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Jobson L, McAvoy D, Ahmadi SJ. Psychological Problems in the Context of Political Violence in Afghan Children. Curr Psychiatry Rep 2024; 26:222-228. [PMID: 38564145 PMCID: PMC11081985 DOI: 10.1007/s11920-024-01496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW This review provides an overview of recent literature examining psychological problems in the context of political violence among Afghan children. RECENT FINDINGS Using recent literature (2018-2023) we identified: 1) heightened levels of psychological problems experienced by children in Afghanistan; 2) the factors associated with these psychological problems, including loss of family and community members, poverty, continuous risk of injury and death, gender, substance use, war, daily stressors, and poor access to education; 3) psychological problems have potentially worsened since the 2021 political changes; 4) conflict and poverty have resulted in violence against children being a serious issue; 5) emerging psychological interventions have been adapted to Afghan contexts; and 6) there is a desperate need for psychological assistance and further research in the region. All children in Afghanistan have experienced conflict and political violence. While children are not responsible for this conflict, it has impacted their mental health. Further research is needed to examine the development and evaluation of interventions.
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Affiliation(s)
- Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, 3800, Australia.
| | - Daniel McAvoy
- Centre for Humanitarian Leadership, Deakin University, Melbourne, VIC, Australia
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Alemi Q, Panter-Brick C, Oriya S, Ahmady M, Alimi AQ, Faiz H, Hakim N, Sami Hashemi SA, Manaly MA, Naseri R, Parwiz K, Sadat SJ, Sharifi MZ, Shinwari Z, Ahmadi SJ, Amin R, Azimi S, Hewad A, Musavi Z, Siddiqi AM, Bragin M, Kashino W, Lavdas M, Miller KE, Missmahl I, Omidian PA, Trani JF, van der Walt SK, Silove D, Ventevogel P. Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions. BJPsych Open 2023; 9:e125. [PMID: 37424447 PMCID: PMC10375890 DOI: 10.1192/bjo.2023.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. AIMS We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. METHOD In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. RESULTS Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. CONCLUSIONS We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.
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Affiliation(s)
- Qais Alemi
- School of Behavioral Health, Loma Linda University, California, USA
| | - Catherine Panter-Brick
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, Connecticut, USA
| | | | - Mariam Ahmady
- Department of Counselling, Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan
| | | | - Hafizullah Faiz
- Jalalabad Regional Management Office, Swedish Committee for Afghanistan, Jalalabad, Afghanistan
| | - Nadia Hakim
- Migration Health Unit, International Organization for Migration, Kabul, Afghanistan
| | | | | | - Roman Naseri
- Mental Health and Psychosocial Support Unit, International Medical Corps, Kabul, Afghanistan
| | | | - Sayed Javid Sadat
- Mental Health and Peacebuilding Program, International Assistance Mission, Herat, Afghanistan
| | | | - Zalmai Shinwari
- Mental Health and Psychosocial Support Unit, HealthNet TPO, Kabul, Afghanistan
| | | | - Rohullah Amin
- Faculty of Humanities and Social Sciences, Helmut-Schmidt University, Germany
| | - Sayed Azimi
- Independent Mental Health Specialist, Geneva, Switzerland
| | - Atal Hewad
- Department of Ipso Academy and Quality Management, International Psychosocial Organisation, Konstanz, Germany
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | - Martha Bragin
- Silberman School of Social Work, The City University of New York, New York, USA
| | - Wataru Kashino
- Prevention Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Michalis Lavdas
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | | | - Inge Missmahl
- International Psychosocial Organisation, Konstanz, Germany
| | | | | | - Sarah Kate van der Walt
- Mental Health and Psychosocial Support Unit, Première Urgence – Aide Médicale Internationale, Kabul, Afghanistan
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Ahmadi SJ, Jobson L, Musavi Z, Rezwani SR, Amini FA, Earnest A, Samim N, Sarwary SAA, Sarwary SA, McAvoy D. Effect of the Memory Training for Recovery-Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e236086. [PMID: 36995710 PMCID: PMC10064255 DOI: 10.1001/jamanetworkopen.2023.6086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Importance Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions. Objective To investigate the efficacy of Memory Training for Recovery-Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan. Design, Setting, and Participants This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used. Interventions Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks. Main Outcomes and Measures Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment. Results The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, -20.38 to -14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, -8.50 to -4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, -6.05 to -0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, -0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P < .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants). Conclusions and Relevance In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts. Trial Registration anzctr.org.au Identifier: ACTRN12621001160820.
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Affiliation(s)
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | | | - Arul Earnest
- Biostatistics Unit, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nasratullah Samim
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | | | - Daniel McAvoy
- Centre for Humanitarian Leadership, Deakin University, Melbourne, Victoria, Australia
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Ahmadi SJ, Musavi Z, Ahmadi S, Masha S, Muradi N, Samim NU, Sarwary SA, Sarwary SAA, Shahinzada S, McAvoy D, Earnest A, Jobson L. Examining MEmory Training for Recovery-Adolescent among Afghan adolescent boys: a pilot randomised controlled trial. Eur J Psychotraumatol 2023; 14:2251780. [PMID: 37672117 PMCID: PMC10484046 DOI: 10.1080/20008066.2023.2251780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
Objective: To conduct a pilot randomised controlled trial examining the feasibility, acceptability and efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychological symptoms among Afghan adolescent boys following a terrorist attack.Method: A pilot randomised controlled trial compared METRA to a Control Group, with a three-month follow-up. The study occurred in Kabul (June-November 2022). Fifty-eight boys aged 14-19 years (Mage = 16.70, SD = 1.26) with heightened posttraumatic stress disorder (PTSD) symptoms were recruited through a local school that had recently experienced a terrorist attack. Participants were randomised 1:1 to receive METRA (n = 28) (10 session group-intervention) or Control (n = 30) (10 group-sessions of study skills). Primary outcomes were self-reported PTSD symptoms at post-intervention. Secondary outcomes included self-reported anxiety, depression, Afghan-cultural distress symptoms and psychiatric difficulties.Results: There were challenges in youth participation related to security and competing education demands. For those who did complete METRA, METRA was deemed feasible and acceptable. Following the intent-to-treat principle, linear mixed effects models found at posttreatment the METRA group had a 20.89-point (95%CI -30.66, -11.11) decrease in PTSD symptoms, while the Control Group had a 1.42-point (95%CI -8.11, 5.27) decrease, with the group over time interaction being significant (p < .001). METRA participants had significantly greater reductions in depression, anxiety, Afghan-cultural distress symptoms and psychiatric difficulties than did Controls. All gains were maintained at three-month follow-up.Conclusions: With some modifications, METRA appears a feasible intervention for adolescent boys in humanitarian contexts in the aftermath of a terrorist attack.
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Affiliation(s)
| | - Zeinab Musavi
- American University of Afghanistan (AUAF), Kabul, Afghanistan
| | - Sumia Ahmadi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | - Sakina Masha
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | - Nasima Muradi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | - Nasrat Ullah Samim
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | | | - Shamila Shahinzada
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | - Daniel McAvoy
- Centre for Humanitarian Leadership, Deakin University, Melbourne, Australia
| | - Arul Earnest
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia
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Ahmadi SJ, Jobson L, Earnest A, McAvoy D, Musavi Z, Samim N, Sarwary SAA. Prevalence of Poor Mental Health Among Adolescents in Kabul, Afghanistan, as of November 2021. JAMA Netw Open 2022; 5:e2218981. [PMID: 35737391 PMCID: PMC9226996 DOI: 10.1001/jamanetworkopen.2022.18981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study assesses the mental health of adolescents in Afghanistan and evaluates their risk of having a psychiatric disorder by age and sex.
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Affiliation(s)
| | - Laura Jobson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniel McAvoy
- Centre for Humanitarian Leadership, Deakin University, Melbourne, Australia
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | - Nasratullah Samim
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
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Ahmadi SJ, Musavi Z, Samim N, Sadeqi M, Jobson L. Investigating the Feasibility, Acceptability and Efficacy of Using Modified-Written Exposure Therapy in the Aftermath of a Terrorist Attack on Symptoms of Posttraumatic Stress Disorder Among Afghan Adolescent Girls. Front Psychiatry 2022; 13:826633. [PMID: 35463492 PMCID: PMC9027104 DOI: 10.3389/fpsyt.2022.826633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the efficacy, acceptability and feasibility of using modified written exposure therapy (m-WET) to treat symptoms of posttraumatic stress disorder (PTSD) in Afghan adolescent girls in the aftermath of a terrorist attack. METHODS 120 Afghan (Hazara) adolescent girls who had been exposed to the Sayed al-Shuhada school terrorist attack were randomly assigned to the m-WET (n = 40), trauma-focused cognitive behavior therapy (TF-CBT) (n = 40), or control groups (n = 40). m-WET involved five consecutive daily group sessions where participants simply wrote about the terrorist attack including thoughts and feelings. TF-CBT was an intensive five-session group intervention. The control group had no additional contact. The trial was undertaken at a local non-government organization in Kabul. The primary analysis was comparing PTSD symptoms (Child Revised Impact of Event Scale-13) in the three groups at post-intervention and three-month follow-up. RESULTS Overall, participant and facilitator satisfaction with m-WET was high. Acceptability of m-WET was relatively high, with 15% drop-out in the m-WET group and all m-WET sessions were attended. While the groups did not differ significantly in PTSD symptoms at baseline, the m-WET group had significantly lower levels of PTSD symptoms compared to the control group at post-intervention and follow-up. There was no significant difference between the m-WET and TF-CBT groups. CONCLUSION The findings suggest m-WET may be promising intervention for the treatment of PTSD among adolescent girls in humanitarian settings. Further research in the area is warranted.
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Affiliation(s)
- Sayed Jafar Ahmadi
- Counselling Department, Psychology Faculty, Kabul Education University, Kabul, Afghanistan
| | - Zeinab Musavi
- Behrawan Research and Psychological Services Organization, Kabul, Afghanistan
| | - Nasratullah Samim
- Behrawan Research and Psychological Services Organization, Kabul, Afghanistan
| | - Masooma Sadeqi
- Behrawan Research and Psychological Services Organization, Kabul, Afghanistan
| | - Laura Jobson
- Turner Institute for Brain and Mental Health, School of Psychological Services, Monash University, Melbourne, VIC, Australia
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Sepehrian H, Ahmadi SJ, Waqif-Husain S, Faghihian H, Alighanbari H. Adsorption studies of heavy metal ions on mesoporous aluminosilicate, novel cation exchanger. J Hazard Mater 2010; 176:252-256. [PMID: 19954883 DOI: 10.1016/j.jhazmat.2009.11.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 10/31/2009] [Accepted: 11/03/2009] [Indexed: 05/28/2023]
Abstract
Mesoporous aluminosilicates, have been prepared with various mole ratios of Si/Al and Cethyltrimethylammonium bromide (CTAB). They have been characterized by XRD, nitrogen adsorption/desorption measurements, FT-IR and thermogravimetry. Adsorption behavior of heavy metal ions on this adsorbent have been studied and discussed. The results show that incorporation of aluminum ions in the framework of the mesoporous MCM-41 has transformed it into an effective cation exchanger. The K(d) values of several metal ions have been increased. Separation of Sr(II)-Ce(III), Sr(II)-U(VI) and Cd(II)-Ce(III) has been developed on columns of this novel mesoporous cation exchanger.
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Affiliation(s)
- H Sepehrian
- NFCRS, Nuclear Science and Technology Research Institute, AEOI, P.O. Box 11365/8486, Tehran, Iran.
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Zonoz FM, Ahmadi SJ, Nosrati SA, Maragheh MG. Preparation and characterization of zirconium (IV) molybdo tungsto vanado silicate as a novel inorganic ion exchanger in sorption of radionuclides. J Hazard Mater 2009; 169:808-812. [PMID: 19443117 DOI: 10.1016/j.jhazmat.2009.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 04/05/2009] [Accepted: 04/07/2009] [Indexed: 05/27/2023]
Abstract
A new mixed metal heteropoly anion-based cation exchanger Zr(IV) molybdo tungsto vanado silicate (ZMTVS) was prepared under varying conditions. The material was characterized by FTIR, X-ray diffraction, TGA-DTA and SEM techniques. Its ion exchange capacity (IEC) for K(+) was found to be 0.86 meq g(-1). Distribution coefficients (K(d)) values for 10 metal ions and three radioisotopes were determined. On the basis of K(d) values, two important and analytically difficult quantitative binary separations viz. Ni(II)-Co(II) and Ni(II)-Pb(II) were achieved on its column. Decontamination of aqueous nuclear waste solution was also studied.
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Affiliation(s)
- F Mohammadi Zonoz
- Faculty of Chemistry, Damghan University of Basic Science, Damghan, Iran
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