaxine group compared to the sertraline group. Although this could indicate that sertraline was better tolerated, which is supported by other studies, a final conclusion on tolerability cannot be drawn from the current study due to lack of systematic reporting of side effects.
Current issue:
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.
Related 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., 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. Fifty-seven 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. Twenty-two percent of the youngest group met the criteria for Post-Traumatic Stress Disorder (PTSD). Eighty-five percent 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.
Related publications:
Sørensen, S. D. & Elklit, A. (2003). De glemte generationer-perspektiver på tværgenerationel traumetransmission. Psyke & Logos, 24, (1): 162-195
Completed: 2010
Related publications:
Johannsen, M. (2011). Testbank for traumatiserede flygtninge. Psykolog Nyt nr. 15.
Related 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.
Related 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 group of highly traumatized refugees n = 26 with diverse cultural backgrounds in a Danish Clinic for Traumatized Refugees (CTR) was assessed for symptoms of post-traumatic stress disorder and other aspects of general functioning. Patients were assessed at intake, after the end of treatment and six months later. The results point to very high symptom levels and a large need for treatment in this population. Psychiatric symptoms and their correlates were assessed with the Harvard Trauma Questionnaire (HTQ), the Trauma Symptom Checklist-23 (TSC-23), the Global Assessment of Function (GAF), and the Crisis Support Scale (CSS). The Trail Making Test A & B (TMT) was used as a screening instrument for acquired brain damage, with promising results. Indications of effectiveness from 16-18 weeks of multidisciplinary treatment (physiotherapy, pharmacotherapy, psychotherapy, and social counseling) were supported with small to medium effect sizes on most outcome measures. The results are discussed in terms of clinical implications and future treatment, assessment, and research needs.
Current issue:
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 rehabilitation of traumatized refugees. Torture, 19 (3), 248-270.
Related 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
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 of Psychotraumatology’s Ph.d. student Sarah Dokkedahl was in Northern Uganda over a period of time, which resulted in 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 of Pychotraumatology´s former Ph.D.-student Karen -Inge Karstoft
Current issue:
Karstoft, Kl. (2011). Uledsagede afghanske flygtningebørn. Odense: Videnscenter for Psykotraumatologi.
Related publications:
Karstoft, Kl. (2011). Børn uden ledsager.Psykolog Nyt nr.10, 2011, 20-2
Projects related to veterans:
Ongoing projects related to veterans
Completed projects related to Veterans
Current issue:
Elklit, A., Knudsen, H.(1995) Danske FN-soldater i fredsbevarende mission - belastninger og efterreaktioner. Psykologisk Skriftserie, 20 (5).
Related 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. (1995) Danske FN-soldater i Kroatien og Bosnien. Forskningsnyt fra Psykologien, 4 (6), 1-3.
Current issue:
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 controversy regarding the nature of posttraumatic growth includes two main competing claims: one which argues that posttraumatic growth reflects authentic positive changes and the other which argues that posttraumatic growth reflects illusory defenses. While the former might suggest that posttraumatic growth enhances intimacy and close relationships, the latter might imply that posttraumatic growth hinders interpersonal relations. The present study aimed to test these claims by investigating the association between posttraumatic growth and dyadic adjustment over time at both the individual and dyadic levels, and the potential role of posttraumatic stress symptoms. Former prisoners of war and comparable war veterans and their wives (n = 229) were assessed twice, 30–31 (T1) and 35–38 (T2) years after the 1973 Yom Kippur War in Israel, with regard to posttraumatic growth, posttraumatic stress symptoms and dyadic adjustment. Results indicated that posttraumatic growth was associated with both elevated posttraumatic stress symptoms and low dyadic adjustment among both husbands and wives. Posttraumatic stress symptoms at T1 and T2 mediated the association between posttraumatic growth and dyadic adjustment. Wives’ posttraumatic growth at T1 predicted posttraumatic growth and dyadic adjustment of the husbands at T2. The higher the wives’ posttraumatic growth, the higher the posttraumatic growth and the lower the dyadic adjustment of the husbands in the subsequent measure. The findings suggest that posttraumatic growth reflects defensive beliefs which undermine marital relationships and that posttraumatic growth might be transmitted between spouses and implicated in the deterioration of the marital relationship over time.
Current issue:
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
Method: A latent growth mixture modeling analysis on PTSD symptoms was conducted to identify PTSD trajectories and predictors. PTSD was defined according to DSM-III and assessed through the PTSD Inventory. Israeli male veterans with (n = 369) and without (n = 306) CSR were queried at 1, 2, and 20 years after war about combat exposure, military unit support, family environment, and social reintegration.
Results: For both study groups, we identified 4 distinct trajectories with varying prevalence across groups: resilience (CSR = 34.4%, non-CSR = 76.5%), recovery (CSR = 36.3%, non-CSR = 10.5%), delayed onset (CSR = 8.4%, non-CSR = 6.9%), and chronicity (CSR = 20.9%, non-CSR = 6.2%). Predictors of trajectories in both groups included perception of war threat (ORs = 1.59-2.47, P values ≤ .30), and negative social reintegration (ORs = 0.24-0.51, P values ≤ .047). Social support was associated with symptomatology only in the CSR group (ORs = 0.40-0.61, P values ≤ .045), while family coherence was predictive of symptomatology in the non-CSR group (OR = 0.76, P = .015) but not in the CSR group.
Conclusions: Findings confirmed heterogeneity of long-term sequelae of combat, revealing 4 trajectories of resilience, recovery, delay, and chronicity in veterans with and without CSR. Symptomatic trajectories were more prevalent for the CSR group, suggesting that acute functional impairment predicts pathological outcomes. Predictors of symptomatic trajectories included perceived threat and social resources at the family, network, and societal levels
Current issue:
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.13.m084822013
Current issue:
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