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Shah J, Shah A, Tokhi AF, Shedrow J, Hernandez N, Varney J, Qaderi P, Masoumi SJ, Qaderi S. Afghan Health Related Concerns Following the US Withdrawal: Results of a Survey Given via Social Media. Front Public Health 2022; 10:905481. [PMID: 35910864 PMCID: PMC9332619 DOI: 10.3389/fpubh.2022.905481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The United States Armed Forces completed their withdrawal from Afghanistan on August 30th, 2021, ending 20 years of war in Afghanistan. This rapid timeline from announcement to withdrawal and subsequent power transfer had profound consequences on the Afghan people, particularly in the domains of health and healthcare. Methods On 15 September 2021, we posted an anonymous online cross-sectional survey on social media (Twitter, Facebook, and WhatsApp groups) to collect data about respondents from Afghanistan. Questions focused on COVID-19 symptoms, concerns, and individual care with a focus on changes related to the United States (US) withdrawal from Afghanistan. The form was composed of 17 questions which included multiple choice, single choice, and numeric options. All questions were optional including demographic data. Results Our survey yielded 1,074 responses from the Farsi version and 572 responses from the Pashto version for a total of 1,646 responses. 1,286 (80%) of respondents were in Afghanistan at the time of survey submission. Concerning the US withdrawal from Afghanistan, 26% (412) respondents were extremely concerned and 12% (181) were moderately concerned. A majority of respondents report concerns regarding mental health due to the US withdrawal. 27% (418) report extreme concern, 12% (186) report moderate concern, and 15% (229) report a little concern. There is a significant difference in the proportions of concern (for US withdrawal generally, as well as physical and mental health) across gender. 49% of Female respondents report extreme concern regarding the US withdrawal compared to 22% of Male respondents (P < 0.001). With respect to physical health concerns 36% of Females report extreme concern compared to 16% of Males (P < 0.001). Finally on the mental health concerns, 54% of Females report extreme concern compared to 22% of Males (P < 0.001). Conclusion The results from this survey are susceptible to the possibility of internal validity and/or external validity. However, we are accepting of those possibilities considering this survey wasn't designed to be bulletproof, but rather serve as a voice for those who can't be heard and to inform the public of the hardships occurring across the globe due to a steadfast retraction of the US footprint from their soil. Our findings indicate salient changes and public health concerns among Afghans following the US withdrawal from the region. These concerns varied across gender and ethnic groups. Our findings may serve as the first step in addressing the health concerns of Afghans following two decades of US military presence. The results should be understood through the limitations associated with a survey study design. Future research and policy aimed at tackling short and long-term health and social concerns in Afghanistan should consider the role of US withdrawal.
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Affiliation(s)
- Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan
- Afghanistan National Charity Organization for Special Diseases, Kabul, Afghanistan
| | - Asghar Shah
- Division of Biology and Medicine, Brown University, Providence, RI, United States
| | - Ahmad Fahim Tokhi
- Department of Stem Cell and Regenerative Medicine, Eskiseir Osmangazi University, Eskiseir, Turkey
| | - Jordan Shedrow
- American University of the Caribbean Medial School, Cupe Coy, Sint Maarten
| | - Nicolas Hernandez
- American University of the Caribbean Medial School, Cupe Coy, Sint Maarten
| | - Joseph Varney
- American University of the Caribbean Medial School, Cupe Coy, Sint Maarten
| | - Pashton Qaderi
- Psychology and Educational Science Department, Balkh University, Balkh, Afghanistan
| | - Seyed Javad Masoumi
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Shohra Qaderi
- Afghanistan National Charity Organization for Special Diseases, Kabul, Afghanistan
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Shohra Qaderi
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Roth G, Ekblad S, Agren H. A longitudinal study of PTSD in a sample of adult mass-evacuated Kosovars, some of whom returned to their home country. Eur Psychiatry 2020; 21:152-9. [PMID: 16529915 DOI: 10.1016/j.eurpsy.2005.11.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractPTSD among a sample of mass-evacuated adults from Kosovo was studied using a prospective design with a baseline study and follow-ups at 3 and 6 months in Sweden, and with an additional follow-up after 1.5 years in both Sweden and Kosovo. Trauma events and PTSD-related symptoms were measured by the Harvard Trauma Questionnaire (HTQ). At the additional follow-up after 1.5 years the same measure (HTQ) was used as well as clinical diagnostic interviews with the SCID instrument and measurement of saliva cortisol levels. Thirty-seven percent had PTSD-related symptoms at baseline. Morbidity increased at the three follow-ups. About 80% of the participants had PTSD at the additional follow-up after 1.5 years. The HTQ results were confirmed by clinical diagnoses and the participants diagnosed with PTSD also had low saliva cortisol levels. The results are discussed in terms of trauma, time needed to develop PTSD, post-migration stress and selection mechanisms.
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Affiliation(s)
- Göran Roth
- Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, M56, 141 86 Stockholm, Sweden.
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Ostuzzi G, Barbui C, Hanlon C, Chatterjee S, Eaton J, Jones L, Silove D, Ventevogel P. Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance. BMC Med 2017; 15:197. [PMID: 29224570 PMCID: PMC5724240 DOI: 10.1186/s12916-017-0960-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Populations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings. METHODS Following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations. RESULTS When first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions. CONCLUSIONS Adapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.
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Affiliation(s)
- Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Charlotte Hanlon
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Sudipto Chatterjee
- Sangath Centre, Porvorim, Goa, India.,School of Population Health, Melbourne, Australia
| | - Julian Eaton
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,CBM International, Bensheim, Germany
| | - Lynne Jones
- FXB Center for Health & Human Rights, Harvard University, Boston, USA
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Llosa AE, Van Ommeren M, Kolappa K, Ghantous Z, Souza R, Bastin P, Slavuckij A, Grais RF. A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study. BMC Psychiatry 2017; 17:28. [PMID: 28100197 PMCID: PMC5241938 DOI: 10.1186/s12888-016-1154-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting. METHODS Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010. RESULTS The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity. CONCLUSIONS Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.
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Affiliation(s)
| | - Mark Van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Kavitha Kolappa
- MGH/McLean Psychiatry Residency, Harvard University, Boston, MA USA
| | - Zeina Ghantous
- Operational Center Geneva, Médecins Sans Frontières, Geneva, Switzerland
| | - Renato Souza
- Operational Center Geneva, Médecins Sans Frontières, Geneva, Switzerland
| | - Pierre Bastin
- Operational Center Geneva, Médecins Sans Frontières, Geneva, Switzerland
| | - Andrej Slavuckij
- Operational Center Geneva, Médecins Sans Frontières, Geneva, Switzerland
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Jones LM, Ghani HA, Mohanraj A, Morrison S, Smith P, Stube D, Gm JA. Crisis into Opportunity: Setting up Community Mental Health Services in Post-Tsunami Aceh. Asia Pac J Public Health 2016; 19 Spec No:60-8. [DOI: 10.1177/101053950701901s10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- LM Jones
- International Medical Corps, Santa Monica, California, USA
| | - HA Ghani
- International Medical Corps, Santa Monica, California, USA
| | - A Mohanraj
- International Medical Corps, Santa Monica, California, USA
| | - S Morrison
- International Medical Corps, Santa Monica, California, USA
| | - P Smith
- International Medical Corps, Santa Monica, California, USA
| | - D Stube
- Nardi and Stube Counseling, Montana, USA
| | - J Asare Gm
- International Medical Corps, Santa Monica, California, USA
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Tierney D, Bolton P, Matanu B, Garasu L, Barnabas E, Silove D. The mental health and psychosocial impact of the Bougainville Crisis: a synthesis of available information. Int J Ment Health Syst 2016; 10:18. [PMID: 26941835 PMCID: PMC4776395 DOI: 10.1186/s13033-016-0054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Bougainville Crisis (1988–1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis. Methods A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues. Results The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage; and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues. Conclusions The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs.
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Affiliation(s)
- David Tierney
- St. John of God Frankston Rehabilitation Hospital, 255-265 Cranbourne Rd, Frankston, VIC Australia
| | - Paul Bolton
- Center for Refugee and Disaster Response, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Barnabas Matanu
- Buka Hospital, Autonomous Region of Bougainville, Buka, Papua New Guinea
| | - Lorraine Garasu
- Nazareth Treatment Centre, Chabi, Autonomous Region of Bougainville, Buka, Papua New Guinea
| | - Essah Barnabas
- Buka Hospital, Autonomous Region of Bougainville, Buka, Papua New Guinea
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, University of New South Wales, Southwest Sydney Local Health District, Sydney, Australia
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia.
| | - Philip B Ward
- Schizophrenia Research Unit, School of Psychiatry, University of New South Wales, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia
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Ayazi T, Lien L, Eide A, Swartz L, Hauff E. Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: a cross-sectional community study in South Sudan. BMC Psychiatry 2014; 14:6. [PMID: 24410951 PMCID: PMC3893536 DOI: 10.1186/1471-244x-14-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. METHODS In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. RESULTS The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. CONCLUSION In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.
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Affiliation(s)
- Touraj Ayazi
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway.
| | - Lars Lien
- National Center for Dual Diagnosis, Innlandet Hospital Trust, Furnesvegen 26, 2380 Brumunddal, Norway,Faculty of Public Health, Hedmark University College, PO Box 400, 2418 Elverum, Norway
| | - Arne Eide
- SINTEF Technology and Society, PO Box 124, Blindern, 0314 Oslo, Norway
| | - Leslie Swartz
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Private Bag X1, 7602 Matieland, South Africa
| | - Edvard Hauff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway,Division of Mental Health and Addiction, Department of Research and Development, Oslo University Hospital, Ulleval, Kirkeveien 166, Building 20, 0407 Oslo, Norway
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Marquer C, Barry C, Mouchenik Y, Hustache S, Djibo DM, Manzo ML, Falissard B, Révah-Lévy A, Grais RF, Moro MR. A rapid screening tool for psychological distress in children 3-6years old: results of a validation study. BMC Psychiatry 2012; 12:170. [PMID: 23072651 PMCID: PMC3503833 DOI: 10.1186/1471-244x-12-170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 10/10/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The mental health needs of young children in humanitarian contexts often remain unaddressed. The lack of a validated, rapid and simple tool for screening combined with few mental health professionals able to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of the principle cross-cultural validation of the "Psychological Screening for Young Children aged 3 to 6" (PSYCAa3-6). The PSYCa 3-6 is a simple scale for children 3 to 6 years old administered by non-specialists, to screen young children in crises and thereby refer them to care if needed. METHODS This study was conducted in Maradi, Niger. The scale was translated into Hausa, using corroboration of independent translations. A cross-cultural validation was implemented using quantitative and qualitative methods. A random sample of 580 mothers or caregivers of children 3 to 6 years old were included. The tool was psychometrically examined and diagnostic properties were assessed comparing the PSYCa 3-6 against a clinical interview as the gold standard. RESULTS The PSYCa 3-6 Hausa version demonstrated good concurrent validity, as scores correlated with the gold standard and the Clinical Global Impression Severity Scale (CGI-S) [rho = 0.41, p-value = 0.00]. A reduction procedure was used to reduce the scale from 40 to 22 items. The test-retest reliability of the PSYCa 3-6 was found to be high (ICC 0.81, CI95% [0.68; 0.89]). In our sample, although not the purpose of this study, approximately 54 of 580 children required subsequent follow-up with a psychologist. CONCLUSIONS To our knowledge, this is the first validation of a screening scale for children 3 to 6 years old with a cross-cultural validation component, for use in humanitarian contexts. The Hausa version of the PSYCa 3-6 is a reliable and a valuable screening tool for psychological distress. Further studies to replicate our findings and additional validations of the PSYCa 3-6 in other populations may help improve the delivery of mental health care to children.
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Affiliation(s)
| | - Caroline Barry
- Inserm U669, Université Paris-Sud et Université Paris Descartes, Paris, France
| | - Yoram Mouchenik
- Université Toulouse le Mirail, Toulouse, France
- Hospital Sainte-Anne, Paris, France
- Médecins Sans Frontières, Paris, France
| | | | - Douma M Djibo
- National program of mental health, Ministry of Health, Niamey, Niger
| | | | - Bruno Falissard
- Inserm U669, Université Paris-Sud et Université Paris Descartes, Paris, France
| | - Anne Révah-Lévy
- Inserm U669, Université Paris-Sud et Université Paris Descartes, Paris, France
| | | | - Marie-Rose Moro
- Inserm U669, Université Paris-Sud et Université Paris Descartes, Paris, France
- Médecins Sans Frontières, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
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Skovdal M. Pathologising healthy children? A review of the literature exploring the mental health of HIV-affected children in sub-Saharan Africa. Transcult Psychiatry 2012; 49:461-91. [PMID: 23008352 DOI: 10.1177/1363461512448325] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews the expanding body of literature that examines the mental health of HIV-affected children in sub-Saharan Africa. Focusing on primary research across disciplines and methodologies, the review examines the use of universalistic assumptions about childhood adversity and mental health in driving forward this body of research. Of the 31 articles identified for this review, 23 had a focus on the psychological distress experienced by HIV-affected children, while only 8 explored social psychological pathways to improved mental health, resilience and coping. The article argues that this preoccupation with pathology reflects global assemblages of definitions, understandings and practices that constitute the global mental health framework. While such a focus is useful for policy interventions and the mobilisation of resources to support children living in HIV-affected communities, it overshadows more culturally relevant and strengths-based conceptualisations of how mental health is understood and can be achieved in different parts of Africa. Furthermore, a continued focus on the psychological distress experienced by HIV-affected children runs the risk of medicalising their social experiences, which in turn may transform the social landscape in which children give meaning to loss and difficult experiences. The article concludes that mental health professionals and researchers need to take heed of the biopolitical implications of their work, and argues for more community-oriented and resilience-enhancing research that brings forward the voices of local people to inform interventions tackling the psychosocial challenges inevitably experienced by many children in sub-Saharan Africa.
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Affiliation(s)
- Morten Skovdal
- Department of Health Promotion and Development, University of Bergen, Christiesgate 13, Bergen, Norway.
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11
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Aeromedical Transport in EMS (Including Helicopter Emergency Medical Services). Prehosp Disaster Med 2012. [DOI: 10.1017/s1049023x00021324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Bolton P, Tang AM. Using Ethnographic Methods in the Selection of Post-Disaster, Mental Health Interventions. Prehosp Disaster Med 2012; 19:97-101. [PMID: 15453166 DOI: 10.1017/s1049023x00001540] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis paper describes a short, ethnographic study approach for understanding how people from non-Western cultures think about mental health and mental health problems, and the rationale for using such an approach in designing and implementing mental health interventions during and after disasters. It describes how the resulting data can contribute to interventions that are more acceptable to local people, and therefore, more effective and sustainable through improved community support.
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Affiliation(s)
- Paul Bolton
- Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Hollander AC, Bruce D, Ekberg J, Burström B, Borrell C, Ekblad S. Longitudinal study of mortality among refugees in Sweden. Int J Epidemiol 2012; 41:1153-61. [PMID: 22552872 DOI: 10.1093/ije/dys072] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Refugee immigrants have poorer health than other immigrant groups but little is known about their mortality. A comparison of mortality among refugees and non-refugee immigrants is liable to exaggerate the former if the latter includes labour migrants, whose mortality risk may be lower than that of the general population. To avoid bias, labour migrants are not included in this study. The aim was to investigate mortality risks among refugees compared with non-labour non-refugee immigrants in Sweden. METHODS Population-based cohort design, starting 1 January 1998 and ending with death or censoring 31 December 2006. Persons included in the study were those aged 18-64 years, had received a residence permit in Sweden 1992-98 and were defined by the Swedish Board of Migration as either a refugee or a non-labour non-refugee immigrant. The outcomes were all-cause and cause-specific mortalities and the main exposure was being a refugee. Cox-regression models estimated hazard ratios (HRs) of mortality. RESULTS The study population totalled 86,395 persons, 49.3% women, 24.2 % refugees. Adjusted for age and origin, refugee men had an over-risk of cardiovascular mortality (HR = 1.58, 95% CI = 1.08-2.33). With socio-economic factors added to the model, refugee men still had an over-risk mortality in cardiovascular disease (HR = 1.53, 95% CI = 1.04-2.24) and external causes (HR = 1.59, 95% CI = 1.01-2.50). CONCLUSION Refugee men in Sweden have a higher mortality risk in cardiovascular and external causes compared with male non-labour non-refugee immigrants. This study suggests that the refugee experience resembles other stressors in terms of the association with cardiovascular mortality.
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Affiliation(s)
- Anna-Clara Hollander
- Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Institutet, Stockholm, Sweden.
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Swartz L, Tomlinson M, Landman M. Evidence, Policies and Practices: Continuities and Discontinuities in Mental Health Promotion in a Developing Country. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2004.9721922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Johansson Blight K, Ekblad S, Lindencrona F, Shahnavaz S. Promoting Mental Health and Preventing Mental Disorder among Refugees in Western Countries. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2009.9721780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hollander AC, Bruce D, Burström B, Ekblad S. Gender-related mental health differences between refugees and non-refugee immigrants--a cross-sectional register-based study. BMC Public Health 2011; 11:180. [PMID: 21435212 PMCID: PMC3072337 DOI: 10.1186/1471-2458-11-180] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 03/24/2011] [Indexed: 11/25/2022] Open
Abstract
Background Being an immigrant in a high-income country is a risk factor for severe mental ill health. Studies on mental ill health among immigrants have found significant differences in mental health outcome between immigrants from high income countries and low-income countries. Being an asylum seeker or a refugee is also associated with mental ill health. This study aimed to assess if there is a difference in mental ill health problems between male and female refugee and non-refugee immigrants from six low-income countries in Sweden. Methods A cross-sectional, population-based study design was used comparing refugees with non-refugees. The study size was determined by the number of persons in Sweden fulfilling the inclusion criteria at the time of the study during 2006. Outcome: Mental ill health, as measured with the proxy variable psychotropic drugs purchased. Refugee/Non-refugee: Sweden grants asylum to refugees according to the Geneva Convention and those with a well-grounded fear of death penalty, torture or who need protection due to an internal or external armed conflict or an environmental disaster. The non-refugees were all family members of those granted asylum in Sweden. Covariates: Gender and origin. Potential confounders: Age, marital status, education and duration of stay in Sweden. Background variables were analysed using chi square tests. The association between outcome, exposure and possible confounders was analysed using logistic regression analyses. Multiple logistic regression analysis was used to adjust for potential confounders. Results The study population comprised 43,168 refugees and non-refugees, of whom 20,940 (48.5%) were women and 24,403 (56.5%) were refugees. Gender, age, origin, marital status and education were all associated with the outcome. For female, but not male, refugees there was a significantly higher likelihood of purchasing psychotropic drugs than non-refugees (OR = 1.27, 95% CI = 1.15 - 1.40). Conclusions Female refugees from low-income countries seem to be a risk group among immigrant women from low-income countries, whereas male refugees had the same risk patterns as non-refugee immigrants from low-income countries. This underlines the need for training of clinicians in order to focus on pre-migration stress and the asylum process, among female newcomers.
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Affiliation(s)
- Anna-Clara Hollander
- Division of Social Medicine, Norrbacka, Department of Public Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Village characteristics associated with posttraumatic stress symptoms in postconflict Liberia. Epidemiology 2010; 21:454-8. [PMID: 20453652 DOI: 10.1097/ede.0b013e3181df5fae] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group-level factors may be associated with mental health. We assessed whether various village-level variables were associated with posttraumatic stress symptoms in a resettled postconflict population in Liberia. METHODS Individual surveys were administered to a population-based sample (n = 1434). We used multilevel random intercept linear regression models to estimate associations between individual- and village-level variables and posttraumatic-stress-symptom score. RESULTS In a multilevel model taking into account individual-level covariates, living in a village with higher mean number of traumatic experiences or greater history of displacement was associated with a higher symptom score. Conversely, living in a village with a more equal distribution of household wealth was associated with lower symptom score. CONCLUSIONS Characteristics of communities, as well as of individuals, may be important determinants of posttraumatic stress in low-income countries, such as Liberia, that are recovering from conflict.
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Mels C, Derluyn I, Broekaert E, Rosseel Y. Community-based cross-cultural adaptation of mental health measures in emergency settings: validating the IES-R and HSCL-37A in Eastern Democratic Republic of Congo. Soc Psychiatry Psychiatr Epidemiol 2010; 45:899-910. [PMID: 19707700 DOI: 10.1007/s00127-009-0128-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aims at providing qualitative and quantitative evidence on the relevance of two broadly used mental health self-report measures--Impact of Event Scale Revised (IES-R) and Hopkins Symptom Checklist 37 for Adolescents (HSCL-37A)--for use in Eastern Democratic of Congo, as no psychological assessment instruments were available for this region. We therefore describe an apt procedure to adapt and translate standard screening instruments in close collaboration with the local community, feasible under challenging conditions in emergency settings. METHOD Focus groups and interviews with community key figures in psychosocial care were employed to ensure local validity of the adaptation and translation process. Consequently, the questionnaires' internal consistency (Cronbach's alpha) and construct validity (principal component analysis, testing of theoretical assumptions) were assessed based on a clustered school-based community survey among 1,046 adolescents (13-21 years) involving 13 secondary schools in the Ituri district in Eastern Democratic Republic of Congo. RESULTS Key-informant qualitative data confirmed face and construct validity of all IES-R and all HSCL-37A anxiety items. Additional culture-specific symptoms of adolescent mental ill-health were added to enhance local relevance of the HSCL-37A depression and externalizing subscales. Quantitative analysis of the survey data revealed adequate internal consistency and construct validity of both adapted measures, yet weaker results for the externalizing scale. Furthermore, it confirmed the internalizing/externalizing factor structure of the HSCL-37A and the theoretically deviating intrusion/arousal versus active avoidance factor structure for the IES-R. CONCLUSIONS Community-based adaptation can extend the validity and local relevance of mental health screening in emergency and low-income settings. The availability of adequate Swahili and Congolese French adaptations of the IES-R and HSCL-37A could stimulate the assessment of psychosocial needs in war-exposed Eastern Congolese adolescents.
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Affiliation(s)
- Cindy Mels
- Department of Orthopedagogics, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
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Jordans MJD, Tol WA, Komproe IH, Susanty D, Vallipuram A, Ntamatumba P, Lasuba AC, de Jong JTVM. Development of a multi-layered psychosocial care system for children in areas of political violence. Int J Ment Health Syst 2010; 4:15. [PMID: 20553603 PMCID: PMC2907307 DOI: 10.1186/1752-4458-4-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 06/16/2010] [Indexed: 10/29/2022] Open
Abstract
Few psychosocial and mental health care systems have been reported for children affected by political violence in low- and middle income settings and there is a paucity of research-supported recommendations. This paper describes a field tested multi-layered psychosocial care system for children (focus age between 8-14 years), aiming to translate common principles and guidelines into a comprehensive support package. This community-based approach includes different overlapping levels of interventions to address varying needs for support. These levels provide assessment and management of problems that range from the social-pedagogic domain to the psychosocial, the psychological and the psychiatric domains. Specific intervention methodologies and their rationale are described within the context of a four-country program (Burundi, Sri Lanka, Indonesia and Sudan). The paper aims to contribute to bridge the divide in the literature between guidelines, consensus & research and clinical practice in the field of psychosocial and mental health care in low- and middle-income countries.
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Affiliation(s)
- Mark JD Jordans
- Department of Research & Development, HealthNet TPO, Amsterdam, The Netherlands
| | - Wietse A Tol
- Department of Research & Development, HealthNet TPO, Amsterdam, The Netherlands
| | - Ivan H Komproe
- Department of Research & Development, HealthNet TPO, Amsterdam, The Netherlands
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Joop TVM de Jong
- VU University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
- School of Medicine, Boston University, Boston, USA
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Abstract
The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia's recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today.
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Abstract
People with severe mental disorders are a neglected and vulnerable group in complex emergencies. Here, we describe field experiences in establishing mental health services in five humanitarian settings. We show data to quantify the issue, and suggest reasons for this neglect. We then outline the actions needed to establish services in these settings, including the provision of practical training, medication, psychosocial supports, and, when appropriate, work with traditional healers. We have identified some persisting problems locally, nationally, and internationally, and suggest some solutions. Protection and care of people with severe mental disorders in complex emergencies is a humanitarian responsibility.
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Affiliation(s)
- Lynne Jones
- International Medical Corps Santa Monica, CA, USA.
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Developing inter-agency guidelines on mental health and psychosocial support in emergency settings. INTERVENTION 2008. [DOI: 10.1097/wtf.0b013e328321e142] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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System Developments—New Horizons and Evaluation. Prehosp Disaster Med 2008. [DOI: 10.1017/s1049023x00021336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Coton X, Poly S, Hoyois P, Sophal C, Dubois V. The healthcare-seeking behaviour of schizophrenic patients in Cambodia. Int J Soc Psychiatry 2008; 54:328-37. [PMID: 18720893 DOI: 10.1177/0020764008090286] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To understand the patterns of the schizophrenic patients' healthcare-seeking behaviour (HCSB) in the context of a post-conflict country where psychiatric facilities are scarce. METHODS Cross-sectional survey assessing schizophrenic patients and their caregivers who consulted for the first time in four different outpatient psychiatric departments. RESULTS One hundred and four schizophrenic patients were selected: 56.7% began the HCSB with traditional medicine; 22.1% with western medicine, psychiatry included, and 20.2% with religious medicine; 77.3% did not begin the HCSB with psychiatry because they did not know it was a mental problem or because they did not know mental health services existed. The patients' education was the only factor that significantly influenced the HCSB. CONCLUSION In Cambodia, traditional and religious medicine are the first pathway to mental healthcare when patient and caregiver decide to seek help due to psychotic symptoms. The lack of knowledge on mental health and facilities appears the main reason to explain the schizophrenic patients' HCSB. This suggests that the development of psychiatry in Cambodia will be facilitated by a better spreading of knowledge on mental health and will have to take traditional and religious medicine into account.
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Rajkumar AP, Premkumar TS, Tharyan P. Coping with the Asian tsunami: perspectives from Tamil Nadu, India on the determinants of resilience in the face of adversity. Soc Sci Med 2008; 67:844-53. [PMID: 18562066 DOI: 10.1016/j.socscimed.2008.05.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Indexed: 11/24/2022]
Abstract
The Asian tsunami of December 26, 2004 wreaked havoc along the southeastern coast of India and resulted in devastating losses. The high rates of long-term mental health consequences in adult survivors predicted immediately after the disaster have not been borne out by recent surveys. This qualitative study explored the psychological impact of the tsunami on survivors with a view to gaining insights into the ethno-cultural coping mechanisms of affected communities and evaluating resilience in the face of incomprehensible adversity. We conducted focus group discussions 9 months after the tsunami with two groups of fishermen, two groups of housewives, a group of village leaders and a group of young men in four affected villages of Nagapattinam district in Tamil Nadu, India. In spite of incomplete reconstruction of their lives, participants reconstructed meaning for the causes and the aftermath of the disaster in their cultural idiom. Qualitative changes in their social structure, processes and attitudes towards different aspects of life were revealed. Survivors valued their unique individual, social and spiritual coping strategies more than formal mental health services. Their stories confirm the assertion that the collective response to massive trauma need not necessarily result in social collapse but also includes positive effects. The results of this study suggest that interventions after disaster should be grounded in ethno-cultural beliefs and practices and should be aimed at strengthening prevailing community coping strategies.
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Affiliation(s)
- Anto P Rajkumar
- Department of Psychiatry, Christian Medical College, Bagayam, Vellore 632002, Tamil Nadu, India.
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27
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Hugo M. Six months in Aceh. Australas Psychiatry 2007; 15:140-3. [PMID: 17464658 DOI: 10.1080/10398560701196760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Brief case histories are presented of people with schizophrenia treated in the Indonesian province of Aceh, where the author worked as a clinical psychologist for Medecines Sans Frontieres in 2005. Aceh was severely affected by the December 2004 tsunami, with significant destruction and loss of life. CONCLUSIONS The case studies highlight the needs of patients and the current opportunities to establish more effective mental health services. The role of culture as a significant consideration and a possible barrier to accessing care is also discussed.
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Affiliation(s)
- Malcolm Hugo
- Central Northern Adelaide Health Service, Mental Health Division, SA, Australia.
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Batniji R, Van Ommeren M, Saraceno B. Mental and social health in disasters: Relating qualitative social science research and the Sphere standard. Soc Sci Med 2006; 62:1853-64. [PMID: 16202495 DOI: 10.1016/j.socscimed.2005.08.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Indexed: 11/28/2022]
Abstract
Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.
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Eisenman D, Weine S, Green B, de Jong J, Rayburn N, Ventevogel P, Keller A, Agani F. The ISTSS/Rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries. J Trauma Stress 2006; 19:5-17. [PMID: 16568460 DOI: 10.1002/jts.20094] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.
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Affiliation(s)
- David Eisenman
- RAND, Santa Monica, California and David Geffen School of Medicine, UCLA, USA.
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Blight KJ, Ekblad S, Persson JO, Ekberg J. Mental health, employment and gender. Cross-sectional evidence in a sample of refugees from Bosnia-Herzegovina living in two Swedish regions. Soc Sci Med 2005; 62:1697-709. [PMID: 16171914 DOI: 10.1016/j.socscimed.2005.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Indexed: 10/25/2022]
Abstract
Large regional differences regarding access to employment have been observed amongst persons from Bosnia-Herzegovina coming to Sweden in 1993-1994. This has led to questions about the role of mental health. To explore this further, postal survey questionnaires were distributed to a community sample (N = 650) that was stratified and, within strata, randomly selected from a sampling frame of persons coming to Sweden from Bosnia-Herzegovina in 1993-1994. Four hundred and thirteen persons returned the questionnaire providing a response rate of 63.5%. The aim was to increase knowledge about the relationship between mental health and employment in the chosen population. The main mental health outcome measure was the Göteborg Quality of Life instrument from which 360 respondents were grouped according to low or high symptom levels. Data were cross tabulated (chi2-tested) against background variables such as age, gender and occupational status, and then tested using binary logistic regression. Binary logistic regression revealed unemployed men but not women, and women who had been working for longer periods during 1993-1999, to be associated with high levels of symptoms of poor mental health. Women living in the urban region were also overrepresented in the high symptom group. These findings indicate that, job occupancy is important to the health of men in the study. However, for the women, further understanding is needed, as job occupancy at some level as well as living in the urban region appear to be associated with poor mental health.
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Affiliation(s)
- Karin Johansson Blight
- Karolinska Institutet, Department of Clinical Neuroscience, Psychiatry-HS, Stockholm, Sweden.
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31
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit and Centre for Population Mental Health Research, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
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Weine S, Ukshini S, Griffith J, Agani F, Pulleyblank-Coffey E, Ulaj J, Becker C, Ajeti L, Elliott M, Alidemaj-Sereqi V, Landau J, Asllani M, Mango M, Pavkovic I, Bunjaku A, Rolland J, Cala G, Sargent J, Saul J, Makolli S, Sluzki C, Statovci S, Weingarten K. A family approach to severe mental illness in post-war Kosovo. Psychiatry 2005; 68:17-27. [PMID: 15899707 DOI: 10.1521/psyc.68.1.17.64187] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study describes the effects of a psychoeducational multiple-family group program for families of people with severe mental illness in post-war Kosovo that was developed by a Kosovar-American professional collaborative. The subjects were 30 families of people with severe mental illnesses living in two cities in Kosovo. All subjects participated in multiple-family groups and received family home visits. The program documented medication compliance, number of psychiatric hospitalizations, family mental health services use, and several other characteristics, for the year prior to the groups and the first year of the groups. The families attended an average of 5.5 (out of 7) groups, and 93% of these families attended four or more meetings. The uncontrolled pre- to post-intervention comparison demonstrated decreases in medication non-compliance and hospitalizations, and increases in family mental health service use. The program provided training for mental health professionals, led to policy change in the Ministry of Health, and resulted in dissemination to other community mental health centers. This study provides preliminary evidence that a collaboratively designed and implemented psychoeducational, multiple-family program is a feasible and beneficial intervention for families of people with severe mental illness in impoverished post-war settings.
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Affiliation(s)
- Stevan Weine
- International Center on Responses to Catastrophes, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, 60612, USA.
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Abstract
Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scientific evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies.
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Affiliation(s)
- R F Mollica
- Harvard Program in Refugee Trauma, Massachusetts General Hospital, Cambridge, MA, USA.
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Silove D, Manicavasagar V, Baker K, Mausiri M, Soares M, de Carvalho F, Soares A, Fonseca Amiral Z. Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation. Aust N Z J Psychiatry 2004; 38:929-32. [PMID: 15555027 DOI: 10.1080/j.1440-1614.2004.01483.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. METHOD Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. RESULTS Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. CONCLUSIONS Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.
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Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales, Australia.
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Silove D. The challenges facing mental health programs for post-conflict and refugee communities. Prehosp Disaster Med 2004; 19:90-6. [PMID: 15453165 DOI: 10.1017/s1049023x00001539] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The majority of refugees and communities exposed to warfare and oppression live in low-income countries with few resources or special skills. Yet, epidemiological studies have identified high levels of traumatic stress reactions in such populations. These stress reactions can be intensified by harsh policies aimed at deterring survivors from seeking refuge in technologically advanced societies. The scale of the problem of mass violence and displacement creates formidable challenges for mental health professionals in their efforts to develop practical frameworks for responding to the extensive needs of displaced persons. In this article, a model is proposed for low-income, post-conflict countries, based on a two-tiered formulation. At the eco-social level, mental health professionals can play a supportive, but not a lead, role in facilitating recovery of core adaptive systems that hasten natural recovery from stress for the majority of the population. Where small-scale, community mental health services are established, the emphasis should be on assisting persons and their families who are at greatest survival and adaptive risk. Training and promotion of local workers to assume leadership in such programs are essential. In technologically advanced societies in which refugees are in a minority, torture and trauma services can focus more specifically on traumatic stress reactions, acculturation, and resettlement. In a historical epoch in which displaced persons are facing particularly harsh treatment, there is a pressing need for consensus amongst mental health professionals in advocating for their needs.
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Affiliation(s)
- Derrick Silove
- Centre for Population Mental Health Research, Southwestern Sydney Area Health Service, Sydney, Australia.
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Jones L, Rrustemi A, Shahini M, Uka A. Mental health services for war-affected children: report of a survey in Kosovo. Br J Psychiatry 2003; 183:540-6. [PMID: 14645026 DOI: 10.1192/bjp.183.6.540] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions. AIMS To describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented. METHOD Data were collected on 559 patients over 2 years, including their referring problems and diagnoses. RESULTS Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to a traumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories. CONCLUSIONS Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in 'depathologising' normative responses.
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Affiliation(s)
- Lynne Jones
- Child Advocacy International and Centre for Family Research, Cambridge University, UK
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Weiss MG, Saraceno B, Saxena S, van Ommeren M. Mental health in the aftermath of disasters: consensus and controversy. J Nerv Ment Dis 2003; 191:611-5. [PMID: 14504571 DOI: 10.1097/01.nmd.0000087188.96516.a3] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mitchell G Weiss
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
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van Ommeren M, Saxena S, Loretti A, Saraceno B. Ensuring care for patients in custodial psychiatric hospitals in emergencies. Lancet 2003; 362:574. [PMID: 12938670 DOI: 10.1016/s0140-6736(03)14123-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark van Ommeren
- Department of Mental Health and Substance Dependence, WHO, Avenue Appia, CH-1211, Geneva, Switzerland.
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Mollica RF, Cui X, McInnes K, Massagli MP. Science-based policy for psychosocial interventions in refugee camps: a Cambodian example. J Nerv Ment Dis 2002; 190:158-66. [PMID: 11923650 DOI: 10.1097/00005053-200203000-00004] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
No longer are the high rates of psychiatric morbidity associated with mass violence in refugee populations invisible to the humanitarian assistance community. However, identification of mental health risk and protective factors that can be utilized by policy planners is still lacking. The objective of this report is to provide an analytic approach to determining these factors. A description is provided from the first large-scale epidemiological study of Cambodian refugees confined to the Thailand-Cambodian border in the 1980s and 1990s. The original data from this study are reanalyzed to evaluate the mental health impact of psychosocial factors subject to the influence of camp authorities, such as opportunities in the refugee camp environment and personal behaviors, in addition to trauma. The results suggest the extraordinary capacity of refugees to protect themselves against mental illness despite horrific life experiences. The recommendation emerges for refugee policy makers to create programs that support work, indigenous religious practices, and culture-based altruistic behavior among refugees. As refugee mental health policy receives increasing attention from the international community, it must consist of recommendations and practices based on scientific analysis and empirical evidence.
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Affiliation(s)
- Richard F Mollica
- Harvard Program in Refugee Trauma, Massachusetts General Hospital and Harvard Medical School, 22 Putnam Street, Cambridge, Massachusetts 02139, USA
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