Implementation of mental health services in conflict and post-conflict zones: Lessons from Syria

Prevalence and determinants of depression and anxiety among Sudanese during the ongoing civil conflicts: A cross-sectional study

Armed conflicts have profound effects on mental health, including elevated rates of depression and anxiety among affected populations. The ongoing civil conflict in Sudan since April 2023 has exacerbated these challenges. This study aimed to determine the prevalence and identify the determinants of depression and anxiety among Sudanese residents affected by the ongoing civil conflict. This cross-sectional study was conducted between April 1st and May 30, 2024. Data were collected through online surveys and face-to-face interviews. The validated Arabic versions of the Beck Depression Inventory and Hamilton Anxiety Rating Scale were used to assess depression and anxiety levels, respectively. In total, 920 Sudanese participants were included with a mean age of 35.0 ± 12.2 years; 52.3% were females and 90.1% had migrated due to civil conflicts. Of the participants, 99.3% and 98.6% reported varying levels of depression and anxiety, respectively. Predictors of depression were female sex (β = 4.71, P < .0001), living in the Eastern state (β = 4.13, P < .0001), living in a rural area (β = 2.33, P = .012), noncompletion of formal education (β = 7.36, P = .026), working individuals (β = -5.58, P < .0001), larger household sizes (16-20 members) (β = 6.79, P = .026), sufficient income (β = -10.22, P < .0001), those with the ability to save money (β = -11.56, P < .0001), and individuals with insufficient income (β = -5.61, P < .0001). The predictors of anxiety were being female (β = 6.05, P < .0001), and noncompletion of formal education (β = 7.11, P = .024), current working (β = -5.56, P < .0001), larger household sizes (16-20 members) (β = 6.12, P = .035), sufficient income ((β = -5.60, P < .0001), ability to save money (β = -5.52, P = .004), and insufficient income (β = -2.60, P = .006). These findings underscore the impact of war on mental health. Effective humanitarian interventions targeting vulnerable groups and addressing socioeconomic determinants are critical for mitigating the psychological toll of ongoing conflict in Sudan.

Sustainable development goals (SDGs) and resilient healthcare systems: Addressing medicine and public health challenges in conflict zones

This review explores the integration of sustainable development goals (SDGs) into healthcare organizations in conflict zones, with a specific focus on emergent models aimed at improving population health. The primary objective is to examine how innovative approaches such as telemedicine, mobile health clinics, and community health worker initiatives can be aligned with SDG targets, thereby enhancing healthcare outcomes in conflict-affected regions. The review focuses on the important areas of concern which encompasses technology, infrastructure, community engagement, and social/psychological factors. Particularly, strategies of improving existing technologies such as electronic health records and mobile health applications, enhancing health systems and community-based interventions, and integrating of mental health services are highlighted. Other focal points include advancing better water, sanitation and hygienic practices, sustainable water resource management, and other alternative financing mechanisms, such as public-private partnerships. Integrating these strategies are closely linked with the active participation of international, local governments, and affected communities in their effective implementation. This review highlights the need for monitoring and evaluation to assess intervention effectiveness and advocacy efforts to ensure that interventions supported and advocated by the international community are creating successful outcomes towards the SDG goals and improving population health in post conflict settings.

Assessment of the response to kidney patients' needs in disaster-stricken Syria

PURPOSE OF REVIEW

The major fighting activities in the Syrian conflict have subsided, but the country continues to deal with significant political, economic, and psychosocial consequences that gravely impact the healthcare system, including the care of patients with kidney disease. The purpose of this manuscript is to review some of the problems faced by kidney patients in postconflict Syria and their available and proposed remedies.

RECENT FINDINGS

Many challenges, such as unfair, poorly planned, and poorly organized distribution of resources, suboptimal quality-monitoring infrastructure, psychosocial barriers, and workforce shortages, impede the delivery of quality care and negatively impact outcomes. The negative impact of these problems is not uniform and tends to affect certain areas more than others because of geopolitical factors imposed by the conflict.

SUMMARY

After prolonged conflicts, healthcare resources remain limited for prolonged periods, leading to inadequate care, poor outcomes, and worsening inequities. Involvement of the international community and expatriate nephrologists is essential to guide care delivery and improve outcomes. The lessons learned from the Syrian conflict apply to many limited resources and disaster situations.

Demographics and risk factors for suicide in Syria: A retrospective media content analysis of online news sources

Since the beginning of the Syrian conflict in 2011, Syrians have faced violence and displacement causing an increase in mental health issues. The COVID-19 pandemic, the 2023 earthquake, and deteriorating living conditions have exacerbated these issues. Suicide in Syria remains an under-researched topic since accurate data are difficult to obtain. In this study, we aimed to explore the demographics and risk factors of suicide in Syria by performing a retrospective content analysis of selected online news (media) outlets from across Syria. Twelve news outlets from the three regions of Syria were selected and news of suicide cases were searched retrospectively. The age range was between 9 and 79 years old with the average age being 27.1 ± SD 5.9 years. The most reported causes of suicide were harsh living conditions (18.5%) and relationship problems (18.3%). The most common method of suicide was hanging followed by using firearms. More suicides occurred at night and in the summer and spring seasons. Based on our study's results, young adult, male, unmarried, individuals in rural settings and northern governorates were at the highest risk of suicide in Syria. This study highlights the urgent need for mental health interventions that address the unique challenges faced by Syrians.

The prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics in wartime-An observational cross-sectional study six months after outbreak

Russia's invasion of Ukraine is the largest European land offensive since World War II. Individuals affected by conflicts such as war are at an increased risk of mental disorders, which result from frequent exposure to traumatic events and the breakdown of supportive social networks. The aim of the study was to assess the prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics six months after the Russian invasion of Ukraine. A cross-sectional study was conducted using validated questionnaires: The Life Events Checklist, PTSD Checklist for DSM-5, The International Trauma Questionnaire (ICD-11), The Generalized Anxiety Disorder-7, The Patient Health Questionnaire-9, The World Health Organization Disability Assessment Schedule 2.0. The study showed that 61.1 % of participants indicated combat or exposure to a war zone as the most bothersome event in their experience. Physicians and paramedics did not differ in the prevalence of PTSD according to the DSM-5 diagnostic rule and of depression (criteria met by 14.5 % and 9 % of participants, respectively). However, more physicians than paramedics met the criteria of PTSD according to the ICD-11 diagnostic rule (5.1 % vs. 1.2 %) and of anxiety (16.5 % vs. 10.0 %). The risk factors for the mental health problems included personal combat experience, total trauma exposure, parenthood, and economic situation. Despite the differences found in the prevalence of PTSD depending on the criteria used, the severity of mental problems and disability in this group is significant. It is advisable to monitor the mental state and need for help among Ukrainian civilian medical personnel.

Social Stigma Toward Individuals with Schizophrenia in a Lebanese Population

Background

Schizophrenia has been recognized as the most stigmatized mental disorder, imposing a substantial burden on affected individuals. However, no prior studies have investigated social stigma toward individuals with schizophrenia in Lebanon.

Purpose

We aimed to examine three components of social stigma including knowledge, attitude, and behavior toward individuals with schizophrenia in a Lebanese population and to explore associated factors with the level of social stigma.

Patients and Methods

A cross-sectional online survey was administered, and data from 469 participants were gathered from January 31, 2023, to February 18, 2023. We used previously validated questionnaires to assess the knowledge, attitude (Social Distance Scale), and behavior (Reported and Intended Behavior Scale) of participants toward individuals with schizophrenia. The score for each section was calculated and used to explore the associations between sociodemographic factors and the levels of stigma in each domain.

Results

The study participants had a moderate understanding of schizophrenia. However, a substantial proportion showed negative attitudes and unfavorable behaviors toward individuals with schizophrenia. We identified several sociodemographic factors associated with the knowledge, attitude, and behavior scores. Notably, a higher knowledge score and more positive attitudes were positively correlated with improved intended behaviors.

Conclusion

This study highlights the pervasive stigma encompassing issues in knowledge, attitudes, and behavior surrounding schizophrenia in a Lebanese population. Our study suggests a pressing need for targeted interventions to increase public awareness and decrease the social stigma of schizophrenia in Lebanon.

Mental distress links with physical activities, sedentary lifestyle, social support, and sleep problems: A Syrian population cross-sectional study

BACKGROUND

Mental diseases are very widespread and difficult to treat, affecting around 12% of the global population in 2019. Since social interaction is crucial to human existence and loneliness has been proven to be a significant predictor of depressive symptoms, it stands to reason that social connection problems would also contribute to depression. Physical inactivity seems to weaken and aggravate insulin tolerance alterations, glucose homeostasis, and plasma triglyceride levels, thereby influencing one's mood and happiness. This suggests that physical inactivity may be a significant risk factor for mental illness. This research contributes to our understanding of the mental health situation in Syria by exploring associations between a set of measurable characteristics that may be adjusted.

METHODS

An online quantitative cross-sectional study was conducted between March and April 2022 in Syria, using a structured questionnaire that assesses data on behaviors of health, health in general, wellbeing, and adult population quality of life.

RESULTS

Among 1,224 respondents (371 men and 853 women), women have shown higher levels of mental distress, sleep issues, low engagement in structured activities, and a difficult work environment than men. Women experiencing mental anguish have reported being more sedentary, participating in less scheduled activities, and receiving less social support.

CONCLUSIONS

There are observable connections between high sedentary time and women experiencing mental distress. The mental health of Syrian women in distress was associated with a lack of participation in both organized activities and physical exercise in their free time. Furthermore, sleep issues and financial troubles were seen in persons with mental diseases of both males and females.