51
|
Bangpan M, Felix L, Dickson K. Mental health and psychosocial support programmes for adults in humanitarian emergencies: a systematic review and meta-analysis in low and middle-income countries. BMJ Glob Health 2019; 4:e001484. [PMID: 31646006 PMCID: PMC6782047 DOI: 10.1136/bmjgh-2019-001484] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/08/2022] Open
Abstract
Background Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people’s mental and psychological health. Effective interventions in humanitarian settings are needed to support the mental health and psychosocial needs of affected populations. To fill this gap, this systematic review synthesises evidence on the effectiveness of a wide range of mental health and psychosocial support (MHPSS) programmes delivered to adults affected by humanitarian emergencies in low and middle-income countries (LMICs). Methods A comprehensive search of 12 electronic databases, key websites and citation checking was undertaken in 2015 and updated in May 2018. We included controlled trials published in English from 1980. We extracted data and assessed risk of bias prior to performing a meta-analysis using random effects models. When meta-analysis was not used, we narratively described individual trial effect sizes using forest plots. Results Thirty-five studies were included. Overall, MHPSS programmes show benefits in improved functioning and reducing post-traumatic stress disorder. There are also indications from a limited pool of evidence that cognitive–behavioural therapy and narrative exposure therapy may improve mental health conditions. Other psychotherapy modalities also showed a positive trend in favour of MHPSS programmes for improving several mental health outcomes. Conclusion In addition to MHPSS programme for improving mental health outcomes in adults affected by humanitarian emergencies in LMICs, there is also a need to generate robust evidence to identify potential impact on broader social dimensions. Doing so could aid the future development of MHPSS programmes and ensure their effective implementation across different humanitarian contexts in LMICs. Future research on MHPSS programmes which focus on basic services and security, community and family programmes, their cost-effectiveness and mechanisms of impact could also strengthen the MHPSS evidence base to better inform policy and practice decision-making in humanitarian settings. Protocol registration number CRD42016033578.
Collapse
Affiliation(s)
- Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinatng Centre (EPPI-Centre), Department of Social Science, University College London Institute of Education, London, UK
| | - Lambert Felix
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Kelly Dickson
- The Evidence for Policy and Practice Information and Co-ordinatng Centre (EPPI-Centre), Department of Social Science, University College London Institute of Education, London, UK
| |
Collapse
|
52
|
Basheti IA, Ayasrah SM, Basheti MM, Mahfuz J, Chaar B. The Syrian refugee crisis in Jordan: a cross sectional pharmacist-led study assessing post-traumatic stress disorder. Pharm Pract (Granada) 2019; 17:1475. [PMID: 31592018 PMCID: PMC6763294 DOI: 10.18549/pharmpract.2019.3.1475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/28/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The United Nations has declared the Syrian crisis as the worst humanitarian
crisis of the twenty-first century. Pharmacists play a vital role in
humanitarian aid and in delivering health advices for refugees. Many Syrian
refugees are in need of psychosocial assessments. Objective: Objective of this study was to investigate the prevalence of post-traumatic
stress disorder (PTSD), assessed by pharmacists among Syrian civilian
refugees residing in Amman, Jordan. Methods: A cross-sectional study involving Syrian civilian refugees living in Amman,
Jordan, was conducted using the published and validated Arabic version of
the Harvard Trauma Questionnaire (HTQ). Pharmacists recruited civilian
Syrian refugees and completed the HTQ. The questionnaire included 45
questions, with the first 16 questions (HTQ-16) intended to assess the
trauma symptoms felt by refugees. Assessments were done by the pharmacists
and refugees were categorized to suffer PTSD if their mean item score for
the HTQ-16 scale was > 2.5. Results: Study participants (n=186; mean age 31.5 years; 51.3% males) had a
HTQ-16 mean score of 2.35 (SD=0.53), with a range of 1.19 - 3.63. Over a
third of participants (38.7%) were categorized as having PTSD. Males
reported significantly worse PTSD symptoms (mean=2.42, SD=0.50) compared to
females (mean=2.26, SD=0.57). Correlation between the mean item score for
the HTQ-16 and characteristics of the study participants showed higher mean
item score correlated with being a male, older in age, a smoker, and if
trauma was experienced. Conclusions: Many Syrian civilian refugees living in Jordan suffer from PTSD. Male
participants were found to be more affected by the severity of the disorder.
Pharmacists are suitably situated to identify civilian Syrian refugees
suffering from PTSD in dire need of help, paving the way for much needed
healthcare resources to be delivered to this particular group of
refugees.
Collapse
Affiliation(s)
- Iman A Basheti
- Professor in Clinical Pharmacy. Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Shahnaz M Ayasrah
- Department of Applied Science/Nursing, Al-Balqa Applied University a. Al-Salt (Jordan).
| | - Mariam M Basheti
- Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
| | - Judeh Mahfuz
- Professor in human resource management. Applied Science Private University. Amman (Jordan).
| | - Betty Chaar
- Associate Professor in pharmacy practice. School of Pharmacy, Faculty of Medicine and Health, University of Sydney. Sydney, NSW a (Australia).
| |
Collapse
|
53
|
Bain K, Landman M, Frost K, Raphael-Leff J, Baradon T. Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions. Infant Ment Health J 2019; 40:889-905. [PMID: 31425644 DOI: 10.1002/imhj.21814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The recent call for the scale-up of evidence-based early childhood development interventions, in lower and middle-income countries and for minority groups in high-income countries, has seen numerous suggestions to train greater numbers of lay mental health workers to fulfill these functions. While studies have found that concepts from developed country settings, such as attachment, parental sensitivity, and containment, find purchase and relevance within developing settings, the management of contextual and cultural factors and the tensions of cultural interfacing in the rollout of these programs in developing country settings require consideration. Drawing on the experiences of two successful South African mother-infant home-visiting programs as examples, this article discusses some of the challenges in provision of attachment-based infant mental health programs and highlights the need for careful consideration of a number of factors pertaining to the recruitment, supervision, and management of lay mental health workers before large-scale rollout is conducted.
Collapse
Affiliation(s)
- Katherine Bain
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Katherine Frost
- Ububele Educational and Psychotherapy Trust, Johannesburg, South Africa
| | | | | |
Collapse
|
54
|
Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis. Epidemiol Psychiatr Sci 2019; 28:376-388. [PMID: 30739625 PMCID: PMC6669989 DOI: 10.1017/s2045796019000027] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
UNLABELLED AimsIn the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers. METHODS We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason. RESULTS We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = -0.71; 95% confidence interval [CI] -1.01 to -0.41; I2 = 83%; 95% CI 78-88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = -1.02; 95% CI -1.52 to -0.51; I2 = 89%; 95% CI 82-93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = -1.05; 95% CI -1.55 to -0.56; I2 = 87%; 95% CI 79-92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life. CONCLUSIONS Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly.
Collapse
|
55
|
Winiarski DA, Rufa AK, Karnik NS. Using Layperson-Delivered Cognitive-Behavioral Therapy to Address Mental Health Disparities. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190711-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
56
|
Slekiene J, Mosler HJ. The link between mental health and safe drinking water behaviors in a vulnerable population in rural Malawi. BMC Psychol 2019; 7:44. [PMID: 31287032 PMCID: PMC6615249 DOI: 10.1186/s40359-019-0320-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/24/2019] [Indexed: 11/15/2022] Open
Abstract
Background Mental disorders, particularly depression and post-traumatic stress disorder, are common long-term psychological outcomes in emergency contexts arising from conflicts, natural disasters, and other challenging environmental conditions. In emergencies, people suffer not only from the lack of external resources such as drinking water and food but also from poor mental health. Mental disorders can substantially impair daily activities in vulnerable individuals. However, water, sanitation, and hygiene (WASH) behaviors are daily activities that require effort, time, and strong internal motivation. Therefore, questions arise: whether there is a relationship between mental health and safe water behaviors, and if so, whether the motivational drivers of these behaviors are affected by mental health. Methods Our cross-sectional study conducted face-to-face interviews with 638 households in rural Malawi. We used a quantitative questionnaire based on the risks, attitudes, norms, abilities, and self-regulation (RANAS) approach to measure motivational psychosocial factors. Mental health was assessed using the validated Chichewa version of the Self-Reporting Questionnaire (SRQ-20). Results. Almost a third of the respondents reported poor mental health. We found significant negative association between mental health and self-reported safe water collection (p = .01, r = −.104) but not between safe water transportation and storage behavior. The moderation analysis revealed significant interaction effects of mental health with some psychosocial factors and therefore on WASH behaviors. Poor mental health changed the influence of three psychosocial factors—perceived others’ behavior, commitment, and remembering—on safe drinking water collection behavior. The influence on water transportation and storage behavior of the perceived severity of contracting a disease, the belief that transporting and storing water requires substantial effort, and others’ approval depended on the mental health condition of the respondent. Conclusions These results imply that populations with a significant proportion of individuals with poor mental health will benefit from interventions to mitigate mental health before or parallel to behavioral change interventions for WASH. Specific population-level interventions have been shown to have a positive effect on mental well-being, and they have been successfully applied at scale. This research is especially relevant in emergency contexts, as it indicates that mental health measures before any WASH interventions will make them more effective.
Collapse
Affiliation(s)
- Jurgita Slekiene
- EAWAG, Swiss Federal Institute of Aquatic Science and Technology, Environmental Social Sciences, Environmental and Health Psychology, Überlandstrasse 133, P.O. Box 611, CH-8600, Dübendorf, Switzerland.
| | - Hans-Joachim Mosler
- EAWAG, Swiss Federal Institute of Aquatic Science and Technology, Environmental Social Sciences, Environmental and Health Psychology, Überlandstrasse 133, P.O. Box 611, CH-8600, Dübendorf, Switzerland
| |
Collapse
|
57
|
Murray LK, Haroz E, Dorsey S, Kane J, Bolton PA, Pullmann MD. Understanding mechanisms of change: An unpacking study of the evidence-based common-elements treatment approach (CETA) in low and middle income countries. Behav Res Ther 2019; 130:103430. [PMID: 31780251 DOI: 10.1016/j.brat.2019.103430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022]
Abstract
There is a recognized need to better understand "essential ingredients" of psychological treatments, and refine interventions to be more scalable and sustainable. The goal of the present study was to look within a specific modular, flexible, multi-problem transdiagnostic psychological intervention -the Common Elements Treatment Approach (CETA) - and examine questions that would lead to optimizing CETA for scale up and sustainment. Utilizing data from two trials of CETA in two different countries (Thailand and Iraq), this manuscript aims to: 1) determine the "active treatment dose" or how many sessions are needed to achieve clinically meaningful change overall, in CETA); and 2) test how trajectories of client symptom change varied based on client characteristics and/or on delivery of certain elements. Results showed that overall 50% of CETA clients show some improvement after 4-6 sessions (1 SD) and large improvement (2 SD) after 7-10 sessions. Trajectories of change show steady symptom decline over time. Results support gradual exposure as one of the "active ingredients". Findings suggest that modular, flexible transdiagnostic models may allow for more efficient, targeted treatment as we gain more knowledge about key ingredients, their timing within treatment, and client outcomes.
Collapse
Affiliation(s)
- Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA.
| | - Emily Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA.
| | - Shannon Dorsey
- Department of Psychology, Guthrie Hall, University of Washington, Seattle, WA 98195, USA.
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA.
| | - Paul A Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA.
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 74th Street, Building 29, 98115, USA.
| |
Collapse
|
58
|
Evidenced-Based Treatment of Posttraumatic Stress Disorder: An Updated Review of Validated Psychotherapeutic and Pharmacological Approaches. Harv Rev Psychiatry 2019; 26:99-115. [PMID: 29734225 DOI: 10.1097/hrp.0000000000000186] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate psychotherapeutic and pharmacologic approaches to treating patients with posttraumatic stress disorder. ABSTRACT A strong evidence base exists for psychological and pharmacological interventions for the treatment of posttraumatic stress disorder (PTSD). The published literature investigating the effectiveness of these treatments in reducing the symptoms and impairments associated with PTSD has expanded substantially in recent years. This review provides a concise overview of the empirical literature examining these treatment approaches. Evidence-based, trauma-focused therapies are recommended as first-line interventions, with the most support for cognitive- and exposure-based approaches. Prolonged exposure and cognitive processing therapy are the two most cited and rigorously investigated. Various other evidence-supported protocols are discussed. Pharmacotherapies can be used when evidence-based psychotherapies are not available or are ineffective, or on the basis of patient preference. Pharmacotherapy with the most support for PTSD includes selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Evidence supports the implementation of these interventions across genders, populations, and settings. Given that little research directly compares the effectiveness of different PTSD interventions and their mechanisms of action, it remains uncertain how to best select and tailor treatments to optimize individual outcomes. Future directions and novel, ongoing research are discussed.
Collapse
|
59
|
Adorjan K, Mulugeta S, Odenwald M, Ndetei DM, Osman AH, Hautzinger M, Wolf S, Othman M, Kizilhan JI, Pogarell O, Schulze TG. [Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. DER NERVENARZT 2019. [PMID: 28646248 DOI: 10.1007/s00115-017-0365-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).
Collapse
Affiliation(s)
- K Adorjan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland. .,Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland. .,Center for International Health, Ludwig Maximilians Universität München, München, Deutschland.
| | - S Mulugeta
- International Medical Corps, Mental Health and Psychosocial Support Program, (UNHCR and ARRA) Dolo Ado Refugee Camps, Dolo Ado, Äthiopien
| | - M Odenwald
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - D M Ndetei
- Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenia
| | - A H Osman
- Department of Psychiatry, University of Khartoum, Khartoum, Sudan
| | - M Hautzinger
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - S Wolf
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - M Othman
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak
| | - J I Kizilhan
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak.,Fakultät für Sozialwesen, Duale Hochschule Baden Württemberg, Villingen-Schwenningen, Deutschland
| | - O Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| | - T G Schulze
- Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland
| |
Collapse
|
60
|
Lahuis AM, Scholte WF, Aarts R, Kleber RJ. Undocumented asylum seekers with posttraumatic stress disorder in the Netherlands. Eur J Psychotraumatol 2019; 10:1605281. [PMID: 31231474 PMCID: PMC6567193 DOI: 10.1080/20008198.2019.1605281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/24/2019] [Accepted: 03/28/2019] [Indexed: 11/24/2022] Open
Abstract
Background: To date, most studies on the mental health of refugees in Europe have focused on the prevalence and treatment of psychopathology. Little is known about those who illegally reside in the host country, referred to, in the Netherlands, as undocumented asylum seekers. There are indications that mental health and psychosocial problems are more prevalent in this group than among refugees in general, with unsatisfactory treatment outcomes. Objective: To describe characteristics and mental health and psychosocial problems of undocumented asylum seekers, and to establish the need for, and feasibility of, a tailored treatment approach. Method: Based on a literature review and extensive clinical experience, common mental health and psychosocial problems and accessibility of care for undocumented asylum seekers are established, as well as the common treatment approach in the Netherlands. A tailored treatment programme and experiences with its implementation are described. Results: Mental health and psychosocial problems are highly prevalent among undocumented asylum seekers, and access to care is limited. In addition, treatment in the Netherlands, if provided, is mostly insufficient yet prolonged. Given the specific psychosocial problems and living conditions of undocumented asylum seekers, a necessary criterion to enable adequate and evidence-based treatment provision is acknowledgement of their distinct needs. A tailored treatment programme as currently implemented in the Netherlands appears to meet this criterion and be feasible under certain conditions. Collaboration between mental health care providers and involved social service and governmental parties by regular meetings, though complicated, is a relevant element. Conclusions: Even though undocumented asylum seekers are illegally residing in a country, medical ethics and the human rights perspective necessitate for adequate and evidence-based treatment for those among them with mental health problems. The tailored treatment approach presented here suggests that, notwithstanding factors complicating care provision which require specific attention, this is feasible.
Collapse
Affiliation(s)
- Anke M Lahuis
- Equator Foundation / Arq, Diemen, The Netherlands.,Foundation Center '45 / Arq, Diemen, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Willem F Scholte
- Equator Foundation / Arq, Diemen, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Rembrant Aarts
- Equator Foundation / Arq, Diemen, The Netherlands.,Foundation Center '45 / Arq, Diemen, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Rolf J Kleber
- Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
61
|
Lely JCG, Smid GE, Jongedijk RA, W Knipscheer J, Kleber RJ. The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. Eur J Psychotraumatol 2019; 10:1550344. [PMID: 31007868 PMCID: PMC6450467 DOI: 10.1080/20008198.2018.1550344] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Narrative exposure therapy (NET) is a short-term psychological treatment for post-traumatic stress disorder (PTSD) that has been investigated in various contexts among traumatized refugees and other trauma survivors. Sustained treatment results have been reported, but the methodological quality of the trials needs a more thorough examination. Objective: To evaluate the effectiveness of NET for survivors of trauma, using a quality assessment, an updated meta-analysis, and a meta-regression analysis. Method: Following a systematic literature selection, the methodological quality of the included studies was assessed; Non-controlled and controlled effect sizes (Hedges' g) were estimated using a random effects model. Predictor analyses were performed. Non-controlled effect sizes for PTSD and depression included symptom change at post-treatment and follow-up time-points. Controlled effect sizes included post-treatment comparisons of NET with non-active and active comparators: both trauma-focused (TF) and non-trauma-focused (non-TF) interventions. Results: The selected studies showed high external validity; methodological quality was equivalent to other guideline-supported TF interventions. In 16 randomized controlled trials, involving 947 participants, large non-controlled effect sizes were found for PTSD symptoms, at post-treatment (g = 1.18, 95% confidence interval [0.87; 1.50]) and follow-up (g = 1.37 [0.96; 1.77]). For depression symptoms, medium non-controlled effect sizes were found, at post-treatment (g = 0.47 [0.23; 0.71]) and follow-up (g = 0.60 [0.26; 0.94]). Post-treatment, NET outperformed non-active comparators and non-TF active comparators for PTSD, but not the combined active comparators. For depression, NET only outperformed non-active comparators. Advancing age predicted better treatment results for PTSD and depression symptoms; a history of migration predicted smaller treatment results for depression symptoms. Conclusions:The findings of this meta-analysis suggest that patients and providers may expect sustained treatment results from NET. Controlled comparisons with other guideline-supported TF interventions are not yet available.
Collapse
Affiliation(s)
| | | | | | - Jeroen W Knipscheer
- Foundation Centrum '45, Diemen, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Rolf J Kleber
- Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
62
|
Wilker S, Schneider A, Conrad D, Pfeiffer A, Boeck C, Lingenfelder B, Freytag V, Vukojevic V, Vogler C, Milnik A, Papassotiropoulos A, J.-F. de Quervain D, Elbert T, Kolassa S, Kolassa IT. Genetic variation is associated with PTSD risk and aversive memory: Evidence from two trauma-Exposed African samples and one healthy European sample. Transl Psychiatry 2018; 8:251. [PMID: 30467376 PMCID: PMC6250662 DOI: 10.1038/s41398-018-0297-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 09/26/2018] [Accepted: 10/18/2018] [Indexed: 11/11/2022] Open
Abstract
The probability to develop posttraumatic stress disorder (PTSD), characterized by vivid, intrusive emotional memories of the encountered traumatic events, depends - among other factors - on the number of previous traumatic experiences (traumatic load) and individual genetic vulnerability. So far, our knowledge regarding the biological underpinnings of PTSD is relatively sparse. Genome-wide association studies (GWAS) followed by independent replication might help to discover novel, so far unknown biological mechanisms associated with the development of traumatic memories. Here, a GWAS was conducted in N = 924 Northern Ugandan rebel war survivors and identified seven suggestively significant single nucleotide polymorphisms (SNPs; p ≤ 1 × 10-5) for lifetime PTSD risk. Of these seven SNPs, the association of rs3852144 on chromosome 5 was replicated in an independent sample of Rwandan genocide survivors (N = 370, p < .01). While PTSD risk increased with accumulating traumatic experiences, the vulnerability was reduced in carriers of the minor G-allele in an additive manner. Correspondingly, memory for aversive pictures decreased with higher number of the minor G-allele in a sample of N = 2698 healthy Swiss individuals. Finally, investigations on N = 90 PTSD patients treated with Narrative Exposure Therapy indicated an additive effect of genotype on PTSD symptom change from pre-treatment to four months after treatment, but not between pre-treatment and the 10-months follow-up. In conclusion, emotional memory formation seems to decline with increasing number of rs3852144 G-alleles, rendering individuals more resilient to PTSD development. However, the impact on therapy outcome remains preliminary and further research is needed to determine how this intronic marker may affect memory processes in detail.
Collapse
Affiliation(s)
- Sarah Wilker
- Clinical & Biological Psychology, Ulm University, Ulm, Germany.
| | - Anna Schneider
- Clinical & Biological Psychology, Ulm University, Ulm, Germany.
| | - Daniela Conrad
- Clinical & Biological Psychology, Ulm University, Ulm, Germany. .,Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany.
| | - Anett Pfeiffer
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Christina Boeck
- 0000 0004 1936 9748grid.6582.9Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Birke Lingenfelder
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Virginie Freytag
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Vanja Vukojevic
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Christian Vogler
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Annette Milnik
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- 0000 0004 1937 0642grid.6612.3Division of Molecular Neuroscience, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dominique J.-F. de Quervain
- 0000 0004 1937 0642grid.6612.3Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Psychiatric University Clinics, University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- 0000 0001 0658 7699grid.9811.1Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | | | | |
Collapse
|
63
|
Conrad D, Wilker S, Schneider A, Karabatsiakis A, Pfeiffer A, Kolassa S, Freytag V, Vukojevic V, Vogler C, Milnik A, Papassotiropoulos A, J-F de Quervain D, Elbert T, Kolassa IT. Integrated genetic, epigenetic, and gene set enrichment analyses identify NOTCH as a potential mediator for PTSD risk after trauma: Results from two independent African cohorts. Psychophysiology 2018; 57:e13288. [PMID: 30328613 PMCID: PMC7379258 DOI: 10.1111/psyp.13288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 12/17/2022]
Abstract
The risk of developing posttraumatic stress disorder (PTSD) increases with the number of traumatic event types experienced (trauma load) in interaction with other psychobiological risk factors. The NOTCH (neurogenic locus notch homolog proteins) signaling pathway, consisting of four different trans‐membrane receptor proteins (NOTCH1–4), constitutes an evolutionarily well‐conserved intercellular communication pathway (involved, e.g., in cell–cell interaction, inflammatory signaling, and learning processes). Its association with fear memory consolidation makes it an interesting candidate for PTSD research. We tested for significant associations of common genetic variants of NOTCH1–4 (investigated by microarray) and genomic methylation of saliva‐derived DNA with lifetime PTSD risk in independent cohorts from Northern Uganda (N1 = 924) and Rwanda (N2 = 371), and investigated whether NOTCH‐related gene sets were enriched for associations with lifetime PTSD risk. We found associations of lifetime PTSD risk with single nucleotide polymorphism (SNP) rs2074621 (NOTCH3) (puncorrected = 0.04) in both cohorts, and with methylation of CpG site cg17519949 (NOTCH3) (puncorrected = 0.05) in Rwandans. Yet, none of the (epi‐)genetic associations survived multiple testing correction. Gene set enrichment analyses revealed enrichment for associations of two NOTCH pathways with lifetime PTSD risk in Ugandans: NOTCH binding (pcorrected = 0.003) and NOTCH receptor processing (pcorrected = 0.01). The environmental factor trauma load was significant in all analyses (all p < 0.001). Our integrated methodological approach suggests NOTCH as a possible mediator of PTSD risk after trauma. The results require replication, and the precise underlying pathophysiological mechanisms should be illuminated in future studies. Integrating genetic, epigenetic, and gene set enrichment analyses, while accounting for the environmental factor traumatic load, we identified stress‐ and memory‐associated neurogenic locus notch homolog protein (NOTCH) genes and related gene sets as potential risk mediators for the development of posttraumatic stress disorder (PTSD) after trauma. Thus, our results strengthen the presumed role of memory‐ and inflammation‐associated genes in PTSD development, and revealed a promising target for future treatment studies. Furthermore, we demonstrated the importance of traumatic load in PTSD etiology, and of an integrated approach in order to obtain a more comprehensive understanding of the functionality of PTSD‐associated markers.
Collapse
Affiliation(s)
- Daniela Conrad
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany.,Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anna Schneider
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | | | - Virginie Freytag
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Vanja Vukojevic
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Christian Vogler
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Annette Milnik
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Division of Molecular Neuroscience, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dominique J-F de Quervain
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.,Psychiatric University Clinics, University of Basel, Basel, Switzerland.,Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| |
Collapse
|
64
|
Deimling Johns L, Power J, MacLachlan M. Community-Based Mental Health Intervention Skills: Task Shifting in Low- and Middle-Income Settings. ACTA ACUST UNITED AC 2018. [DOI: 10.1037/ipp0000097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a global need to provide human resources for health in low- and middle-income countries. To increase access to care, task shifting has been implemented in community-based rehabilitation (CBR) programs where skills and responsibilities are transferred to local people with shorter and more focused training. Through realist review and synthesis, this research aimed to consolidate the literature when considering (a) what skills CBR workers are reportedly using and/or being trained in relating to mental health, (b) how different settings affect how these task shifting programs work, and (c) the evidence of effectiveness when community health workers come from within the community itself. A total of 11 databases (PubMed, ABI/Inform Global, CINAHL, Cochrane, Emerald, Google Scholar, PsycINFO, SAGE, Science Direct, Scopus, and Web of Science) were systematically searched for specific terms relating to mental health, CBR, and low- and middle-income country. A total of 27 publications were identified as fitting the criteria (4 qualitative, 20 quantitative including 10 randomized controlled trials, and 3 noninvestigatory editorials). Core skills have been identified along with themes that affect how programs work in particular contexts. The use of task shifting in this area may be a potentially viable option for increasing access to mental health care. This resulted in the development of a theory to explain the outcomes being observed. When Task-shifting mental health intervention skills collaboration, harnessing resources available within the community, and the provision of ongoing supervision interact to influence awareness gains, social bonding, the building of trust, and the development of skills and understanding within the community itself. This effects intervention buy-in, overall effectiveness and sustainability, mental health symptoms and local empowerment. These findings can be considered when developing training programs for CBR mental health workers, as well as policy and intervention program design.
Collapse
Affiliation(s)
| | - Jessica Power
- Centre for Global Health, Trinity College Dublin, University of Dublin
| | | |
Collapse
|
65
|
Lenglet A, Lopes-Cardozo B, Shanks L, Blanton C, Feo C, Tsatsaeva Z, Idrisov K, Bolton PA, Pintaldi G. Outcomes of an individual counselling programme in Grozny, Chechnya: a randomised controlled study. BMJ Open 2018; 8:e019794. [PMID: 30139892 PMCID: PMC6112398 DOI: 10.1136/bmjopen-2017-019794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of individual counselling on functioning of clients participating in a mental health intervention in a humanitarian setting. DESIGN Randomised controlled trial. SETTING Mental health programme implemented by Médecins Sans Frontières in Grozny, Republic of Chechnya. PARTICIPANTS 168 eligible clients were randomly assigned to the intervention and waitlisted (2 months) arms between November 2014 and February 2015. INTERVENTION Individual counselling sessions. MAIN OUTCOME MEASURES Change in functioning was measured using the Short Form 6 (SF6) and gender-specific locally adapted Chechen functioning instruments in the intervention group at the end of counselling and the waitlisted group after their waitlisted period. Unadjusted differences in gain scores (DGSs) between intervention and waitlisted groups were calculated with effect size (Cohen's d) for both tools. Linear regression compared the mean DGS in both groups. RESULTS The intervention group (n=78) improved compared with waitlisted controls (n=80) on the SF6 measures with moderate to large effect sizes: general health (DGS 12.14, d=0.52), body pain (DGS 10.26, d=0.35), social support (DGS 16.07, d=0.69) and emotional functioning (DGS 16.87, d=0.91). Similar improvement was seen using the Chechen functioning instrument score (female DGS -0.33, d=0.55; male DGS -0.40, d=0.99). Adjusted analysis showed significant improvement (p<0.05) in the intervention group for all SF6 measures and for the Chechen functioning instrument score in women but not men (p=0.07). CONCLUSIONS Individual counselling significantly improved participants' ability to function in the intervention group compared with the waitlisted group. Further research is needed to determine whether similar positive results can be shown in other settings and further exploring the impact in male clients' population. TRIAL REGISTRATION NUMBER NTR4689.
Collapse
Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Barbara Lopes-Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Shanks
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Kyuri Idrisov
- Psychiatry Department, Chechnya State University, Grozny, Republic of Chechnya
| | - Paul A Bolton
- Departments of International Health and Mental Health,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giovanni Pintaldi
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
66
|
Orang T, Ayoughi S, Moran JK, Ghaffari H, Mostafavi S, Rasoulian M, Elbert T. The efficacy of narrative exposure therapy in a sample of Iranian women exposed to ongoing intimate partner violence-A randomized controlled trial. Clin Psychol Psychother 2018; 25:827-841. [PMID: 30079583 DOI: 10.1002/cpp.2318] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 05/12/2018] [Accepted: 06/25/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The mental health needs of women affected by intimate partner violence (IPV) and living under continuous domestic violence are currently not well understood. The present study investigates the feasibility and efficacy of narrative exposure therapy (NET), compared with commonly used counselling (treatment-as-usual, TAU), in a group of currently IPV-affected women in Tehran, Iran. METHOD Forty-five IPV-affected women with a diagnosis of post-traumatic stress disorder (PTSD) were randomized to 10 to 12 sessions of either NET (n = 24) or TAU (n = 21). Primary outcome measures, including PTSD, depression, and perceived stress symptoms, were examined at pretreatment and 3- and 6-month follow-ups. IPV experiences, general lifetime traumatic events, childhood adversities, borderline symptoms, and daily functioning impairment were also inspected. RESULTS NET participants showed a significantly greater symptom reduction in comparison with the TAU group in PTSD, depression, and perceived stress at both follow-ups. Improvement in daily functioning and reduction of IPV experiences and borderline symptoms at 3- and 6-month follow-ups were pronounced but not significantly different between the two treatment groups. CONCLUSION IPV-affected women living under continuous threat and violence would benefit from trauma-focused interventions such as NET.
Collapse
Affiliation(s)
- Tahereh Orang
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Sarah Ayoughi
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - James K Moran
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hakimeh Ghaffari
- Department of Psychology, Allameh Tabataba'i University, Tehran, Iran
| | | | - Maryam Rasoulian
- Mental Health Research Center, Psychiatry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
| |
Collapse
|
67
|
Ali TM, Gul S. Community mental health services in Pakistan: Review study from Muslim world 2000-2015. PSYCHOLOGY, COMMUNITY & HEALTH 2018. [DOI: 10.5964/pch.v7i1.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim
This study attempted to analyse the potential of two primary sources of mental health service delivery at a grassroots level, religious/faith healers and community/lady health workers, and how they can be effectively used to deliver mental health services in a resource-scarce country like Pakistan.
Method
A literature review was carried out for relevant studies conducted in Muslim countries between 2000 to 2015 reporting empirical results. Using the inclusion criteria, thirteen studies were selected for the review.
Results
The presented studies suggest that the main proportion of mental health patients in countries with major Muslim population including Pakistan, visit religious/faith healers first for treatment, however all studies are silent about the outcomes through these healers. The only potential visible outcome of contacting religious/faith healers is the identification of mental health cases. However, community/lady health workers with minimal training appeared to be a beneficial source of mental health service delivery in communities.
Conclusion
In a resource scarce country like Pakistan, networking with religious/faith healers can be established for effective identification and referral of mental health cases whereas strong and already existing community/lady health workers system can be used as a first level to deliver mental health service at the doorstep.
Collapse
|
68
|
Murray LK, Haroz EE, Doty SB, Singh NS, Bogdanov S, Bass J, Dorsey S, Bolton P. Testing the effectiveness and implementation of a brief version of the Common Elements Treatment Approach (CETA) in Ukraine: a study protocol for a randomized controlled trial. Trials 2018; 19:418. [PMID: 30075806 PMCID: PMC6090833 DOI: 10.1186/s13063-018-2752-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental illness is a major public health concern. Despite progress understanding which treatments work, a significant treatment gap remains. An ongoing concern is treatment length. Modular, flexible, transdiagnostic approaches have been offered as one solution to scalability challenges. The Common Elements Treatment Approach (CETA) is one such approach and offers the ability to treat a wide range of common mental health problems. CETA is supported by two randomized trials from low- and middle-income countries showing strong effectiveness and implementation outcomes. METHODS/DESIGN This trial evaluates the effectiveness and implementation of two versions of CETA using a non-inferiority design to test two primary hypotheses: (1) a brief five-session version of CETA (Brief CETA) will provide similar effectiveness for reducing the severity of common mental health problems such as depression, post-traumatic stress, impaired functioning, anxiety, and substance use problems compared with the standard 8-12-session version of CETA (Standard CETA); and (2) both Brief and Standard CETA will have superior impact on the outcomes compared to a wait-list control condition. For both hypotheses, the main effect will be assessed using longitudinal data and mixed-effects regression models over a 6-month period post baseline. A secondary aim includes exploration of implementation factors. Additional planned analyses will include exploration of: moderators of treatment impact by disorder severity and comorbidity; the impact of individual therapeutic components; and trends in symptom change between end of treatment and 6-month assessment for all participants. DISCUSSION This trial is the first rigorous study comparing a standard-length (8-12 sessions) modular, flexible, transdiagnostic, cognitive-behavioral approach to a shortened version of the approach (five sessions). Brief CETA entails "front-loading" with elements that research suggests are strong mechanisms of change. The study design will allow us to draw conclusions about the effects of both Brief and Standard CETA as well as which elements are integral to their mechanisms of action, informing future implementation and fidelity efforts. The results from this trial will inform future dissemination, implementation and scale-up of CETA in Ukraine and contribute to our understanding of the effects of modular, flexible, transdiagnostic approaches in similar contexts. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03058302 (U.S. National Library of Medicine). Registered on 20 February 2017.
Collapse
Affiliation(s)
- Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Emily E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - S. Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Namrita S. Singh
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sergey Bogdanov
- Centre for Mental Health and Psychosocial Support, National University Kyiv-Mohyla Academy, Glasunova str 2/4, Kyiv, 01042 Ukraine
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA 98105 USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205 USA
| |
Collapse
|
69
|
Crombach A, Siehl S. Impact and cultural acceptance of the Narrative Exposure Therapy in the aftermath of a natural disaster in Burundi. BMC Psychiatry 2018; 18:233. [PMID: 30021559 PMCID: PMC6052646 DOI: 10.1186/s12888-018-1799-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the aftermath of natural disasters, affected populations are at risk of suffering from trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) or depression. Particularly in poor post-conflict regions, these mental disorders have the potential to impair the ability of individuals to move on with their lives. We aimed to evaluate the feasibility, cultural acceptance, and effect of a trauma-focused psychotherapy, Narrative Exposure Therapy (NET), in the aftermath of a flood disaster in Burundi. METHODS Fifty-one individuals who were living in emergency camps overseen by the Burundian Red Cross in the aftermath of a flood disaster, and who had lost homes and close relatives, were invited to participate in semi-structured diagnostic interviews. Trained Burundian psychology students conducted these interviews, and six sessions of NET were offered to the 15 individuals most affected by trauma-related symptoms. An additional group of psychology students, blind to the treatment conditions, conducted three and 9 months follow-ups with them including also 25 participants who had reported significant but less severe trauma-related symptoms, assessing mental health symptoms, acceptance of NET, stigmatization due to trauma symptoms, and participants' economic well-being. RESULTS Between baseline and 9-months post-intervention assessment, symptoms of PTSD (Hedges' g = 3.44) and depression (Hedges' g = 1.88) improved significantly within participants who received NET and within those who received no treatment (Hedges' gPTSD = 2.55; Hedges' gdepression = 0.72). Furthermore, those who received NET felt less stigmatized by their participation in the intervention than by the trauma-related mental health symptoms they experienced. Overall, participants reported that they would be willing to forego as much as 1 month's worth of income in exchange for receiving trauma-focused interventions in the months following the disaster. CONCLUSIONS Individuals severely affected by trauma-related mental health symptoms might benefit significantly from NET in the aftermath of natural disasters, while less affected individuals seem to recover spontaneously. Despite significant challenges conducting NET in emergency camps in the aftermath of natural disaster in a post-conflict country, such interventions are feasible, appreciated and might have long-lasting impacts on the lives of survivors if conducted with due respect to participants' privacy. TRIAL REGISTRATION UKCR2014 , the 19.06.2014, retrospectively registered.
Collapse
Affiliation(s)
- Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Germany. .,Department of Psychology, University Lumière of Bujumbura, Bujumbura, Burundi. .,Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi. .,Non-Governmental Organization vivo international e.V., Konstanz, Germany.
| | - Sebastian Siehl
- Non-Governmental Organization vivo international e.V., Konstanz, Germany ,0000 0001 2190 4373grid.7700.0Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,0000 0001 0943 599Xgrid.5601.2Graduate School of Economic and Social Sciences, University of Mannheim, Mannheim, Germany
| |
Collapse
|
70
|
van de Water T, Rossouw J, Yadin E, Seedat S. Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting. PLoS One 2018; 13:e0199816. [PMID: 29990372 PMCID: PMC6038985 DOI: 10.1371/journal.pone.0199816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/14/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses). METHOD Adolescent participants and nurse providers were purposively recruited to share their experiences of trial participation through face to face semi-structured in-depth interviews and treatment-specific focus groups (all recorded). Twelve adolescent participant transcripts (ten interviews and two focus groups) and three nurse provider transcripts were doubly transcribed. Thematic content analysis was applied using Atlas.ti software. Two emerging themes are presented in this paper: 1) Perceptions of the intervention and 2) Usefulness of the intervention. RESULTS Regardless of treatment arm, adolescents experienced warm counselling relationships and described the process of extending trust to the counselor. Adolescents in the PE-A arm provided clear descriptions of session structure and treatment rationale compared with adolescents receiving SC. The most helpful tools were breathing retraining and imaginal exposure for PE-A and creation of distraction strategies during non-directive SC. Adolescents in both arms continued to use the techniques acquired during treatment and reported symptom improvement. Participants who received SC acknowledged ongoing reexperiencing. Nurses perceived SC to be an immediately transferable skill, but feedback on their preference for one intervention over the other was inconclusive. CONCLUSION Both PTSD treatment strategies, implemented by non-specialists, were perceived as helpful. Overall, adolescents reported warm therapeutic relationships and a reduction in PTSD symptoms. Nurses stated that they would require institutional support to ensure delivery of these interventions in a scalable and sustainable manner.
Collapse
Affiliation(s)
- Tanya van de Water
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, United States of America
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
71
|
Budde H, Akko DP, Ainamani HE, Murillo-Rodríguez E, Weierstall R. The impact of an exercise training intervention on cortisol levels and post-traumatic stress disorder in juveniles from an Ugandan refugee settlement: study protocol for a randomized control trial. Trials 2018; 19:364. [PMID: 29986761 PMCID: PMC6038242 DOI: 10.1186/s13063-018-2753-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/20/2018] [Indexed: 01/06/2023] Open
Abstract
Background Latest research demonstrates a significant improvement in stress-related symptoms in psychological disorders as a result of exercise training (ET). Controlled clinical trials further validate the significance of ET by demonstrating lower salivary cortisol levels in patients with post-traumatic stress disorder (PTSD) after intervention. A significant change in cortisol and dehydroepiandrosterone (DHEA) levels can already be found after an 8–12-week ET program. The proposed study aims to investigate the impact of an 8-week ET on PTSD symptoms and changes in cortisol levels in a juvenile refugee sample from the Democratic Republic of the Congo (DRC) at an Ugandan refugee settlement. It is the first to implement an ET intervention in a resource-poor, post-conflict setting. Methods/design In a randomized controlled trial, 198 adolescent participants aged 13–16 years from the DRC who, suffer from PTSD, will be investigated. The participants are based at the Nakivale refugee settlement, an official refugee camp in Uganda, Africa, which is among the largest in the world. The participants will be randomized into an Exercise Training (ET) group with a maximum heart rate (HRmax) of > 60%, an Alternative Intervention (AI) group with low-level exercises, and a Waiting-list Control (WC) group. After the 8-week interventional phase, changes in cortisol awakening response (CAR) and DHEA in the ET group that correspond to an improvement in PTSD symptoms are expected that remain at follow-up after 3 months. Discussion To date, there is no controlled and reliable longitudinal study examining the effects of an ET program on symptom severity in individuals with PTSD that can be explained with a harmonization of cortisol secretion. The presented study design introduces an intervention that can be implemented with little expenditure. It aims to provide a promising low-threshold and cost-effective treatment approach for the application in resource-poor settings. Trial registration German Trials Register, ID: DRKS00014280. Registered prospectively on 15 March 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2753-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Henning Budde
- Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany.,Sports Science Department, School of Science and Engineering, Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Reykjavik University, Reykjavik, Iceland.,Lithuanian Sports University, Kaunas, Lithuania
| | - Davin P Akko
- Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Herbert E Ainamani
- Department of Psychology and Development Management, Bishop Stuart University, Mbarara, Uganda
| | - Eric Murillo-Rodríguez
- Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab Mérida, Mérida, Yucatán, Mexico
| | - Roland Weierstall
- Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany
| |
Collapse
|
72
|
Purgato M, Gastaldon C, Papola D, van Ommeren M, Barbui C, Tol WA. Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2018; 7:CD011849. [PMID: 29975811 PMCID: PMC6513488 DOI: 10.1002/14651858.cd011849.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND People living in humanitarian settings in low- and middle-income countries (LMICs) are exposed to a constellation of stressors that make them vulnerable to developing mental disorders. Mental disorders with a higher prevalence in these settings include post-traumatic stress disorder (PTSD) and major depressive, anxiety, somatoform (e.g. medically unexplained physical symptoms (MUPS)), and related disorders. A range of psychological therapies are used to manage symptoms of mental disorders in this population. OBJECTIVES To compare the effectiveness and acceptability of psychological therapies versus control conditions (wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at treating people with mental disorders (PTSD and major depressive, anxiety, somatoform, and related disorders) living in LMICs affected by humanitarian crises. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (Wiley), MEDLINE (OVID), Embase (OVID), and PsycINFO (OVID), with results incorporated from searches to 3 February 2016. We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify any unpublished or ongoing studies. We checked the reference lists of relevant studies and reviews. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing psychological therapies versus control conditions (including no treatment, usual care, wait list, attention placebo, and psychological placebo) to treat adults and children with mental disorders living in LMICs affected by humanitarian crises. DATA COLLECTION AND ANALYSIS We used standard Cochrane procedures for collecting data and evaluating risk of bias. We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed data at endpoint (zero to four weeks after therapy); at medium term (one to four months after therapy); and at long term (six months or longer). GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence for post-traumatic stress disorder (PTSD), depression, anxiety and withdrawal outcomes. MAIN RESULTS We included 36 studies (33 RCTs) with a total of 3523 participants. Included studies were conducted in sub-Saharan Africa, the Middle East and North Africa, and Asia. Studies were implemented in response to armed conflicts; disasters triggered by natural hazards; and other types of humanitarian crises. Together, the 33 RCTs compared eight psychological treatments against a control comparator.Four studies included children and adolescents between 5 and 18 years of age. Three studies included mixed populations (two studies included participants between 12 and 25 years of age, and one study included participants between 16 and 65 years of age). Remaining studies included adult populations (18 years of age or older).Included trials compared a psychological therapy versus a control intervention (wait list in most studies; no treatment; treatment as usual). Psychological therapies were categorised mainly as cognitive-behavioural therapy (CBT) in 23 comparisons (including seven comparisons focused on narrative exposure therapy (NET), two focused on common elements treatment approach (CETA), and one focused on brief behavioural activation treatment (BA)); eye movement desensitisation and reprocessing (EMDR) in two comparisons; interpersonal psychotherapy (IPT) in three comparisons; thought field therapy (TFT) in three comparisons; and trauma or general supportive counselling in two comparisons. Although interventions were described under these categories, several psychotherapeutic elements were common to a range of therapies (i.e. psychoeducation, coping skills).In adults, psychological therapies may substantially reduce endpoint PTSD symptoms compared to control conditions (standardised mean difference (SMD) -1.07, 95% confidence interval (CI) -1.34 to -0.79; 1272 participants; 16 studies; low-quality evidence). The effect is smaller at one to four months (SMD -0.49, 95% CI -0.68 to -0.31; 1660 participants; 18 studies) and at six months (SMD -0.37, 95% CI -0.61 to -0.14; 400 participants; five studies). Psychological therapies may also substantially reduce endpoint depression symptoms compared to control conditions (SMD -0.86, 95% CI -1.06 to -0.67; 1254 participants; 14 studies; low-quality evidence). Similar to PTSD symptoms, follow-up data at one to four months showed a smaller effect on depression (SMD -0.42, 95% CI -0.63 to -0.21; 1386 participants; 16 studies). Psychological therapies may moderately reduce anxiety at endpoint (SMD -0.74, 95% CI -0.98 to -0.49; 694 participants; five studies; low-quality evidence) and at one to four months' follow-up after treatment (SMD -0.53, 95% CI -0.66 to -0.39; 969 participants; seven studies). Dropout rates are probably similar between study conditions (19.5% with control versus 19.1% with psychological therapy (RR 0.98 95% CI 0.82 to 1.16; 2930 participants; 23 studies, moderate quality evidence)).In children and adolescents, we found very low quality evidence for lower endpoint PTSD symptoms scores in psychotherapy conditions (CBT) compared to control conditions, although the confidence interval is wide (SMD -1.56, 95% CI -3.13 to 0.01; 130 participants; three studies;). No RCTs provided data on major depression or anxiety in children. The effect on withdrawal was uncertain (RR 1.87 95% CI 0.47 to 7.47; 138 participants; 3 studies, low quality evidence).We did not identify any studies that evaluated psychological treatments on (symptoms of) somatoform disorders or MUPS in LMIC humanitarian settings. AUTHORS' CONCLUSIONS There is low quality evidence that psychological therapies have large or moderate effects in reducing PTSD, depressive, and anxiety symptoms in adults living in humanitarian settings in LMICs. By one to four month and six month follow-up assessments treatment effects were smaller. Fewer trials were focused on children and adolescents and they provide very low quality evidence of a beneficial effect of psychological therapies in reducing PTSD symptoms at endpoint. Confidence in these findings is influenced by the risk of bias in the studies and by substantial levels of heterogeneity. More research evidence is needed, particularly for children and adolescents over longer periods of follow-up.
Collapse
Affiliation(s)
- Marianna Purgato
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Chiara Gastaldon
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Davide Papola
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Mark van Ommeren
- World Health OrganizationDepartment of Mental Health and Substance AbuseAvenue AppiaGenevaSwitzerlandCH‐1211
| | - Corrado Barbui
- University of VeronaDepartment of Neurosciences, Biomedicine and Movement Sciences, Section of PsychiatryPiazzale LA Scuro 10VeronaItaly37134
- University of VeronaCochrane Global Mental HealthVeronaItaly
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public HealthDepartment of Mental Health624 N BroadwayHampton HouseBaltimoreMarylandUSA
- HealthRight InternationalPeter C. Alderman Program for Global Mental HealthNew YorkUSA
| | | |
Collapse
|
73
|
Thompson CT, Vidgen A, Roberts NP. Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: A systematic review and meta-analysis. Clin Psychol Rev 2018; 63:66-79. [DOI: 10.1016/j.cpr.2018.06.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
|
74
|
Mutamba BB, Kohrt BA, Okello J, Nakigudde J, Opar B, Musisi S, Bazeyo W, de Jong J. Contextualization of psychological treatments for government health systems in low-resource settings: group interpersonal psychotherapy for caregivers of children with nodding syndrome in Uganda. Implement Sci 2018; 13:90. [PMID: 29954423 PMCID: PMC6025709 DOI: 10.1186/s13012-018-0785-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 06/20/2018] [Indexed: 11/23/2022] Open
Abstract
Background Evidence for the effectiveness of psychological treatments in low- and middle-income countries is increasing. However, there is a lack of systematic approaches to guide implementation in government health systems. The objective of this study was to address this gap by employing the Replicating Effective Programs (REP) framework to guide contextualization of a psychological treatment in the Uganda public health system for caregivers of children affected by nodding syndrome, a neuropsychiatric disorder endemic to Sub-Saharan Africa associated with high morbidity and disability. Methods To contextualize a psychological treatment, we followed the four components of the REP framework: pre-conditions, pre-implementation, implementation, and maintenance and evolution. A three-step process involved reviewing health services available for nodding syndrome-affected families and current evidence for psychological treatments, qualitative formative research, and analysis and documentation of implementation activities. Stakeholders included members of affected communities, health care workers, therapists, local government leaders, and Ministry of Health officials. Detailed written, audio, and video documentation of the implementation activities was used for content analysis. Results During the pre-condition component of REP, we selected group interpersonal therapy (IPT-G) because of its feasibility, acceptability, effectiveness in the local setting, and availability of locally developed training materials. During the pre-implementation component, we adapted the training, logistics, and technical assistance strategies in conjunction with government and stakeholder working groups. Adaptations included content modification based on qualitative research with caregivers of children with nodding syndrome. During the implementation component, training was shortened for feasibility with government health workers. Peer-to-peer supervision was selected as a sustainable quality assurance method. IPT-G delivered by community health workers was evaluated for fidelity, patient outcomes, and other process-level variables. More than 90% of beneficiaries completed the treatment program, which was effective in reducing caregiver and child mental health problems. With the Ministry of Health, we conducted preparatory activities for the maintenance and evolution component for scale-up throughout the country. Conclusions The REP framework provides a systematic approach to guide contextualization of psychological treatments for delivery in low-resource public health systems. Specific recommendations are provided for REP’s application in global mental health. Trial registration ISRCTN11382067; 08/06/2016; retrospectively registered Electronic supplementary material The online version of this article (10.1186/s13012-018-0785-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Byamah B Mutamba
- Butabika National Mental Hospital, Kampala, Uganda. .,Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - James Okello
- Department of Psychiatry, Gulu University, Gulu, Uganda
| | - Janet Nakigudde
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bernard Opar
- Ministry of Health Headquarters, Kampala, Uganda
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Bazeyo
- Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Joop de Jong
- Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
75
|
Kayrouz R, Dear BF, Kayrouz B, Karin E, Gandy M, Titov N. Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder. Cogn Behav Ther 2018; 47:412-430. [PMID: 29714106 DOI: 10.1080/16506073.2018.1445124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A meta-analysis of the literature of cognitive behaviour therapy (CBT) with Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder (PTSD) was conducted. Nine studies (n = 536) met the eligibility criteria. Three of the nine studies (33%) were randomised control trials using waitlist control groups. All studies (100%) reported a statistically significant reduction in psychological symptoms at post-treatment with large effect sizes for anxiety (effect size, 95% confidence interval) (1.44 [1.29, 1.59]), depression (1.26 [1.16, 1.35]) and PTSD (2.08 [1.94, 2.23]). Six out of the nine studies (67%) collated follow-up data and reported that reductions of psychological symptoms were maintained at follow-up. An average dropout rate of 26% indicated good overall acceptability. Five out of nine (55%) of the trials reported diagnostic remission rates and of those trials the mean remission rate was 31%). Five of the nine eligible studies (55%) delivered remotely via Internet or telephone were found to have similar effect sizes as face-to-face CBT. The current meta-analysis indicates the potential of CBT, delivered either face-to-face or via internet, as efficacious and acceptable interventions for the treatment of anxiety, depression and PTSD for Arab adult populations.
Collapse
Affiliation(s)
- Rony Kayrouz
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Blake F Dear
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Bechara Kayrouz
- b Department of Psychology , Western Sydney University , Milperra , Australia
| | - Eyal Karin
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Milena Gandy
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Nickolai Titov
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| |
Collapse
|
76
|
Barnett ML, Gonzalez A, Miranda J, Chavira DA, Lau AS. Mobilizing Community Health Workers to Address Mental Health Disparities for Underserved Populations: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:195-211. [PMID: 28730278 PMCID: PMC5803443 DOI: 10.1007/s10488-017-0815-0] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This systematic review evaluates efforts to date to involve community health workers (CHWs) in delivering evidence-based mental health interventions to underserved communities in the United States and in low- and middle-income countries. Forty-three articles (39 trials) were reviewed to characterize the background characteristics of CHW, their role in intervention delivery, the types of interventions they delivered, and the implementation supports they received. The majority of trials found that CHW-delivered interventions led to symptom reduction. Training CHWs to support the delivery of evidence-based practices may help to address mental health disparities. Areas for future research as well as clinical and policy implications are discussed.
Collapse
Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Gervitz Graduate School of Education, Santa Barbara, CA, 93106-9490, USA.
| | - Araceli Gonzalez
- Department of Psychology, California State University, Long Beach, CA, USA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, CA, USA
| |
Collapse
|
77
|
Barnett ML, Lau AS, Miranda J. Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care. Annu Rev Clin Psychol 2018; 14:185-208. [PMID: 29401043 DOI: 10.1146/annurev-clinpsy-050817-084825] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.
Collapse
Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, California 93106, USA;
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, California 90095, USA;
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095, USA;
| |
Collapse
|
78
|
Slobodin O, Ghane S, De Jong J. Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: A pilot study. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2018. [DOI: 10.4103/intv.intv_2_18] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
79
|
de Fouchier C, Kedia M. Trauma-related mental health problems and effectiveness of a stress management group in national humanitarian workers in the Central African Republic. INTERVENTION 2018. [DOI: 10.4103/intv.intv_9_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
80
|
Zehetmair C, Kaufmann C, Tegeler I, Kindermann D, Junne F, Zipfel S, Herpertz SC, Herzog W, Nikendei C. Psychotherapeutic Group Intervention for Traumatized Male Refugees Using Imaginative Stabilization Techniques-A Pilot Study in a German Reception Center. Front Psychiatry 2018; 9:533. [PMID: 30420815 PMCID: PMC6215850 DOI: 10.3389/fpsyt.2018.00533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/08/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Due to persecution, human rights violations and armed conflicts, the prevalence of post-traumatic stress disorder (PTSD) is high in refugee populations. Previous studies indicate that trauma-focused treatments are highly effective in treating PTSD in refugees. However, these approaches rely on the stability of the therapeutic setting, treatment continuity, and safe housing. Although early treatment of PTSD is recommended, these requirements are not met in reception centers. Therefore, we conducted a pilot study to examine the effect of imaginative stabilization techniques derived from psychodynamic psychotraumatology therapy for the early stabilization of traumatized refugees in a reception center. Methods: From May 2017 to April 2018, 86 imaginative stabilization group therapy sessions have taken place. A sample of 43 out of 46 traumatized refugees completed self-report questionnaires assessing PTSD, depression, and anxiety symptoms prior to attending open imaginative stabilization group therapy sessions. Furthermore, participants filled in self-report questionnaires on distress and emotional state (valence/arousal/dominance) before and after each session. After having participated in four consecutive sessions, a sub-group of 17 participants completed a follow-up assessment of PTSD, depression, and anxiety symptoms. Follow-up interviews were conducted with 25 participants 2 weeks after their last session attendance to explore self-practice habits post intervention. Results: The pre-post-intervention comparison of scores indicated a significant reduction of distress (z = -3.35, p < 0.001, r = -0.51) and an improvement of affective reports for valence (z = -4.79, p < 0.001, r = -0.82) and dominance (z = -3.89, p < 0.001, r = -0.59), whereas arousal scores were not affected. We found a significant reduction of anxiety symptoms (z = -2.04, p < 0.05, r = -0.49), whereas PTSD and depression scores remained unchanged. Follow-up interviews revealed that 80% of the participants continued to practice the imaginative stabilization techniques after redistribution to other accommodation. Conclusion: The results indicate that imaginative stabilization techniques are a promising and feasible approach to treat refugees in unstable reception center settings. In regular imaginative stabilization group therapy sessions, we were able to reduce the participants' distress and anxiety symptoms while strengthening their internal resources and increasing their emotional stability.
Collapse
Affiliation(s)
- Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany.,Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Claudia Kaufmann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Inga Tegeler
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Tübingen, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| |
Collapse
|
81
|
Bakalar JL, Carlin EA, Blevins CL, Ghahramanlou-Holloway M. Generalizability of Evidence-Based PTSD Psychotherapies to Suicidal Individuals: A Review of the Veterans Administration and Department of Defense Clinical Practice Guidelines. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jennifer L. Bakalar
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Elisabeth A. Carlin
- Trauma Services Program, Washington DC Veterans Affairs Medical Center, Washington, D.C
| | - Cara L. Blevins
- Department of Health Psychology, The University of North Carolina at Charlotte
| | | |
Collapse
|
82
|
Yuval K, Bernstein A. Avoidance in posttraumatic stress among refugee survivors of violent conflict and atrocities: Testing trans-cultural risk processes and candidate intervention targets. Behav Res Ther 2017; 99:157-163. [PMID: 29107937 DOI: 10.1016/j.brat.2017.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND A fast-growing population of refugees and survivors of violent conflict and atrocities are at risk for trauma-related mental health problems. Experimental clinical research key to the development of interventions tailored to this population is limited. AIMS In an experimental psychopathology laboratory paradigm, we tested the expression and function of avoidance in posttraumatic stress (PTS) among a highly traumatized community sample of forcibly displaced refugees seeking asylum. METHOD We measured behavioral avoidance and emotional reactivity to repeated exposure to threatening stimuli (trauma-, war-, and geographically-relevant natural threat) in 110 Sudanese male asylum seekers (M(SD)age = 32.7(6.5)) recruited from the community in Israel. RESULTS First, we found evidence of sensitization - traumatized refugees expressed increasing levels of behavioral avoidance and emotional reactivity in response to repeated exposure to threatening stimuli. Second, as predicted, refugees suffering from more severe PTS were more likely to exhibit greater behavioral avoidance and emotional reactivity reflexively or immediately upon exposure to threat stimuli. Finally, as predicted, behavioral avoidance mediated the effect of PTS severity on emotional reactivity to threat exposure. CONCLUSIONS Findings are consistent with theorizing that avoidance may function as a trans-cultural malleable risk process sub-serving PTS and thereby a promising intervention target among highly traumatized refugees from E. Africa.
Collapse
|
83
|
van de Water T, Rossouw J, Yadin E, Seedat S. Impediments and catalysts to task-shifting psychotherapeutic interventions for adolescents with PTSD: perspectives of multi-stakeholders. Child Adolesc Psychiatry Ment Health 2017; 11:48. [PMID: 28947915 PMCID: PMC5609026 DOI: 10.1186/s13034-017-0187-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This qualitative study was nested within a randomized controlled trial (RCT) where two psychotherapeutic interventions (supportive counselling and prolonged exposure for adolescents) were provided by supervised nurses (who served as 'nurse counsellors') to adolescents with PTSD in school settings. This paper describes the perspectives of nurse counsellors (NCs) and school liaisons (SLs). SLs were teachers or administrative personnel at the schools who coordinated the study visits of participants with the NCs. We focus on the impediments and catalysts to and recommendations for treatment implementation. METHODS NCs (n = 3) and SLs (n = 3) who participated in the RCT during 2014 were purposively recruited by telephone and participated in face-to-face semi-structured in-depth interviews that were recorded and doubly transcribed. Thematic content analysis was applied using Atlas.ti software to identify emerging themes. This paper describes the impediments and catalysts to provide psychotherapy by task-shifting in a community setting across three sub-themes: personal, community, and collaborative care. RESULTS Although nurses were initially resistant to supervision it was central to personally coping with complex interventions, managing traumatic content, and working apart from a multi-disciplinary team. Delivering the interventions in the community presented multiple logistical impediments (e.g. transport, communication, venue suitability) which required creative solutions. In light of resource shortages, networking is central to effective delivery and uptake of the interventions. Collaboration between government departments of health and education may have a major impact on providing school-based psychotherapy through task-shifting. CONCLUSIONS Impediments to implementation are not insurmountable. This article provides recommendations to maximize the success of task-shifting interventions should they be rolled out.
Collapse
Affiliation(s)
- Tanya van de Water
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
84
|
Morina N, Malek M, Nickerson A, Bryant RA. Meta-analysis of interventions for posttraumatic stress disorder and depression in adult survivors of mass violence in low- and middle-income countries. Depress Anxiety 2017; 34:679-691. [PMID: 28419625 DOI: 10.1002/da.22618] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most survivors of mass violence live in low- and middle-income countries (LMICs). We conducted a meta-analysis of randomized controlled psychotherapy trials for adult posttraumatic stress disorder (PTSD) and/or depression in LMICs. METHODS We included 18 clinical trials (3,058 participants), in which 25 and 18 treatment arms measured symptoms of PTSD and depression, respectively. RESULTS Active treatments for PTSD yielded a large aggregated pre-post effect size (g = 1.29; 95% CI = [0.99; 1.59]) and a small to medium effect size at posttreatment when compared to control conditions (g = 0.39; 95% CI = [0.24; 0.55]). Effect sizes were similar for pretreatment versus follow-up (g = 1.75; 95% CI = [1.17; 2.32]) and in comparison to waitlist at follow-up (g = 0.93; 95% CI = [0.56; 1.31]). Active treatments for depression produced large pre-post (g = 1.28; 95% CI = [0.96; 1.61]) and controlled effect sizes (posttreatment, comparison to control conditions, g = 0.86; 95% CI = [0.54; 1.18]). CONCLUSIONS Our findings suggest that psychological interventions can effectively reduce symptoms of PTSD and depression in LMICs. Future research needs to focus on cost-effective interventions that are likely to be disseminated to the large numbers of war survivors in LMICs.
Collapse
Affiliation(s)
- Nexhmedin Morina
- Department of Psychology, University of Münster, Münster, Germany
| | - Mina Malek
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
85
|
Javadi D, Feldhaus I, Mancuso A, Ghaffar A. Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence. Glob Ment Health (Camb) 2017; 4:e14. [PMID: 29230310 PMCID: PMC5719475 DOI: 10.1017/gmh.2017.15] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. METHODS Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. RESULTS Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. CONCLUSIONS There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.
Collapse
Affiliation(s)
- D. Javadi
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - I. Feldhaus
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Mancuso
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A. Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| |
Collapse
|
86
|
Narrative Expositionstherapie (NET) für Menschen nach Gewalt und Flucht. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
87
|
Adorjan K, Kluge U, Heinz A, Stamm T, Odenwald M, Dohrmann K, Mokhtari-Nejad R, Hasan A, Schulze TG, Falkai P, Pogarell O. [Healthcare models for traumatized refugees in Germany]. DER NERVENARZT 2017. [PMID: 28642982 DOI: 10.1007/s00115-017-0364-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
People with a migration background are a risk group for psychiatric disorders. Innovative, transnational and sustainable projects are necessary to ensure adequate care for refugees and asylum seekers. Selected projects of the University of Munich, the Charité Berlin and the University of Konstanz show promising approaches in addition to other initiatives.
Collapse
Affiliation(s)
- K Adorjan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland. .,Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland. .,Center for International Health, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - U Kluge
- Zentrum für Interkulturelle Psychiatrie und Psychotherapie (ZIPP), Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Berliner Institut für empirische Integrations- und Migrationsforschung (BIM), Humboldt Universität zu Berlin, Berlin, Deutschland
| | - A Heinz
- Berliner Institut für empirische Integrations- und Migrationsforschung (BIM), Humboldt Universität zu Berlin, Berlin, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Stamm
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Ruppiner Kliniken, Hochschulklinikum der Medizinischen Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - M Odenwald
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - K Dohrmann
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - R Mokhtari-Nejad
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| | - A Hasan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland
| | - T G Schulze
- Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland
| | - P Falkai
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland
| | - O Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| |
Collapse
|
88
|
Tribe RH, Sendt KV, Tracy DK. A systematic review of psychosocial interventions for adult refugees and asylum seekers. J Ment Health 2017; 28:662-676. [PMID: 28485636 DOI: 10.1080/09638237.2017.1322182] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Europe is in the midst of the largest refugee migration since the Second World War; there is an urgent need to provide an updated systematic review of the current best evidence for managing mental distress in refugee populations.Aims: The aim of this review is to provide an exhaustive summary of the current literature on psychosocial interventions, both trauma- and non-trauma-focused, for refugee populations experiencing post-traumatic stress disorder (PTSD), depressive or anxiety symptoms. To produce recommendations for future research and current clinical practice.Method: Searches were conducted in PubMed, PsychINFO (Hosted by Ovid), PILOTS and Social Services Abstracts; 5305 articles were screened and 40 were included.Results: This review found medium to high quality evidence supporting the use of narrative exposure therapy (NET). A lack of culturally adapted treatments was apparent and there was less evidence to support standard cognitive behavioural therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and multidisciplinary treatments.Conclusion: NET produced positive outcomes in refugees from a diverse range of backgrounds and trauma types. There is a general dearth of research in all intervention types: further research should include more "real-world" multidisciplinary interventions that better model clinical practice. Recommendations for evaluating local need, and creating a culturally sensitive workforce are discussed.
Collapse
Affiliation(s)
- Rachel H Tribe
- Division of Psychology and Language Sciences, University College London, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and
| | - Kyra-Verena Sendt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and
| | - Derek K Tracy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and.,Oxleas NHS Foundation Trust, London, UK
| |
Collapse
|
89
|
Feasibility of Training Frontline Therapists in Prolonged Exposure: A Randomized Controlled Pilot Study of Treatment of Complex Trauma in Diverse Victims of Crime and Violence. J Nerv Ment Dis 2017; 205:283-293. [PMID: 28157725 DOI: 10.1097/nmd.0000000000000659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The study aims were to determine whether prolonged exposure (PE) improved mental health and was feasible to implement by frontline clinicians in a culturally diverse sample with complex trauma. Seventy-one individuals were randomly assigned to PE or person-centered therapy (PCT). Outcome measures were administered at baseline and sessions 3, 6, 9, and 12. Mixed modeling was used to regress outcome measures on time, treatment group, and number of visits. Individuals who received PE showed significant moderate association with decline in reported posttraumatic stress disorder (PTSD) symptoms as noted by the PTSD Checklist for DSM-5 (p = 0.05) compared with PCT. Results indicated improved scores on all measures at each follow-up time point compared with baseline (p ≤ 0.01). PE was feasible, shown by positive recruitment and ability of clinicians to effectively implement and maintain treatment fidelity. Findings suggest that PE can be effective for treating complex trauma when used by clinicians in community settings.
Collapse
|
90
|
[Dissemination of psychotherapy modules for traumatized refugees : Experience gained from trauma work in crisis and conflict regions]. DER NERVENARZT 2017; 88:26-33. [PMID: 27853854 DOI: 10.1007/s00115-016-0245-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With each additional accumulative exposure to severe and traumatic stressors, the likelihood of developing mental health problems and physical diseases increases. Displaced individuals have usually experienced a number of serious threats to health due to organized violence in their home country or attacks during the flight. Frequently, domestic violence adds additional strain to the stressors experienced. The resulting impairments in psychosocial functioning reduce the resources needed for social adjustment and integration. Social exclusion then in turn often further aggravates the existing mental health complications. For the treatment of trauma spectrum disorders, different evidence-based psychotherapies are available. In high-income countries, trained and licensed psychotherapists are typically in positions to apply such interventions; however, even an advanced system with a high capacity, such as the psychotherapeutic care offered in Germany, severely struggles to manage the demands associated with the rapid addition of hundreds of thousands of displaced people. Germany's mental healthcare system at present lacks the resources, both human and technological, to effectively manage the present demands. Systematic scientific studies in resource-poor regions of war and conflict have demonstrated that the dissemination of effective treatment to local personnel, even with limited training, results in substantial improvements in the mental health challenges within the community: Organized as a cascade model, members of the refugee community learn to identify weakened fellow citizens requiring in-depth diagnostic interviews. Educated, bilingual individuals acquainted with their country's healthcare system (e. g. nurses, teachers and social workers) receive training to conduct structured interviews and evidence-based interventions under the supervision of centrally organized licensed psychotherapists. More complex cases are referred to local psychotherapists, psychiatrists or specialized treatment centers. These humanitarian efforts are based on the convention for the protection of human rights and secure the safety, freedom and dignity of these persons.
Collapse
|
91
|
Sweileh WM. Bibliometric analysis of medicine - related publications on refugees, asylum-seekers, and internally displaced people: 2000 - 2015. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:7. [PMID: 28320410 PMCID: PMC5360014 DOI: 10.1186/s12914-017-0116-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Wars and violent domestic conflicts have forced millions of people to move outside their homes. Meeting the basic health needs of those people requires an understanding of research activity and research output on this topic. The objective of this study was to shed light on the quantity and impact of medicine - related publications on refugees, asylum seekers and internally displaced people (IDP). METHOD Scopus database was used to retrieve required data. Specifically, the number of publications, top productive countries and institutions, highly cited articles, citation analysis, international collaboration, and journals involved in publishing articles on refugees, asylum seekers and IDP were reviewed and analyzed. The time span for the study was set from year 2000 to 2015. RESULTS Two thousands five hundred and thirty publications were retrieved. The h-index of retrieved articles was 64. A steep rise in number of publications was noticed after 2011. Top productive countries were the United States of America, Australia and the United Kingdom. The American public health institute (Centers for Disease Control and Prevention) and the United Nations refugee agency were among the top active organizations on this topic. Active journals in publishing on health of refugees, asylum seekers and IDP were those on mental health, psychology, public health and general medicine. Publications on Somali, Afghani, Iraqi, and Syrian refugees received a significant share of medicine-related publications. Analysis of publications based on region showed that publications on refugees from Middle East is rising sharply and is approaching those on African refugees. CONCLUSION Bibliometric analysis reveals that research publications on refugees have been increasing in a dramatic way and articles are being published in journals with high impact factor and international reputation, not only in general medicine and public health, but also mental health and psychology journals. Analysis of publications related to refugees can be helpful to international health agencies and governments not only to document the psychological trauma of fled people, but also to identify best mental health programs to face the consequences of wars and aggression that led to this refugee crisis.
Collapse
Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology, and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| |
Collapse
|
92
|
Steinert C, Bumke PJ, Hollekamp RL, Larisch A, Leichsenring F, Mattheß H, Sek S, Sodemann U, Stingl M, Ret T, Vojtová H, Wöller W, Kruse J. Resource activation for treating post-traumatic stress disorder, co-morbid symptoms and impaired functioning: a randomized controlled trial in Cambodia. Psychol Med 2017; 47:553-564. [PMID: 27804900 DOI: 10.1017/s0033291716002592] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mental health morbidity in post-conflict settings is high. Nevertheless, randomized controlled trials of psychotherapy on site are rare. Our aim was to integrate rigorous research procedures into a humanitarian programme and test the efficacy of resource activation (ROTATE) in treating post-traumatic stress disorder (PTSD), co-morbid symptoms and impaired functioning in Cambodia. METHOD A total of 86 out-patients with PTSD were randomly assigned to five sessions of ROTATE (n = 53) or a 5-week waiting-list control (WLC) condition (n = 33). Treatment was provided by six Cambodian psychologists who had received extensive training in ROTATE. Masked assessments were made before and after therapy. RESULTS PTSD remission rates according to the DSM-IV algorithm of the Harvard Trauma Questionnaire were 95.9% in ROTATE and 24.1% in the WLC condition. Thus, patients receiving ROTATE had a significantly higher likelihood of PTSD remission (odds ratio 0.012, 95% confidence interval 0.002-0.071, p < 0.00001). Additionally, levels of anxiety, depression and impaired functioning were significantly reduced compared with the WLC condition (p < 0.00001, between-group effect sizes d = 2.41, 2.26 and 2.54, respectively). No harms were reported. CONCLUSIONS ROTATE was efficacious in treating Cambodian patients with high symptom levels of PTSD, emotional distress and impaired functioning. ROTATE is a brief, culturally adaptable intervention focusing on stabilization and strengthening resources rather than trauma confrontation. It can be taught to local professionals and paraprofessionals and enhance access to mental health care for patients in need.
Collapse
Affiliation(s)
- C Steinert
- University of Giessen,Clinic for Psychosomatic Medicine and Psychotherapy,Ludwigstrasse 76,Giessen,Germany
| | - P J Bumke
- Trauma Aid Germany,Schillerstrasse 6,Berlin,Germany
| | - R L Hollekamp
- University of Giessen,Clinic for Psychosomatic Medicine and Psychotherapy,Ludwigstrasse 76,Giessen,Germany
| | - A Larisch
- University of Giessen,Clinic for Psychosomatic Medicine and Psychotherapy,Friedrichstrasse 33,Giessen,Germany
| | - F Leichsenring
- University of Giessen,Clinic for Psychosomatic Medicine and Psychotherapy,Ludwigstrasse 76,Giessen,Germany
| | - H Mattheß
- Psychotraumatology Institute Europe,Großenbaumer Allee 35a,Duisburg,Germany
| | - S Sek
- Department of Psychology,The Royal University of Phnom Penh,Russian Federation Boulevard,Toul Kork,Phnom Penh,Cambodia
| | - U Sodemann
- Trauma Aid Germany,In den Floragärten 41,Berlin,Germany
| | - M Stingl
- University of Giessen,Clinic for Psychosomatic Medicine and Psychotherapy,Ludwigstrasse 76,Giessen,Germany
| | - T Ret
- Department of Psychology,The Royal University of Phnom Penh,Russian Federation Boulevard,Toul Kork,Phnom Penh,Cambodia
| | - H Vojtová
- Slovak Institute for Psychotraumatology and EMDR,Legionarska 29, Trencin,Slovakia
| | - W Wöller
- Rhein-Klinik, Hospital for Psychsomatic Medicine and Psychotherapy,Luisenstrasse 3, Bad Honnef,Germany
| | - J Kruse
- University of Giessen,Clinic for Psychosomatic Medicine and Psychotherapy,Friedrichstrasse 33,Giessen,Germany
| |
Collapse
|
93
|
Alto ME, Petrenko CLM. Fostering secure attachment in low- and middle-income countries: Suggestions for evidence-based interventions. EVALUATION AND PROGRAM PLANNING 2017; 60:151-165. [PMID: 27865141 DOI: 10.1016/j.evalprogplan.2016.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 06/06/2023]
Abstract
Children struggling with the effects of trauma in low- and middle-income countries (LMIC) face a substantial mental health resource gap that limits their opportunities for positive psychosocial development. Multidisciplinary interventions working to close this gap may benefit from incorporating an empirically supported treatment (EST) into their approach that targets a universal mechanism implicated in resilience, like attachment. ESTs should be selected based on their level of empirical support and cultural adaptability, and then modified on the basis of qualitative evaluations conducted with the local population and stakeholders. This paper will provide an overview of attachment as a mechanism of resilience, a critical analysis of existing attachment-based ESTs, and recommendations for overcoming EST implementation barriers in LMIC.
Collapse
Affiliation(s)
- Michelle E Alto
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh St., Rochester, NY, 14608, United States.
| | - Christie L M Petrenko
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh St., Rochester, NY, 14608, United States.
| |
Collapse
|
94
|
Evidence-based training in the era of evidence-based practice: Challenges and opportunities for training of PTSD providers. Behav Res Ther 2017; 88:37-48. [DOI: 10.1016/j.brat.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
|
95
|
Volpe EM, Quinn CR, Resch K, Sommers MS, Wieling E, Cerulli C. Narrative Exposure Therapy: A Proposed Model to Address Intimate Partner Violence-Related PTSD in Parenting and Pregnant Adolescents. FAMILY & COMMUNITY HEALTH 2017; 40:258-277. [PMID: 26422231 PMCID: PMC4811746 DOI: 10.1097/fch.0000000000000072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pregnant and parenting adolescents experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are 3-fold: (1) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents; (2) describe NET's theoretical principles, its therapeutic process, and provide a review of existing evidence; and (3) discuss NET as a potential treatment to address the mental health burden among adolescents experiencing IPV-related PTSD and depression.
Collapse
Affiliation(s)
- Ellen M. Volpe
- University at Buffalo, State University of New York, School of
Nursing, 3435 Main St, Buffalo, New York 14214,
| | - Camille R. Quinn
- Department of Psychiatry, School of Medicine & Dentistry,
University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester,
NY 14642,
| | - Kathryn Resch
- Department of Psychiatry, School of Medicine & Dentistry,
University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester,
NY 14642,
| | - Marilyn S. Sommers
- Medical-Surgical Nursing, University of Pennsylvania School of
Nursing, 418 Curie Boulevard, Fagin Hall, Room 402, Philadelphia, PA 19104
(w) 215-746-8320,
| | - Elizabeth Wieling
- Family Social Science, University of Minnesota, 293 McNH, 1985
Buford Avenue, St Paul, MN 55108,
| | - Catherine Cerulli
- Director of Susan B. Anthony Center for Woman’s Leadership,
Department of Psychiatry, School of Medicine & Dentistry, University
of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642,
| |
Collapse
|
96
|
Abstract
The origin and development of counselling psychology in South Africa has been profoundly influenced by the country's socio-political history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country's mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentializing or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country's health care and education systems.
Collapse
Affiliation(s)
- Jason Bantjes
- Psychology Department, Stellenbosch University, Stellenbosch, South Africa
| | - Ashraf Kagee
- Psychology Department, Stellenbosch University, Stellenbosch, South Africa
| | - Charles Young
- Psychology Department, Rhodes University, Grahamstown, South Africa
| |
Collapse
|
97
|
El Hatw MM, El Taher AA, El Hamidi A, Alturkait FA. The association of exposure to the 2009 south war with the physical, psychological, and family well-being of Saudi children. Saudi Med J 2016; 36:73-81. [PMID: 25630008 PMCID: PMC4362182 DOI: 10.15537/smj.2015.1.9494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the nutritional, psychological, behavioral, family adjustment, and psychiatric assessment of Saudi children exposed to the 2009-2010 Jazan war. Methods: This retrospective cohort study was conducted in Saudi Arabia in July 2010. One hundred and eighty-six children exposed to the South war in Jazan, and 157 unexposed children in King Khaled Military City, Hafr Al Batin were studied for evidence of malnutrition using physical measures, evaluating psychological problems using the Child Behavior Inventory, behavioral problems using the Rutter Scale A2, family adjustment using the McMaster Family adjustment device, and for psychiatric disorders. The association of different socioeconomic variables with the psychological outcome of the exposed group was also studied. Results: The exposed children were well nourished, had more anxiety (p=0.044), better adaptation (p<0.001), less aggression (p=0.025), less deviant behavior (p=0.007), better family adjustment and had more post traumatic stress disorder, generalized anxiety, nightmares, and grief reaction. In the exposed children, females had more anxiety (p=0.006), and males had more antisocial behavior (p=0.02). Older children had less deviant behavior (p=0.005), better adaptation (p=0.007) and better planful behavior (p<0.001). Children of elder mothers had better planful behavior (p=0.039). Children from bigger families were less aggressive (p=0.049), and had less antisocial behavior (p=0.04). Conclusion: This study found that children exposed to the Jazan war had more anxiety. Unexpectedly they were well nourished and had higher adaptation, lower antisocial behavior, and better family adjustment. The socioeconomic status was associated with the psychological outcome.
Collapse
Affiliation(s)
- Mohamed M El Hatw
- Department of Pediatrics, Northern Area Armed Forces Hospital, King Khaled Military City, PO Box 10018, Hafr Al Batin 31991, Kingdom of Saudi Arabia. Tel. +966 (13) 7871777 Ext. 2359. E-mail.
| | | | | | | |
Collapse
|
98
|
Vally Z, Abrahams L. The Effectiveness of Peer-Delivered Services in the Management of Mental Health Conditions: a Meta-Analysis of Studies from Low- and Middle-Income Countries. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2016. [DOI: 10.1007/s10447-016-9275-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
99
|
Abstract
Zusammenfassung. Angesichts der aktuellen Flüchtlingsproblematik und der hohen Prävalenz psychischer Störungen bei Flüchtlingen stellt sich die Frage nach wirksamen Interventionen zur psychotherapeutischen Versorgung insbesondere minderjähriger Flüchtlinge. Das Review bietet einen Überblick über den aktuellen Forschungsstand zur Wirksamkeit verschiedener therapeutischer Interventionen bei unbegleiteten minderjährigen Flüchtlingen (UMF). Durch eine Recherche von acht Datenbanken wurden 12 Studien identifiziert, die mittels Prä- und Postmessungen psychologischer Outcomes in quantitativer Form über die Wirksamkeit psychotherapeutischer Interventionen bei UMF berichten. Mittels statistischer Informationen wurden außerdem Effektstärken berechnet. Zehn der zwölf Artikel berichteten signifikante Ergebnisse, wenngleich die Befundlage insgesamt dünn und die methodische Qualität oft mangelhaft ist. Replikationsstudien von hoher methodischer Qualität sowie die Erforschung weiterer Maßnahmen, beispielsweise multimodaler psychosozialer Unterstützungsprogramme und im schulischen Kontext, aber auch von potentiellen Moderatoren und Mediatoren, sind notwendig.
Collapse
Affiliation(s)
- Merle Anders
- Klinische Kinder- und Jugendpsychologie, Philipps-Universität Marburg
| | | |
Collapse
|
100
|
Mauritz MW, Van Gaal BGI, Jongedijk RA, Schoonhoven L, Nijhuis-van der Sanden MWG, Goossens PJJ. Narrative exposure therapy for posttraumatic stress disorder associated with repeated interpersonal trauma in patients with severe mental illness: a mixed methods design. Eur J Psychotraumatol 2016; 7:32473. [PMID: 27658371 PMCID: PMC5034153 DOI: 10.3402/ejpt.v7.32473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. OBJECTIVES The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients' experiences with NET and to identify influencing factors on treatment results. METHODS This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes. DISCUSSION The results of this study will provide more insight into influencing factors for clinical changes in this population.
Collapse
Affiliation(s)
- Maria W Mauritz
- GGNet Mental Health Care Center, Warnsveld, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands;
| | - Betsie G I Van Gaal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Ruud A Jongedijk
- Foundation Centrum '45, Oegstgeest, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Lisette Schoonhoven
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Peter J J Goossens
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, The Netherlands
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University Ghent, Belgium
- GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands
| |
Collapse
|