European Child & Adolescent Psychiatry (2024) 33:1217–1226

https://doi.org/10.1007/s00787-023-02362-x
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ESCAP COMMUNICATION

Communications of the European Society for

Child and Adolescent Psychiatry

Address for Correspondence related to ESCAP Communications:

Konstantinos Kotsis
Department of Psychiatry (Community Mental Health Center for Children and
Adolescents), Faculty of Medicine, School of Health Sciences,
University of Ioannina, 45110 Ioannina, Greece
E-mail: [email protected]

Ó The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024

The impact of abduction and hostage-taking disorders, developmental disabilities, mental health prob-
on the mental health of children lems, as well as a history of adversities before, may be
and adolescents: a scoping review found to be risk factors for developing further psychosocial
problems [3, 4]. Thus, the current, rising humanitarian
According to the United Nations, in 2022, 3985 children issue of child abductions, especially in armed conflicts,
were abducted in the context of armed conflicts [1]. The highlights the need to reduce and prevent the harmful
report looked at more than 20 countries or geographical impact on affected children, adolescents, and their families.
units in the world that were affected by armed conflicts and Moreover, there is a need to ban this form of violence on
concluded that ‘‘children continued to be disproportion- minors in general.
ately affected by armed conflict’’ [1] in the last year. That is because child abductions occur all over the
Moreover, verified abductions increased by 15% compared world and they happen in many different contexts. Child
to 2021 [1]. Therefrom, it becomes clear that child abduction due to armed conflicts is just one of these con-
abductions due to armed conflicts are a prevalent issue texts. On a global scale, child abductions by a parent
among many countries in the world. E.g., the abductions appear to be the most frequent type of child abductions,
and transfers of Ukrainian children to the Russian Feder- while in only a small number of cases, grandparents and
ation [1] resulted in the arrest warrant of the Russian other relatives, institutions, or others were the acting per-
president and the Russian children’s right officer. Recently, sons [5]. In 2022, parental abduction remained the second
the abduction of children and adolescents in the course of most prevalent reason of the new missing children cases
the terrorist attacks on civilians in Israel by the terror that were registered via the ‘‘Missing children Europe’’
organization Hamas on the morning of October 7th, 2023 hotlines [6]. The most prevalent reason was children who
highlighted the increasing humanitarian problem. run away, with criminal abductions accounting for only 1%
From a child and adolescent psychiatric and psy- of reported missing children cases [6].
chotherapeutic view, due to the extremely traumatic Although criminal child abductions by acquaintances or
experiences abducted children and adolescents make in this strangers are rare, these cases normally get a lot of media
context, e.g., being forcibly separated from their parents, coverage and evoke fear from parents and the general
sexual violence, torture [1], witnessing murder and public [7]. While in family abductions, the motive often
humiliation of relatives, negative effects on the physical involves divorce or custody disputes, criminal child
and mental health, well-being, and social-emotional abductions are to a large extent sexually motivated [7].
development of affected children and adolescents have to However, economic incentives are also among the primary
be assumed. Being separated from parents and caregivers motives of child abductions [7], where the victim is held
due to the abduction can increase the risk of mental health hostage until the ransom is paid, usually by the family. One
and development impairments, as explained by attachment famous example, among others, is the abduction of the
theory [2]. Furthermore, in the course of crises and disas- 16-year-old million heir John Paul Getty III. 1973 in Rome
ters, pre-existing vulnerabilities and disadvantages in [8]. The other way around, when adults are held hostage,
children and adolescents, including the presence of chronic their children and families are also affected. Regarding the

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1218 European Child & Adolescent Psychiatry (2024) 33:1217–1226

abduction of Jan Philipp Reemtsma in Germany, a social From those, recommendations can be derived to guide
scientist and inheritor of a cigarette manufacturer, the immediate and evidence-based mental health support for
abductee himself described in his book how his wife and abducted children, adolescents, and their families after
son had been affected emotionally and in their social lives their return.
during his time as a hostage [9]. Furthermore, political or
ideological motives are also a common reason for abduc-
tions. For example, in the 1970s, an abduction series by Methods
left-wing terrorists was carried out in Germany with
influential people in government, economy, and society Due to the complexity, heterogeneity, and urgency of the
being their victims [10]. That children and adolescents can research objective [20], we conducted a scoping review to
also fall victim to this type of abduction can be illustrated identify the types of available evidence [21] on the mental
by the hostage-taking in a school in Beslan, Russia, in 2004 health effects and psychosocial functioning of abduction or
by terrorists [11] or, again, by the recent terrorist attack and hostage-takings in children and adolescents. A literature
abductions in Israel by the terror organization Hamas. search on October 23rd, 2023 was conducted in the Med-
One of the first reports of Posttraumatic Stress Disorder line, Embase, and PsycInfo databases. As synonyms for
(PTSD) symptoms in children and adolescents was docu- ‘‘mental health’’, the keywords ‘‘psychological trauma’’,
mented after a school bus kidnapping [12]. What we know ‘‘stress disorder, posttraumatic’’, ‘‘psychotrauma’’, ‘‘post-
from former studies on abductions is that the longer chil- traumatic stress disorder’’, and ‘‘trauma’’ were used. PTSD
dren and adolescents are captured, the risk for developing was included as a search term as initial research on trauma
traumatic reactions increases [13–15]. Second, the so- indicated that PTSD is one of the most common mental
called ‘‘Stockholm Syndrome’’ [16] is a highly discussed disorder after traumatic experiences [see 22], especially in
risk in abduction cases [17]. Nevertheless, it can be children and adolescents who were taken hostage [12], and
assumed that the risk that a hostage develops negative PTSD screenings are still frequently used to assess a
feelings toward authorities and on the other hand develops child’s exposure to a violent act, such as abduction [23].
positive feelings toward the hostage taker is mainly Used keywords for the topic of ‘‘abduction’’ were the
overemphasized due to media coverage [17, 18]. Despite synonyms ‘‘kidnap*’’ and ‘‘hostage*’’. For children and
the lack of academic research on the topic, data from the adolescents, we used ‘‘child*’’ and ‘‘adolesc*’’. In accor-
FBI showed that in 1,200 reported federal, state, and local dance with the Convention on the Rights of the Child
hostage/barricade incidents, only 8% of the victims showed (UNCRC), we defined ‘‘children’’ as persons who had not
aspects of the Stockholm Syndrome [17]. Moreover, reached 18 years of age [24]. Keywords within one topic
research on the Stockholm Syndrome is not clear about the were combined using Boolean operator ‘‘OR’’ and the three
actual existence of the syndrome as it is not included as a topics using Boolean operator ‘‘AND’’. We performed
psychiatric diagnosis in DSM or ICD [18]. Additionally, multiple search strategies which in each case was based on
while former research is mostly based on individual cases, the characteristics of the database in which the respective
no common pattern in cases was found [18, 19] and there is search was conducted. In a second step, we added a fourth
no evidence whether the syndrome is treatable after the topic ‘‘terrorism’’—in regard to our main focus—to the
release of the abductees [19]. search strategy using the keywords ‘‘terrorism’’, ‘‘war’’,
Nonetheless, given the global prevalence and current ‘‘terror*’’, ‘‘terrorist attack’’, as well as ‘‘armed conflict’’
crisis of child abductions, besides prevention, the prepa- and performed the literature search again in each database.
ration for the return of abducted children and adolescents The combinations of search terms and databases resulted
has to be of the highest priority. It is crucial to reduce the in a total of 252 publications. Duplicates were subsequently
harm of the affected children and adolescents by providing removed, leaving 159 hits. We included only studies in
immediate and adequate support, care, and evidence-based English and German that focused on the mental health and
treatment. The aim of this paper is to review the broad psychosocial functioning of individuals who experienced
scientific literature on the mental health and psychosocial abduction or hostage-taking in their childhood or adoles-
functioning of individuals who were abducted or taken cence. Eligible studies were reviewed and assessed quali-
hostage in childhood or adolescence. We strive to illustrate tatively in regard to our research topic. This finally resulted
and aggregate empirical findings on this topic. Given the in 24 studies, which were included in this scoping review to
current humanitarian crisis, our main focus is on child illustrate empirical findings on the impact of abduction and
abductions in the context of war, armed groups, or terror hostage-taking on the mental health of children and ado-
organizations. To gain knowledge on the overall topic of lescents in the main section.
(mental) health outcomes in abducted children and ado-
lescents, different contexts of abductions are considered.

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Impact of abduction and being held hostage with former abducted parents [27]. Results revealed that,
on the mental health and psychosocial on average, former abducted children and adolescents were
functioning of children and adolescents significantly more often exposed to traumatic events than
both comparison groups [15, 27–29] and that the average
In reviewing the scientific literature on mental health out- cumulative number of reported violent traumatic events
comes of people who experienced abduction or hostage- was significantly higher among former abductees [15]. In
taking in childhood or adolescence, it quickly became clear regard to internalizing/emotional and externalizing/behav-
that the respective studies had addressed different contexts ioral problems and in comparison to non-abducted children
of child abductions. In addition, studies differed in the and adolescents, results further illustrated that war-ab-
characteristics of the sample and the outcomes of the ducted adolescents were more likely to have poor emo-
analysis, which is why the included studies were catego- tional and behavioral adjustment [28] and in comparison to
rized into the following sections. one or both comparison groups more often met criteria of
clinical symptoms of (current) PTSD [15, 28, 29], symp-
Abduction in the context of war, rebel groups, toms of depression [15], appetitive aggression [32], major
and terroristic groups depressive disorder (MDD), and generalized anxiety dis-
order [28]. However, a higher prevalence for suicide ten-
Several studies that focused on the short- and long-term dencies was only found in comparison to the formerly
effects of abduction on the mental health of children and abducted parents [27]. The comparison with non-abducted
adolescents referred to minors’ abductions by a rebel group children and adolescents only revealed higher clinical
in Uganda (Lord’s Resistance Army) (see [15, 25–30]). symptoms of past suicidality in abducted children and
Although we could not be sure that all participants had adolescents [28] but not with regard to suicide risk
been children or adolescents at the time of their abduction according to the Mini International Neuropsychiatric
but rather young adults, the descriptive statistics of the Interview [29]. From a more cultural context, researchers
respective studies indicated a high probability that most found high levels of ‘‘spirit possession’’ in formerly
participants were abducted in their childhood or adoles- abducted child soldiers compared to only war-affected
cence (e.g., see [25–30]). Therefore, the study results were, adolescents and young adults [33]. These were interpreted
nevertheless, be regarded as useful for a first conclusion as cultural variants of dissociative disorders as further
about the influence of abduction on the mental health of classified in the DSM-IV [33].
children and adolescents in the context of war, rebel Generally, with regard to mental health outcomes, a
groups, and terroristic groups. systematic review [34] indicated the experience of abduc-
In general, results showed that in this context, abduction tion in former child soldiers to be associated with increased
was associated with a high prevalence of experiencing internalizing and externalizing mental health problems.
several additional traumatic events for affected minors, When asking parents who themselves had been held hos-
such as exposure to killings, seeing dead bodies or body tage during war, about a third indicated that their children
parts, being forced to kill, threatened with death, narrowly were adversely affected by the hostage experience and
escaping from death, as well as physical and sexual abuse described emotional and behavioral difficulties [35]. In a
[25, 31]. Pham et al. (2009) were able to demonstrate that sample of 123 abducted girls in Northern Uganda, almost
the cumulative number of general traumatic exposures and all had clinically significant PTSD symptoms [31]. In a
cumulative number of forced acts of violence were asso- former study [26], it was demonstrated that abduction
ciated with increased odds of meeting criteria for symp- significantly predicted depression outcomes in adolescents.
toms of depression in abductees [15]. The same study also This result was, however, not observed in a study with
illustrated that being exposed to forced acts of violence or internally displaced children in Southern Dafur [36]. After
being exposed to them as a witness was also a risk factor controlling for age and sex, the study did not observe
for developing symptoms of PTSD [15]. In addition, predictive contribution of the variable ‘‘abduction’’ with
abductees who experienced several traumatic events in regard to depressive symptoms but abduction served as the
their lifetime and those with previous combat experience strongest predictor for trauma and grief symptoms [36].
showed specifically increased appetitive aggression (that is,
the pleasure of committing violent acts, see [30, 32]) and The role of sex, age, and length of abduction on abduction
an increased number of their perpetrated violent acts [30]. experiences and mental health outcomes
Besides, some studies compared former abducted chil-
dren and adolescents with non-abducted peers Regarding sex and age, several studies indicated that those
[15, 28, 29, 32], generally non-abducted individuals [33] or variables contributed to the likelihood of being abducted
[15, 26], the prevalence of developing depressive [15, 29]

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1220 European Child & Adolescent Psychiatry (2024) 33:1217–1226

and PTSD symptoms [15], as well as the number of com- children who experienced a hostage history exhibited
mitted violent acts [30]. Males tended to be more likely to symptoms of acute stress [37]. After 2 months, disorders
be abducted than females [15, 26]. However, females with such as PTSD or at least subclinical PTSD, separation
former abduction experience were more likely to report anxiety, specific phobia, and severe depressive disorders
symptoms of PTSD and depression than males [15] and were identified in a majority of the children. Anxiety scores
more depression symptoms than in the group of female decreased after 2–4 months and then stabilized, while
non-abductees [29], but the risk of having symptoms of avoidance symptoms gradually decreased and repetition
depression was shown to increase in male abductees with symptoms decreased less markedly throughout the follow-
higher age, while it decreased in females with age [15]. up period [37]. Further long-term effects of children being
Winkler et al. (2015) demonstrated that the length of held hostage in schools were neuropsychological impair-
abduction correlated with the severity of symptoms of ments in basic attention and memory processes, e.g.,
PTSD and trauma exposure in females, and with the maintenance of attention and short-term memory [38],
severity of symptoms of PTSD, trauma exposure, and posttraumatic effects, traumatic anxiety, recurrences of
depressive symptoms in males, respectively [29]. Another psychophysiological disturbances that had begun with the
study revealed that children and adolescents who were abduction, and repeated nightmares including of their own
abducted for 6 months or more met the criteria for symp- death [12]. Additionally, children who were held hostage
toms of PTSD and symptoms of depression more fre- during a terrorist attack in a school seemed to have sig-
quently than those abducted for shorter periods [15]. In nificantly lower resilience scores than non-hostages [39].
addition, individuals who were abducted young were
shown to be more vulnerable to appetitive aggression and Child abduction by a family member
reported an increased number of their perpetrated violent
acts [30]. In the context of child abductions by a family member, a
lifetime prevalence of 4% in U.S. families was revealed
Mental health problems upon returning home [40]. An association between the experience of a lifetime
family abduction and traumatic stress symptoms was found
When returning to their home communities, 39% of former and their result was independent of demographic variables
abductees reported problems [15]. Common problems were and the exposure to other kinds of victimization [40]. The
mental and social problems (e.g., problems adjusting to life authors also revealed sex differences, with female children
outside the bush, relationship problems with families) and being significantly more often victims of abduction [40].
these were both associated with an increased risk of Although they further mentioned that younger children
meeting criteria for symptoms of depression and PTSD were more often victims of child abduction than older
[15]. Additionally, those who were abducted for 6 months children, they did not provide information on statistical
or more reported more problems after returning home than significance [40].
those who were abducted for a shorter period [15].

Abduction in other contexts Indirect exposure to child abduction

Hostage-taking in schools As demonstrated by Navia and Ossa (2003), the abduction

of an individual can also result in mental health impair-
Regarding school hostage-takings, several studies exam- ments for their family members, e.g., PTSD, general dis-
ined, among other things, the effects of hostage-taking on tress, and psychological disturbance [41]. Scores on mental
mental health, behavior, and intellectual performance. health problems in family members were higher during the
Accordingly, the study by Jessee et al. (1992) found that captivity of a relative but sometimes also persisted after the
children who were held hostage at a school showed release of the abducted family member [41]. Moreover,
increased negative behavior in everyday school life, espe- caretakers of children who were held hostage in a school,
cially through restlessness, attention seeking, distractibil- but themselves were not affected, had high levels of severe
ity, and inattention [13]. As described by further studies in PTSD symptoms, similar to their children [38].
other contexts, the length of the hostage detention was But not only individuals and their families who were
significant with regard to the effects [13]. Negative victims of abduction are affected. Regarding overall levels
behavior was also observed in the personal environment of psychological symptoms as well as emotional and
after the hostage-taking, such as fear of strangers, fear of behavioral problems, Moscardino et al. (2008) found no
being left alone, sleep disorders, and, at times, anger and significant differences in adolescents who were held hos-
hyperactivity [13]. In addition, another study showed that tage by terrorists in a school and adolescents who had been

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indirectly exposed to the attack [11]. Similar results were Regarding the risk of moral injury (MI; that is, com-
found in the study of Vila et al. (1999) in which children mitting crimes against one’s own beliefs and values) in
who had been only indirectly exposed to the event showed abducted children and adolescents, the study by Wong
a long-term posttraumatic symptomatology [37]. Again, (2022) found that abduction history did not moderate the
sex seemed to play an important role as abducted girls as relationship between perpetrating violence and MI [44].
well as indirectly exposed girls reported significantly more
psychological distress and total difficulties [11]. In addi-
tion, they tended to show higher levels of anxiety and more Discussion and limitations
features of intrusion than boys [37]. In directly exposed
adolescents, avoidant coping was related to worse psy- Overall, the present review illustrates that the abduction of
chological functioning for girls and boys, whereas in children and adolescents can occur in different contexts all
indirectly exposed adolescents, this strategy was associated over the world. Regardless whether the abduction occurred
with psychological distress and total difficulties for girls in the context of war, rebel groups, and terroristic groups
only [11]. However, in the long-term, Vila et al. (1999) (e.g., [15, 25–36]), in the context of hostage-taking in
found that intrusion scores were significantly lower than schools [13, 37–39] or by a family member [40], the
those of children directly exposed to hostage-taking, and negative mental and psychosocial health effects for former
the severity of their symptoms decreased in indirectly abducted children and adolescents become apparent. Sev-
affected children over time [37]. eral studies reported not only about the exposure to several
On the other hand, children and adolescents who had traumatic events when being abducted, but also about
been exposed to the event of abduction by television were associations with emotional/internalizing and behavioral/
also affected emotionally, as expressed in worries, and they externalizing symptoms, physical and psychological
partially changed their activities in response to the symptoms and diagnosis, as well as long-term conse-
abduction event [42]. Results indicated that girls, older quences in several life domains and their associations with
ones, single-parented children and adolescents, those with impaired mental health when returning home (e.g.,
low socioeconomic status and/or being exposed to more [13, 15, 25–40, 43]). Furthermore, child abductions seem to
adversities as well as being maltreated and/or living near to affect the social environment on broad sequelae, with not
the place of abduction worried more about getting abducted only family members [41] and caregivers [38] of affected
when they had seen abductions in the media [42]. minors showing mental health problems, but also peers
who are indirectly affected by the abduction [11, 37, 42],
e.g., through living in the same area or hearing about it on
Further effects and consequences the media. By relying on the empirical findings of most of
of a history of abduction or hostage-taking the studies, girls seem to be more vulnerable to experience
on children and adolescents mental health problems after being held hostage [11, 15] or
when they are indirectly exposed to abduction [11, 42].
When reviewing the literature on child abduction, the With regard to the risk of being abducted in boys versus
broad sequelae of outcomes on affected children and ado- girls, it seems that the context in which the abduction
lescents have to be highlighted. Several studies showed occurs is relevant. Girls were reported to be more often the
additional possible effects and consequences of a history of victim of an abduction by a family member [40], while
abduction or hostage-taking on the psychosocial well-being boys were more likely to be abducted in the context of
and physical health of children and adolescents. Besides armed conflicts [15, 26]. However, it was also shown that
emotional problems, physical symptoms (e.g., malnutri- the risk for depressive symptoms increased in males when
tion, dermatological complaints, muscle aches, and irreg- they age, while it decreases in women [15]. This may be an
ular or no menstrual cycles in abducted girls) as well as indicator that abduction experiences affect females more in
cognitive problems (including a lack of concentration or the short term, while males are more affected in the long-
confusion) and behavioral signs (in form of bedwetting, term. Findings on the impact of age in the relationship
thumb sucking, or sleep disturbances) were observed [31]. between abduction experiences and mental health appeared
In this study, most of the formerly abducted girls suffered to be inconsistent. One study reported about increased
from sexually related complaints like abdominal pains, appetitive aggression in younger children who were
pelvic pains, or vaginal candidiasis [31]. Furthermore, abducted [30]. Additionally, older age was linked to
individuals who had had a multiple abduction history emotional impairments in indirectly exposed children [42],
seemed to have a higher risk of acquiring human immun- but younger children seem to have a higher likelihood of
odeficiency virus (HIV) compared to those without an being a victim of abduction [40]. On the other hand, length
abduction history [43]. of abduction [13, 15, 29] and pre-existing vulnerabilities

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[30, 42] consistently were reported when measured to abduction, the length of abduction, and the experienced
impact mental health of former abducted children and traumatic events during abduction to investigate relation-
adolescents or of peers who were indirectly exposed. ships with mental health and in treatment outcomes. Fur-
This review also contains limitations that need to be thermore, the lack of empirical evidence in different
considered to interpret the results of this review appropri- abduction contexts and countries has to be addressed
ately. As this is a scoping review, a systematic and com- through collecting basic data on this topic. Family abduc-
prehensive literature review was not conducted. tions are among the most prevalent motives of child
Furthermore, the studies were primarily selected based on abductions globally [5]. However, we only found one study
their content suitability with regard to the context of child from the U.S. which addressed this issue. Studies from
abduction and its psychological impacts. The method- Europe on the mental health outcomes in children and
ological quality was not assessed. Another limitation is that adolescents with different abduction experiences have to be
some of the selected studies did not make any statement conducted as this is a prevalent problem in Europe and
about the age at the time of the abduction. We could other western countries, too [6]. Besides comparability, this
therefore not always be certain whether the abduction took is also necessary to adapt treatment in regard to the context
place during childhood or adolescence. Similarly, only a of the abduction and cultural background. As former
few studies examined sex-specific characteristics, although research points out that pre-existing vulnerabilities increase
sex differences in abduction are present (e.g., sexual rape the risk for mental health impairments during traumatic
among girls during abduction is more prevalent than in events, differences in social status, adversities, health,
boys [7]). Furthermore, this review only focused on the disabilities, as well as cumulative stresses should be ade-
experience of abduction, thus not considering other quately considered in future research by integrating ques-
potentially cumulative traumatic experiences related to tionnaires into surveys with former child abductees on a
war, which may have a strong impact on outcomes and lead regular basis. Moreover, when child abduction cases get
to even worse mental health outcomes for affected children media coverage, it is important to conduct surveys on
and adolescents. Another limiting factor was that only mental health outcome in the national underage population
studies were available that referred either to abductions in to screen for mental health problems due to the abduction
the context of wars or armed conflicts in developing event. Additionally, future research should focus on con-
countries or to abductions in the context of abductions by ducting longitudinal studies to assess the long-term mental
family members or hostage-taking in schools in industri- health effects of abduction in childhood or adolescence.
alized countries. Therefore, the comparability of the studies Finally, mental and physical health outcomes as well as
is limited. impacts on the social life of those affected should be
Nevertheless, by conducting a scoping review on this measured by standardized questionnaires to increase com-
prevalent and increasing humanitarian problem, especially parability of studies.
about child abductions due to armed conflicts, it is possible
to quickly aggregate empirical evidence on the mental
health and psychosocial functioning of affected minors and Clinical implications
therefore to make recommendations about directing care,
treatment, support, and prevention activities. From a practical view, as PTSD was shown to be a
prevalent mental health outcome in abducted children and
adolescents, trauma-focused cognitive–behavioral therapy
Implications for future research (TF-CBT), in particular individual forms are recom-
mended. That is because those appear to be the most
Due to the fact that child abductions and hostage-takings effective in the management of PTSD [45], PTSS,
occur suddenly, case-by-case and are highly traumatizing depressive, anxiety, and grief symptoms in individual and
for those affected and their families, of course, it is not group settings in youth [46]. Effective to a lesser extent in
possible to conduct immediate, large-scale and regular treating PTSD in youth is ‘‘Eye Movement Desensitization
surveys as well as systematic interventional studies. and Reprocessing’’ (EMDR), emotional freedom tech-
Nonetheless, a systematic collection of basic data and its nique, child–parent psychotherapy, combined TF-
publication is even more important when former child CBT/parent training, and meditation [45]. Additionally, it
abductees are surveyed or agreed to be interviewed to make can be helpful and important for affected children and
research on this topic more comparable. Regarding this, adolescents to create a detailed and coherent narrative of
based on the evidence, we identified in this scoping review their abduction experience and its consequences, to inte-
and the resulting limitations, minimal data in surveys grate this traumatic experience into their previous biogra-
should contain information about sex, age, age at phy and to be confronted with the memories of this event

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(see [47–49]). This has proven to be a helpful way to background of rising prevalences of child abductions due
process traumatic experiences in general and will likely be to armed conflicts [1] and increasing migration to Europe.
effective for the processing of abduction experiences and The need for preparedness and action is also underlined by
related events. A therapeutic approach is the ‘‘Narrative the United Nations International Strategy for Disaster
Exposure Therapy (NET)’’. It is a culturally, universal Reduction’s (UNISDR) definition of preparedness as ‘‘The
short-term therapy for the treatment of adult and child (for knowledge and capacities developed by governments,
children: KIDNET) survivors of multiple and severe trau- professional response and recovery organizations, com-
matic events, such as organized violence, torture, war, rape, munities and individuals to effectively anticipate, respond
and childhood abuse [50, 51]. The effectiveness of NET in to, and recover from, the impacts of likely, imminent or
reducing PTSD and depression symptoms for adults and current hazard events or conditions’’ [57]. Although this
children was shown in meta-analyses [52, 53] and the definition was developed primarily in the context of eco-
effectiveness of KIDNET in improving PTSD symptoms logical disasters and physical consequences (see [57]), the
and functioning, which was invented by a working group of consequences of different crisis for the mental health of
the University of Konstanz, was reported by a randomized- children and adolescents made it obvious that preparedness
controlled trial with refugee children [54]. Regarding and rapid responses (or ‘‘readiness’’ as the UN [57] called
abduction experiences, narrative exposure therapy with it) must also be implemented in the context of mental
former child soldiers was found to significantly improve health prevention (see [4, 58]).
severity of PTSD symptoms compared to control groups In conclusion, in terms of preparedness and rapid
[55]. response, there is an urgent need to build, strengthen, and
Indeed, besides therapy, there are different approaches expand low- and high-threshold services in relevant sectors
to process a traumatic experience. For example, Jan Philipp as well as to improve multidisciplinary networking, train
Reemtsma described in his book that the most important professionals, and bystanders regarding mental health
reason for him to write down his story and to publish it was problems of children and adolescents as a result of
because the period of his abduction was a time of ‘‘forced abduction and other crises. Furthermore, the provision of
intimacy’’ [9]. A legitimate solution for him to destroy this immediate and protective infrastructures, specialized cen-
forced intimacy in his life after the abduction was to ters, and consultation facilities for them and for interven-
publish the experience [9]. tional forces, e.g., in the police, should be of highest
On the other hand, resilience was found to be strongly priority (see also [59]).
inversely related to depression in a sample of Syrian
Acknowledgements The authors would like to thank Karen Schlaegel
refugee children who reported about experiencing trau-
for the linguistic revision of the manuscript and would also like to
matic events, e.g., being held hostage [56]. Therefore, the thank the Ministry of Science, Research and the Arts of Baden-
degree to which a child felt social support was found to be Württemberg for funding the Competence Area Mental Health
the most protective resilience factor on the likelihood of Prevention in the Competence Network Preventive Medicine which
made this research possible.
endorsing symptoms of depression [56]. Maybe, this is
because affected children and adolescents feel safe to open Author contributions Initiation: JMF; conceptualization: JMF and
up about their traumatic experiences, without fear of neg- EG; methodology: EG, KE, TH, and PM; literature search: TH and
ative public reactions, and to deal with the question of PM; data analysis and investigation: EG, KE, TH, and PM; writing—
original draft preparation: EG, KE, TH, and PM; writing—review and
surviving the experience, while maybe others have not.
editing: JMF, CS, VC, EG, KE, TH, and PM; supervision: JMF;
Concluding, empowering children, adolescents, and fami- project coordination: EG.
lies to build resilience through social support may be a
viable, low-threshold prevention and management Funding The authors did not receive support from any organization
for the submitted work.
approach [56].
Such early, culturally adapted, evidence-based treat- Data availability Not applicable.
ments and support approaches that focus on the stabiliza-
tion of the affected children and adolescents upon returning Code availability Not applicable.
home must be available immediately. As abduction might
not only influence the mental health of abductees short and Declarations
long term but also of their families [38, 41] and of other
Conflict of interest The authors EG, KE, TH, PM, CS, and VC have
children and adolescent who were exposed indirectly (e.g.,
no relevant financial or non-financial interests to disclose. In the last
by television coverage, see [42]), it becomes clear that five years, JMF received research funding from EU, BMG (Federal
institutions and organizations must be well prepared to take Ministry of Health), BMBF (Federal Ministry of Education and
rapid actions and prevent mental health problems when Research), BMFSFJ (Federal Ministry of Family, Senior Citizens,
Women and Youth), DFG (German Research Foundation), G-BA
abductions occur. This is especially important against the

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1224 European Child & Adolescent Psychiatry (2024) 33:1217–1226

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