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      A qualitative analysis of factors impacting resilience among youth in post-conflict Liberia

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          Abstract

          Background

          In 2008, 5 years after the Liberian civil war ended, there were an estimated 340,000 orphans in Liberia, 18 % of the total child population of the country. Given that children make up half the population and that these children experienced significant trauma and loss both through direct exposure to the war and then to the Ebola epidemic, and indirectly as a result of the trauma experienced by their parents, the recovery of these children is essential to the recovery of the nation as a whole. The goal of this research was to identify factors contributing to resilience among youth in post-conflict Liberia. Resilience was defined as evidence of adaptive functioning and psychological health.

          Methods

          Seventy-five young people (age 13–18) in the capital city of Monrovia, Liberia were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically.

          Results

          Forty-six of the participants were attending school, and 29 were not enrolled in school. Youth enrolled in school demonstrated greater adaptive functioning. This was particularly true for boys in any school setting and girls attending private school. Youth not attending school were more likely to have lost family members or become estranged from them, and many were also engaging in substance use. Emotion regulation, cognitive flexibility, agency, social intelligence and, in some cases, meaning-making were found in participants who showed resilient outcomes.

          Conclusions

          Caregiver relationships mediate the development of psychological capacities that impact resilience. These findings suggest that youth who have lost a caregiver, many of whom are not attending school, are experiencing a significant ongoing burden in terms of their daily functioning and psychological health in the post-war period and should be the focus of further study and intervention targeting substance use and community reintegration.

          Trial registration Partners Healthcare IRB Protocol# 2012P000367.

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          Most cited references19

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          Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress.

          Most research on the effects of severe psychological stress has focused on stress-related psychopathology. Here, the author develops psychobiological models of resilience to extreme stress. An integrative model of resilience and vulnerability that encompasses the neurochemical response patterns to acute stress and the neural mechanisms mediating reward, fear conditioning and extinction, and social behavior is proposed. Eleven possible neurochemical, neuropeptide, and hormonal mediators of the psychobiological response to extreme stress were identified and related to resilience or vulnerability. The neural mechanisms of reward and motivation (hedonia, optimism, and learned helpfulness), fear responsiveness (effective behaviors despite fear), and adaptive social behavior (altruism, bonding, and teamwork) were found to be relevant to the character traits associated with resilience. The opportunity now exists to bring to bear the full power of advances in our understanding of the neurobiological basis of behavior to facilitate the discoveries needed to predict, prevent, and treat stress-related psychopathology.
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            Resilience in developing systems: progress and promise as the fourth wave rises.

            Ann Masten (2007)
            Perspectives based on the first three waves of resilience research are discussed with the goal of informing the fourth wave of work, which is characterized by a focus on multilevel analysis and the dynamics of adaptation and change. Resilience is defined as a broad systems construct, referring to the capacity of dynamic systems to withstand or recover from significant disturbances. As the systems perspective on resilience builds strength and technologies of measuring and analyzing multiple levels of functioning and their interactions improve, it is becoming feasible to study gene-environment interactions, the development of adaptive systems and their role in resilience, and to conduct experiments to foster resilience or reprogram the fundamental adaptive systems that protect development in the context of adversity. Hot spots for future research to study and integrate multiple levels of analysis are delineated on the basis of evidence gleaned from the first waves of resilience research.
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              The mental health of children affected by armed conflict: protective processes and pathways to resilience.

              This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain 'invulnerable' children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology.
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                Author and article information

                Contributors
                +1 312-420-6033 , elevey@partners.org
                claire.Oppenheim@bmc.org
                brittany.lange@yale.edu
                nsplasky@gmail.com
                harrisbtelekai@yahoo.com
                gondoum@gmail.com
                ikekulah@yahoo.com
                david.henderson@bmc.org
                cborba@mgh.harvard.edu
                Journal
                Child Adolesc Psychiatry Ment Health
                Child Adolesc Psychiatry Ment Health
                Child and Adolescent Psychiatry and Mental Health
                BioMed Central (London )
                1753-2000
                12 August 2016
                12 August 2016
                2016
                : 10
                : 26
                Affiliations
                [1 ]The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 5 Longfellow Place, Boston, MA 02114 USA
                [2 ]Harvard Medical School, 25 Shattuck St., Boston, MA 02115 USA
                [3 ]University of Illinois College of Medicine, 1853 West Polk St, Chicago, IL 60612 USA
                [4 ]Department of Psychiatry, Boston Medical Center, 840 Harrison Ave, Boston, MA 02118 USA
                [5 ]Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, UK
                [6 ]Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205 USA
                [7 ]A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
                [8 ]Boston University School of Medicine, 72 East Concord St, Boston, MA 02118 USA
                Author information
                http://orcid.org/0000-0002-5577-2505
                Article
                114
                10.1186/s13034-016-0114-7
                4983000
                27525038
                a772ab13-8782-415e-b027-f5ceaab079ea
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 May 2016
                : 2 August 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: T32-MH-093310
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Clinical Psychology & Psychiatry
                liberia,post-conflict,qualitative analysis,youth,adolescent,resilience

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