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.

中文翻译：

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非洲孤儿院的童年逆境、精神疾病和攻击性行为：针对创伤治疗的变化和新教学系统的实施。

背景 撒哈拉以南非洲地区的孤儿人数不断增加。虽然众所周知，对非洲孤儿的家庭或社区护理比机构护理更可取，但对孤儿院的护理质量和改进的可能性知之甚少。研究 1：方法 评估生活在坦桑尼亚农村孤儿院的 38 名儿童（平均年龄为 8.64 岁）的创伤性压力、家庭、学校和孤儿院的暴力经历以及心理健康状况不佳和攻击行为在两个时间点。创伤后应激障碍症状 (PTSD)、抑郁症状以及内化和外化问题的严重程度被用作心理健康状况不佳的指标。结果 在时间点 1 时，孤儿院经历的暴力与所有精神疾病指标的相关性比以前的家庭、学校或社区的暴力更强烈。此外，孤儿院经历的暴力与儿童的攻击行为呈正相关在时间点 2。 研究 2：方法 在研究 1 的事前评估的帮助下，对创伤相关疾病的新教学系统和心理治疗 (KIDNET) 的实施进行了评估。结果 作为对 PTSD 教学系统和心理治疗的变化的回应，发现经历的暴力和 PTSD 症状的严重程度大幅下降，而抑郁症状和内化和外化问题几乎没有变化。结论 这些研究表明，暴力，特别是在孤儿院，会严重导致孤儿的心理健康状况不佳，并且可以通过在孤儿院实施新的教学系统和心理治疗来改善心理健康。此外，研究结果表明，孤儿院的暴力经历对孤儿的攻击行为也起着至关重要的作用。