Trauma- and stressor related disorders in the tuareg refugees of a cAMP in burkina faso

A review of the impact of shelter design on the health of displaced populations

There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants' health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters' internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches.

Efficiency of Intervention Counseling Program on the Enhanced Psychological Well-being and Reduced Post-traumatic Stress Disorder Symptoms Among Syrian Women Refugee Survivors

Background:

The number of individuals displaced from their original countries due to civil wars, hunger, disasters, and international wars is increasing worldwide day by day. These refugees are more vulnerable to Post-Traumatic Stress Disorder (PTSD).

Objective:

The present study aimed to examine the effectiveness of the intervention program in improving the well-being and reducing Post-Traumatic Stress Disorder (PTSD) among a sample of Syrian refugee women in Jordan who had been displaced due to civil wars in Syria.

Methods:

The study recruited 40 Syrian refugee females in Jordan who were psychologically challenged, with high PTSD symptoms (assessed by PCL) and a psychological well-being impairment (assessed by PWD). The culture of Jordanian society discriminates and affects the Syrian refugee women, rendering them vulnerable to PTSD. Quasi-experimental design was used, wherein the participants were randomly distributed in experimental and control groups (n=20/group). The control group members did not receive any services related to psychological support or psychiatric medications, while the experimental group underwent a counseling program.

Results:

The present study demonstrated that the intervention program improves the well-being and reduces PTSD among the Syrian refugee women who constituted the experimental group. The intervention program and the PTSD manifestation were not affected by age. The present study recommended that the program be applied to the refugees in Jordan to improve the well-being of the women in the residential areas.

Conclusion:

Furthermore, an intervention on the Jordanian cultural impact on the refugee camps was also essential if the condition for the female refugees worsened. Lastly, the effect of Jordanian culture on Syrian refugees should be investigated since the literature presented a negative impact.

Migrant Women-experiences from the Mediterranean Region

Introduction:

The phenomenon of migration is characterized and influenced by a number of different variables; and the different stages of journey are related to different levels and types of psychological distress. Women, in particular, are exposed to further specific risks during migration.

Aim:

To determine the factors that affect the psychological health of migrant women during the different stages of the migration journey.

Methods:

We provide a narrative review of the literature around the experiences of women during migration process, with a geographical focus on women migrating to the Mediterranean area.

Results:

Little data is currently available on the burden of mental health disorders for female migrants. Most studies about the mental health status of migrants were not gender-disaggregated or focused specifically on migrant women’s experiences of violence. Sexual and Gender-Based Violence (SGBV) was found to be a common risk factor faced by all the women who leave their native country to migrate to other countries.

Conclusion:

Despite the importance of the issue and the gender-specific variables related to the experience of migrant women, few studies have looked specifically at psychological variables and mental health status in the female migrant population. It is crucial that future studies are conducted around female migration, violence towards women, and women’s mental health, in order to provide an evidence-base for promoting adequate policies and prevention/treatment programs for women.

Expulsion from the Motherland: Association between Depression & Health-Related Quality of Life for Ethnic Rohingya Living with Refugee Status in Bangladesh

BACKGROUND

The Rohingyas are an ethnic minority group from Myanmar who have experienced severe forms of violence such as murder, rape, humanitarian defilement and forcible expellation from their motherland. Exposure to trauma has a long-lasting impact on psychological well-being and Health-related Quality of Life (HRQoL).

OBJECTIVE

The purpose of this study was to examine the prevalence of depression and association with HRQoL for Rohingya displaced persons.

METHODOLOGY

This was a prospective, cross-sectional study in two refugee camps in Southern Bangladesh, with a structured and language validated questionnaire.

RESULTS

The study indicates the prevalence of depression was 70% (n=150 respondents), with 8.7% reporting "severe depression" in PHQ-9. WHOQOL-BREF scores were inversely associated with symptoms on the depression scale with a strong and significant correlation (r= 0.652; p<0.01) in total and physical health; psychological (r= 0.757, p<0.01), social relationship (r= 0.479, p<0.01), environment (r= 0.443, p<0.01), increasing age (r= 0.272, p<0.01), severity of depression (r= 0.489, p<0.01). Furthermore, there was a statistically significant correlation with overall quality of life with same variables subsequently (r =0.600, 0.309, 0.482, 0.170, 0.103, 0.272, 0.339; p<0.01), also correlation was observed between married individuals and severity of depression in PHQ (r= 0.346), physical state (r= 0.353), psychological state (r= 0.358), and with social relationship (r= 0.435), with statistical significance (p= <0.01).

CONCLUSION

There are higher incidence rates of moderate to severe depression than the population norms and low health-related quality of life than published population norms for Rohingya displaced persons living in refugee camps. Depression rates were inversely associated with HRQoL for Rohingya displaced persons living in refugee camps. Future research may consider the prevention of related medical issues for long term program implementation.

Prevalence and Correlates of Mental Health Status Among Pre-Hospital Healthcare Staff

Introduction:

Mental stress amongst pre-hospital Emergency Medical Services (EMS) workers is an iceberg phenomenon; owing to unique occupational stressors faced by them. This study was aimed to examine the mental health status of pre-hospital EMS workers and its correlation with Post-Traumatic Stress Disorder (PTSD) and Work Environment Scale (WES).

Methods:

This cross-sectional study incorporated 224 emergency EMS members from urban and road EMS bases in eastern Iran in 2018. General Health Questionnaire (GHQ-28), Post-Traumatic Stress Disorder Checklist-Civilian version (PTSD-C), and Work Environment Scale (WES) were used as research instruments. Data were analyzed via SPSS Statistics software (version 21); while p<0.05 was considered significant.

Results:

The mean age of participants was 31.91±6.9 years; 36(16.1%) had PTSD ≥50, which increased with age (p-0.01), number of offspring (p-0.022) and time working at the EMS (p-0.002). Mean WES scores were 73.41±12.27; with a significant impact of marital status (p-0.007), the number of offspring (p-0.023), qualification (p-0.019) and less time working at the EMS (p-0.008). Mental distress was recorded in 89(39.7%) individuals. Multivariate logistic regression revealed that members at higher risk of mental distress were; those with associate’s degree (adjusted OR 3.192; 95% CI, 1.456-6.998), individuals with 1 or 2 offspring (adjusted OR 2.03; 95% CI, 0.992-4.156; adjusted OR 3.380; 95% CI, 1.483-7.704, respectively), and those with PTSD equal or higher than 50 (adjusted OR 2.504; 95% CI, 1.063-5.903), with a reverse impact of WES (p>0.05).

Conclusion:

PTSD adversely affected mental health and clinical performance of the subjects; while work-place environment augmented working spirit as well as psychological resilience. Strategies aiming at stress-dilution and improvements in a professional environment cannot be over-emphasized.

Gender differences in response to war-related trauma and posttraumatic stress disorder - a study among the Congolese refugees in Uganda

BACKGROUND

The wars in the Democratic Republic of Congo have left indelible marks on the mental health and functioning of the Congolese civilians that sought refuge in Uganda. Even though it is clear that civilians who are exposed to potentially traumatizing events in war and conflict areas develop trauma-related mental health problems, scholarly information on gender differences on exposure to different war-related traumatic events, their conditional risks to developing PTSD and whether the cumulative exposure to traumatic events affects men and women differently is still scanty.

METHODS

In total, 325 (n = 143 males, n = 182 females) Congolese refugees who lived in Nakivale, a refugee settlement in the Southwestern part of Uganda were interviewed within a year after their arrival. Assessment included exposure to war-related traumatic events, and DSM-IV PTSD symptom severity.

RESULTS

Our main findings were that refugees were highly exposed to war-related traumatic events with experiencing dangerous flight as the most common event for both men (97%) and women (97%). The overall high prevalence of PTSD differed among women (94%) and men (84%). The highest conditional prevalence of PTSD in women was associated with experiencing rape. The dose-response effect differed significantly between men and women with women showing higher PTSD symptom severity when experiencing low and moderate levels of potentially traumatizing event types.

CONCLUSION

In conflict areas, civilians are highly exposed to different types of war-related traumatic events that expose them to high levels of PTSD symptoms, particularly women. Interventions focused at reducing mental health problems resulting from war should take the context of gender into consideration.

Impairment of Quality of Life Associated With Lifetime Diagnosis of Post-traumatic Stress Disorder in Women - A National Survey in Italy

Introduction

The aim of the study was to measure the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among women of an Italian community sample, the comorbidity of PTSD with mood and anxiety disorders and the burden attributable to PTSD in worsening the Quality of Life (QoL).

Methods

Community survey on a sample of 1961 adult women randomly selected. Tools: psychiatric clinical interview ANTAS partially derived from the SCID-DSM-IV, administered by psychologists or medical doctors; Short Form Health Survey (SF-12); Mood Disorder Questionnaire (MDQ).

Results

Lifetime prevalence of PTSD in women was 1.3%, (1.4% in<45 years aged, 1.3% in >44 years aged; p=0.8). In order of risk of comorbidity, PTSD was associated with: Bipolar Spectrum Disorders (MDQ+), Panic Disorders (PD) and Major Depressive Disorder (MDD). People with PTSD showed an SF-12 mean score lower than women of the same sample without PTSD (standardized by gender and age), with a mean difference (attributable burden) of 3.9±0.9 similarly to MDD and Eating Disorders and higher than PD. Among the analyzed nonpsychiatric diseases, Multiple Sclerosis and Carotid Atherosclerosis showed a higher burden in impairing QoL than PTSD; Wilson's Disease showed a similar burden and Celiac Disease was found less impairing on QoL than PTSD.

Conclusion

The attributable burden in worsening women' perceived QoL due to a lifetime diagnosis of PTSD was found comparable to those caused by MDD, Eating Disorders or by neurological condition such as Wilson's Disease. The comorbidity of PTSD with Bipolar Spectrum Disorders was remarkable, even further studies are needed to clarify the direction of causality.

Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Syrian Refugees of Different Ages: the Role of Trauma Centrality

It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults' sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.

A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds

Housing is an important social determinant of health and a key element of refugee integration into countries of resettlement. However, the way in which housing may affect mental and physical health for refugees and asylum seekers has not been systematically examined. This systematic review aimed to explore the effects of housing on health and wellbeing for this population, in order to identify key pathways for public health interventions. The review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Social Care Institute for Excellence (SCIE) guidelines. We identified publications through a search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL, Cohrane Library, Google, ProQuest, OpenGrey, MedNar and WHOLIS. Eligibility criteria included: publication in English between 1997 and 2017, with findings pertaining to the relationship between housing and health for refugees and/or asylum seekers. Out of 2371 items, 25 papers were included with a further five identified through reference lists. Eleven of the papers explored housing and health for those refugees and asylum seekers living within refugee camps, with 19 focusing on countries of resettlement. All studies identified housing issues for refugees and asylum seekers, with physical housing conditions particularly poor in refugee camps, and issues of affordability, suitability, insecure tenure and mobility as well as difficulties securing housing also highlighted in countries of resettlement. Consistent relationships were found between physical aspects of housing and physical and mental health, with other aspects of housing such as safety and overcrowding linked to mental health. There were a number of methodological issues with most of the studies, making it difficult to specify precise pathways. However, improvements to housing quality particularly in refugee camps, and targeted housing interventions more generally for refugees and asylum seekers would likely have an important public health benefit.

A Follow-Up on Psychiatric Symptoms and Post-Traumatic Stress Disorders in Tuareg Refugees in Burkina Faso

INTRODUCTION

The aim of this study was to carry out a 2-year follow-up of refugees in a camp in Burkina Faso who had been interviewed previously. We also aimed to verify whether the general conditions in which they lived (e.g., protection by international organizations and the conclusion of negotiations and new hope of returning to Mali and reunification with surviving family members) would affect their mental health state.

METHODS

This is a cross-sectional study repeated over time on a cohort of refugees. People living in the Subgandé camp who had participated in the first survey in 2012 were identified using informational chains and approached for follow-up. Those who agreed were interviewed using the Short Screening Scale for post-traumatic stress disorder (PTSD) and the K6 scale, French versions, to measure general psychopathology and the level of impairment.

RESULTS

The second survey shows a dramatic decrease in psychopathological symptoms (positivity at K6 scale). Improvement was also conspicuous in the frequency of people with stress symptoms (positivity at Short Screening Scale for PTSD and simultaneous positivity to K6 scale). The frequency of people screened positive at the Short Screening Scale for PTSD had also decreased, but the level of improvement was not pronounced.

CONCLUSION

Our findings confirm that when physical conditions improve, psychological symptoms can also improve. Although in the studied sample psychological factors, such as the hope of returning to their own land and thus the possibility of maintaining ethnic cohesion, may have played a role, future research carried out with a proper methodology and sufficient resources to identify protective factors is needed.

Measuring self-rated health status among resettled adult refugee populations to inform practice and policy - a scoping review

BACKGROUND

The health status of refugees is a significant factor in determining their success in resettlement and relies heavily on self-rated measures of refugee health. The selection of robust and appropriate self-rated health measurement tools is challenging due to the number and methodological variation in the use of assessment tools across refugee health studies. This study describes the existing self-report health measures which have been used in studies of adult refugees living in the community to allow us to address the challenges of selecting appropriate assessments to measure health within refugee groups.

METHODS

Electronic databases of Ovid Medline, CINAHL, SCOPUS, Embase and Scopus.

RESULTS

This review identified 45 different self-rated health measurements in 183 studies. Most of the studies were cross sectional explorations of the mental health status of refugees living in community settings within Western nations. A third of the tools were designed specifically for use within refugee populations. More than half of the identified measurement tools have been evaluated for reliability and/or validity within refugee populations. Much variation was found in the selection, development and testing of measurement tools across the reviewed studies.

CONCLUSION

This review shows that there are currently a number of reliable and valid tools available for use in refugee health research; however, further work is required to achieve consistency in the quality and in the use of these tools. Methodological guidelines are required to assist researchers and clinicians in the development and testing of self-rated health measurement tools for use in refugee research.

Factors associated with psychological distress among young women in Kisumu, Kenya

BACKGROUND

Attention to mental health issues is growing globally. In many countries, including Kenya, however, assessment of psychological distress, especially in rural areas, is limited.

METHODS

We analyzed data from young women screened for a longitudinal contraceptive ring study in Kisumu, Kenya. Multivariable regression analysis was used to assess factors associated with recent moderate and high psychological distress, as measured by the Kessler (K-6) psychological distress scale.

RESULTS

Among the 461 women screened, most (58.4%) were categorized as having moderate psychological distress, 20.8% were categorized as having low or no psychological distress, and 20.8% were categorized as having high psychological distress. Moderate psychological distress (vs low/no) was significantly more likely among women who reported a history of forced sex and were concerned about recent food insecurity. High (vs low/no) psychological distress was significantly more likely among women who reported a history of forced sex, who were concerned about recent food insecurity, and who self-reported a sexually transmitted infection.

CONCLUSION

To reduce psychological distress, a focus on prevention as well as care methods is needed. Girls need a path toward a healthy and productive adulthood with a focus on education, which would help them gain skills to avoid forced sex. Women would benefit from easy access to social services and supports that would help them with basic needs like food security among other things. A holistic or ecological approach to services that would address mental, educational, social, health, and economic issues may have the highest chance of having a long-term positive impact on public health.

Human Rights of Asylum Seekers with Psychosocial Disabilities in Europe

BACKGROUND

The migrants crossing the Mediterranean towards Europe have dramatically been increased in 2015 as the number of incidents and deaths.

OBJECTIVE

This editorial summarizes the results of our work and highlights some critical aspects that hinder the care to asylum seekers with stress disorders.

METHOD

Screening for mental disorders was performed in all migrants joint three camps in Sardinia (January-September 2015) using K6, Short Screening Scale for Post Traumatic Stress Disorder (PTSD) and with an interview. Positives were evaluated by psychiatrists and if they needed, have been treated and evaluated at the start of treatment and three months later.

RESULTS

22.1% of the sample, (22.6% female, 38.5±12.9 years) were positive for at least one screener; 8.7%, (24% female) had a diagnosis of depressive or bipolar DSM5 disorders and 7.6%, (25% female) of PTSD. After three months of treatment: 51 treated people (26.8%) had left the camps. 53.1% of those remaining declared had relatives in northern Europe that they wanted to reach. Only 8.3% showed a significant clinical improvement.

CONCLUSION

Clinical improvement was dramatically poor in people who stay in the camps. Dissatisfaction and feeling they could not join relatives may have had a negative impact. In PTSD, with the experience of torture and seeing family members killed, staying with surviving relatives in stable conditions would be an important part of treatment. From this point of view the UE Dublin Regulation seems not to be in agreement with the UN Convention on the rights of persons with disabilities.

War traumas in the Mediterranean area

INTRODUCTION

The purpose is to explore the consequences of war and its impact on mental health with attention to the Mediterranean area.

METHODS

Narrative review of consequences of war on mental health and on the mental health of the communities in the current crises in the Mediterranean region.

RESULTS

A series of outbreaks of war are still raging in the Mediterranean region and producing horrible effects with a considerable number of refugees with unsatisfied needs. Studies relating to conflicts of the past suggest that the mental health consequences of these wars may affect future generations for many years. While violations of human rights are not new, what is new are attacks on medical institutions perceived to be traditionally Western.

CONCLUSION

The scientific community has to fight violence through mediation of conflicts. The idea that science can improve lives is a concept that is found in the history of all Mediterranean cultures. The Greek and Roman medical tradition was saved thanks to doctors of the Arab courts when Christian fundamentalism fought science in the Middle Ages. Health institutions are the product of the great Islamic medical tradition as well as Western culture.

Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy?

BACKGROUND

The prevalence of trauma-related problems among refugees and asylum seekers is extremely high due to adverse experiences associated with forced migration. Although the literature presents a considerable number of guidelines and theoretical frameworks for working with traumatized refugees and asylum seekers, the efficacy, feasibility and applicability of these interventions have little empirical evidence.

AIMS

The purpose of this article is to critically review the literature to provide a rationale for developing culturally sensitive, evidence-based interventions for refugees and asylum seekers.

METHODS

A literature review integrating research findings on interventions designed especially for traumatized asylum seekers and refugees was conducted. Retained studies had to use some quantitative measurements of post-traumatic stress and to have pre- and post-measurements to evaluate the efficacy of the intervention. Studies included in this review cover a wide variety of interventions, including trauma-focused interventions, group therapy, multidisciplinary interventions and pharmacological treatments.

RESULTS

The majority of studies with traumatized refugees and asylum seekers reported positive outcomes of the intervention in reducing trauma-related symptoms. There is evidence to support the suitability of cognitive-behavioral therapy (CBT) and narrative exposure therapy (NET) in certain populations of refugees. Other intervention studies are limited by methodological considerations, such as lack of randomization, absence of control group and small samples.

CONCLUSIONS

This review has again highlighted the shortage of guiding frameworks available to investigators and clinicians who are interested in tailoring interventions to work with refugees and asylum seekers. Theoretical, ethical and methodological considerations for future research are discussed.

Forced migration: health and human rights issues among refugee populations

Undocumented migration is a global phenomenon that is manifest in diverse contexts. In this article, we examine the situations that precipitate the movement of large numbers of people across several African countries, producing a unique type of undocumented migrant--the refugee. These refugee movements impact already fragile African health care systems and often involve human rights violations that are of particular concern, such as gender-based violence and child soldiers. We use examples from several countries in sub-Saharan Africa, including the Democratic Republic of the Congo, Rwanda, Liberia, Sierra Leone, and Mozambique. Drawing on key documents from the United Nations High Commissioner for Refugees, current research, and our personal international experiences, we provide an overview of forced migration and discuss implications and opportunities for nurses to impact research, practice, and policy related to refugee health.