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Wimer G, Larrea M, Streeter J, Hassan A, Angulo A, Armijos A, Bonz A, Tol WA, Greene MC. Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status. Int J Environ Res Public Health 2024; 21:380. [PMID: 38673293 PMCID: PMC11049989 DOI: 10.3390/ijerph21040380] [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] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.
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Affiliation(s)
- Gabrielle Wimer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | | | | | - Amir Hassan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | | | - Andrea Armijos
- HIAS, Silver Spring, MD 62471, USA; (A.A.); (A.A.); (A.B.)
| | - Annie Bonz
- HIAS, Silver Spring, MD 62471, USA; (A.A.); (A.A.); (A.B.)
| | - Wietse A. Tol
- Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark;
| | - M. Claire Greene
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
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Torre SM, Sordo L, Glaría CC, Llosa AE, Umar RD, Usman J, Sagrado Benito MJ. Association between severity of symptoms and minimum mental health treatment duration in humanitarian contexts: a retrospective observational study. EClinicalMedicine 2024; 67:102362. [PMID: 38125965 PMCID: PMC10730340 DOI: 10.1016/j.eclinm.2023.102362] [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: 08/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Background Understanding and optimising mental health and psychosocial support (MHPSS) interventions in humanitarian crises is crucial, particularly for the most prevalent mental health conditions in conflict settings: anxiety, depression, and post-traumatic stress disorder. However, research on what is the most appropriate length of psychological intervention is lacking in this setting. We aimed to establish which factors are most closely related to improvement and to determine the required number of consultations needed to achieve this improvement. Methods We retrospectively analysed records from 9028 patients allocated to treatment for anxiety, depression, and post-traumatic symptoms from the MHPSS programme in Borno State, Nigeria, from January 2018 to December 2019. Patient characteristics, severity (Clinical Global Impression of Severity Scale, CGI-S scale), and clinical improvement were assessed by an attending counsellor (CGI-I scale) and by the patient (Mental Health Global State, MHGS scale). Improvement was defined as scores 1, 2, and 3 in the Clinical Global Impression of Improvement (CGI-I) scale, and as a decrease of at least 4 points in the MHGS scale. We investigated the associations between the category of symptoms, the severity of illness, and improvement of symptoms using multivariable logistic regression. We used Kaplan-Meier (KM) curves to assess the number of consultations (i.e., time of treatment) needed to achieve improvement of symptoms, by symptom category and symptom severity. Findings The patients included were referred to treatment for anxiety (n = 3462), depression (n = 3970), or post-traumatic symptoms (n = 1596). Median age was 31 years (range 16-103), and 84.3% were female. Patients categorised as severe were less likely to present improvement according to the CGI-I scale (OR 0.11, 95% CI 0.05-0.25), while none of the other categories of symptoms showed significant results. Overall, three or more consultations were associated with improvement in both scales (OR 3.55, 95% CI 1.47-8.57 for CGI-I; and OR 3.04, 95% CI 2.36-3.90 for MHGS). KM curves for the category of symptoms showed that around 90% of patients with anxiety, depression, or post-traumatic symptoms, as well as those with mild or moderate severity, presented improvement after three consultations, compared with six consultations for those with severe symptoms. Interpretation Classification by severity among patients with anxiety, depression, or post-traumatic symptoms could predict the probability of improvement, whereas classification by symptoms could not. Our study highlights the importance of classifying patient severity in MHPSS programmes to plan and implement the appropriate duration of care. A major limitation was the number of patients lost to follow up after the first consultation and excluded from the logistic regression and KM analysis. Funding The study was funded and staffed entirely by Médicos Sin Fronteras (Médecins Sans Frontières), Spain.
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Affiliation(s)
| | - Luis Sordo
- Faculty of Medicine, Department of Public Health and Child Health, Complutense University, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Rowe O, Nadkarni A. Barriers and facilitators to the implementation of mental health and psychosocial support programmes following natural disasters in developing countries: A systematic review. Glob Ment Health (Camb) 2023; 11:e5. [PMID: 38283878 PMCID: PMC10808980 DOI: 10.1017/gmh.2023.91] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/16/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024] Open
Abstract
Climate change is leading to more frequent and intense natural disasters, with developing countries particularly at risk. However, most research concerning mental health and natural disasters is based in high-income country settings. It is critically important to provide a mental health response to such events, given the negative psychosocial impacts they elicit. The aim of this systematic review is to explore the barriers and facilitators to implementing mental health and psychosocial support (MHPSS) following natural disasters in developing countries. Eight databases were searched for relevant quantitative and qualitative studies from developing countries. Only studies reporting barriers and/or facilitators to delivering MHPSS in response to natural disasters in a low- or middle-income country were included and full texts were critically appraised using the McGill University Mixed Methods Appraisal Tool. Reported barriers and facilitators were extracted and analysed thematically. Thirty-seven studies were included in the review, reflecting a range of natural disaster settings and developing countries. Barriers to implementing MHPSS included cultural relevance, resources for mental health, accessibility, disaster specific factors and mental health stigma. Facilitators identified included social support, cultural relevance and task-sharing approaches. A number of practical approaches can be used to facilitate the implementation of MHPSS in developing country settings. However, more research is needed on MHPSS in the developing country natural disaster context, especially in Africa, and international policies and guidelines need to be re-evaluated using a decolonial lens.
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Affiliation(s)
- Olivia Rowe
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Schwartz L, Lane H, Hassanpoor Z. Overview and understanding of mental health and psychosocial support in Afghanistan. Int Health 2023; 15:601-607. [PMID: 37490026 PMCID: PMC10472885 DOI: 10.1093/inthealth/ihad055] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/30/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
More than four decades of war in Afghanistan has been both a main driver for poor mental health, and a barrier to the development of crucial mental health services. A study conducted by BMC Psychiatry in 2021, across eight regions in Afghanistan, found staggering levels of depressive and anxiety disorders among the general population. Almost one-half of those interviewed (47.12%) reported having high levels of distress in the last month, and almost 40% (39.44%) reported experiencing impairment to their lives due to poor mental health. Yet, despite the common experiences of much of the population, mental health is a hugely stigmatized topic of discussion in Afghanistan, due to a myriad of cultural, religious, socioeconomic and environmental factors. And now, under the de-facto Taliban government, mental health has been deprioritized in the face of a crumbling economy and acute levels of poverty, all but forgotten. This paper sought to review the impact and change to mental health services under the de-facto government, and to provide the reader with greater awareness into the current situation in Afghanistan and equip them with insight into how to respond to the mental health needs of Afghans.
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Affiliation(s)
- Lyla Schwartz
- Peace of Mind Association, 147 Wheel Meadow Drive, Longmeadow, Boston MA, 01106, United States
| | - Hannah Lane
- Peace of Mind Association, 147 Wheel Meadow Drive, Longmeadow, Boston MA, 01106, United States
| | - Zainab Hassanpoor
- Peace of Mind Association, 147 Wheel Meadow Drive, Longmeadow, Boston MA, 01106, United States
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Ahmed SK, Dhama K, Abdulqadir SO, Omar RM, Ahmed DR, Chakraborty C, Saied AA. The mental health of people in Turkey-Syria earthquake-affected areas needs urgent attention. Asian J Psychiatr 2023; 84:103573. [PMID: 37028233 DOI: 10.1016/j.ajp.2023.103573] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Pediatrics, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaymaniyah, Kurdistan Region 46012, Iraq; Department of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region 46012, Iraq.
| | - Kuldeep Dhama
- Division of Pathology, Indian Veterinary Research Institute, Izatnagar, 243122, Bareilly, India
| | - Salar Omar Abdulqadir
- Department of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region 46012, Iraq
| | - Rukhsar Muhammad Omar
- Department of Kindergarten, College of Basic Education, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region 46012, Iraq
| | - Darya Rostam Ahmed
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koya KOY45, Kurdistan Region-F.R, Iraq
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, West Bengal 700126, India
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Nguyen AJ, Lasater ME, Lee C, Mallawaarachchi IV, Joshua K, Bassett L, Gelsdorf K. Psychosocial support interventions in the context of forced displacement: A systematic review and meta-analysis. J Migr Health 2023; 7:100168. [PMID: 36816445 PMCID: PMC9932448 DOI: 10.1016/j.jmh.2023.100168] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Background Forced displacement is associated with elevated risk for poor psychosocial wellbeing, yet there remains a lack of clarity around the effectiveness of commonly implemented psychosocial support interventions focused on preventing disorder and promoting wellbeing. This study aimed to synthesize the literature on evaluations of psychosocial support interventions for populations affected by forced displacement. Methods We searched for peer reviewed and gray literature in seven databases (PubMed, Embase, Global Health, CINAHL, SocIndex, PsychInfo, PILOTS), fifteen organizational websites, and via solicitation through multiple networks. Various study designs were included, with the criteria that they report an evaluation of a psychosocial intervention delivered to populations affected by forced displacement, and included quantitative or qualitative data on psychosocial outcomes. Records were screened independently by two reviewers at both title/abstract and full-text review; data was double-extracted and study quality assessed, with discrepancies resolved by consensus. Meta-analyses for seven outcomes were conducted on a subset of 33 studies. Results We identified 162 reports. Over half (55%) used a single-group study design, with fewer using non-random (19%) or randomized (21%) comparisons. Study designs incorporating comparison conditions were less likely to report positive findings than single-group studies. In the meta-analyses, a moderately strong overall effect was found for psychosocial wellbeing (ES: -0.534, 95% CI: [-0.870, -0.197], p=.005); small effects on both internalizing (ES: -0.152, 95% CI: [-0.310, 0.005], p= .057) and externalizing (ES: -0.249, 95% CI: [-0.515, 0.016], p=.064) problems were promising but not conclusive. Subgroup analysis suggested differential impacts on internalizing problems for adults (improvement; ES: -0.289, 95% CI: [-0.435, -0.143], p=.001) and children (worsening; ES: 0.129, 95% CI: [.054, 0.204], p=.002). Other subgroup analyses showed little meaningful variation by context, population, or intervention characteristics. Conclusion Pragmatic, field-driven program evaluations are dominated by single-group designs with significant risk of bias. Findings from controlled studies are promising but highlight a need for more rigorous research to support causal inference, align outcomes with theories of change, improve measurement of more positive or wellbeing-focused outcomes, examine subgroup differences, and report potentially negative impacts.
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Affiliation(s)
- Amanda J. Nguyen
- School of Education and Human Development, University of Virginia, PO Box 400281, 417 Emmet St S., Charlottesville, VA 22904, United States,Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States,Corresponding author at: School of Education and Human Development, University of Virginia, PO Box 400281, 417 Emmet St S., Charlottesville, VA 22904, United States.
| | - Molly E. Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, United States
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, United States
| | - Indika V. Mallawaarachchi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22904, United States
| | - Kate Joshua
- Claude Moore Health Sciences Library, University of Virginia, 1350 Jefferson Park Avenue, PO Box 800722, Charlottesville, VA 22908, United States
| | - Lucy Bassett
- Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States
| | - Kirsten Gelsdorf
- Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States
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Martínez Torre S, Carreño C, Sordo L, Llosa AE, Ousley J, Waziri A, Mathela R, Umar RD, Usman J, Sagrado MJ. Severity, symptomatology, and treatment duration for mental health disorders: a retrospective analysis from a conflict-affected region of northern Nigeria. Confl Health 2022; 16:41. [PMID: 35840991 PMCID: PMC9284755 DOI: 10.1186/s13031-022-00473-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mental Health and psychosocial support (MHPSS) programs are essential during humanitarian crises and in conflict settings, like Nigeria’s Borno State. However, research on how types of traumatic stress and symptom severity affect clinical improvement is lacking in these contexts, as is consensus over how long these patients must engage in mental health care to see results.
Methods Records from 11,709 patients from the MHPSS program in Pulka and Gwoza local government areas in Borno State, Nigeria from 2018 and 2019 were retrospectively analyzed. Patient information, symptoms, stress type, severity (CGI-S scale), and clinical improvement (CGI-I and MHGS scales) were assessed by the patient and counselor. Associations between variables were investigated using logistic regression models. Results Clinical improvement increased with consultation frequency (OR: 2.5, p < 0.001 for CGI-I; OR: 2, p < 0.001 for MHGS), with patients who received three to six counseling sessions were most likely to improve, according to severity. Survivors of sexual violence, torture, and other conflict/violence-related stressors were nearly 20 times as likely to have posttraumatic stress disorder (PTSD) (OR: 19.7, p < 0.001), and depression (OR: 19.3, p < 0.001) symptomatology. Children exposed to conflict-related violence were also almost 40 times as likely to have PTSD (OR: 38.2, p = 0.002). Most patients presented an improvement in outcome at discharge, per both counselors (92%, CGI-I) and self-rating scores (73%, MHGS). Conclusion We demonstrate a threshold at which patients were most likely to improve (3 sessions for mild or moderate patients; 6 sessions for severe). In addition, we identify the specific types of stress and symptom severity that affected the number of sessions needed to achieve successful outcomes, and highlight that some stress types (especially torture or having a relative killed) were specifically linked to PTSD and depression. Therefore, we emphasize the importance of classifying patient stress type and severity to identify the appropriate duration of care needed.
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Affiliation(s)
| | - Cristina Carreño
- Médecins Sans Frontières, Carrer de Zamora, 54, 08005, Barcelona, Spain.
| | - Luis Sordo
- Department of Public Health and Child Health, Faculty of Medicine, Complutense University, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Augusto E Llosa
- Médecins Sans Frontières, Carrer de Zamora, 54, 08005, Barcelona, Spain
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Seruwagi G, Nakidde C, Lugada E, Ssematiko M, Ddamulira DP, Masaba A, Luswata B, Ochen EA, Okot B, Muhangi D, Lawoko S. Psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda: burden and associations. Confl Health 2022; 16:25. [PMID: 35551630 PMCID: PMC9096741 DOI: 10.1186/s13031-022-00451-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We studied the association between psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.
Methods Cross-sectional survey data on psychological distress, social support, demographics, socio-economic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed in SPSS-version 22, and statistical significance was assumed at p < 0.05. Results Refugees resident in rural/semi-rural settlements exhibited higher levels of psychological distress [F(2, 1011) = 47.91; p < 0.001], higher availability of social interaction [F(2, 1011) = 82.24; p < 0.001], lower adequacy of social interaction [F(2, 1011) = 54.11; p < 0.001], higher availability of social attachment [F(2, 1011) = 47.95; p < 0.001], and lower adequacy of social attachment [F(2, 1011) = 50.54; p < 0.001] than peers in urban settlements. Adequacy of social interaction significantly explained variations in psychological distress levels overall and consistently across settlements, after controlling for plausible confounders. Additionally, adequacy of social attachment significantly explained variations in psychological distress levels among refugees in rural settlements, after controlling for plausible confounders. Conclusion There is a settlement-inequality (i.e. rural vs. urban) in psychological distress and social support among conflict refugees in Uganda. To address psychological distress, Mental Health and Psychosocial Support Services (MHPSS) should focus on strategies which strengthen the existing social networks among refugees. Variations in social support are a key predictor of distress which should guide tailored need-adapted interventions instead of duplicating similar and generic interventions across diverse refugee settlements.
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Affiliation(s)
- Gloria Seruwagi
- Makerere University School of Public Health, Kampala, Uganda. .,Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda.
| | - Catherine Nakidde
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Eric Lugada
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Maria Ssematiko
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | | | | | - Brian Luswata
- Directorate of Governance and Regulation, Ministry of Health, Kampala, Uganda
| | - Eric A Ochen
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Betty Okot
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Denis Muhangi
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Stephen Lawoko
- Department of Public Health Faculty of Medicine, Gulu University, Gulu, Uganda
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Andersen I, Rossi R, Hubloue I. Community-Level Mental Health and Psychosocial Support During Armed Conflict: A Cohort Study From the Democratic Republic of the Congo, Mali, and Nigeria. Front Public Health 2022; 10:815222. [PMID: 35419344 PMCID: PMC8995431 DOI: 10.3389/fpubh.2022.815222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Community-level mental health and psychosocial support (MHPSS) was the first type of MHPSS program launched by the International Committee of the Red Cross (ICRC) back in 2004. Standardized beneficiary-level monitoring was put in place in late 2018. This is the first study to explore whether this type of program correlates, as intended, with reduced psychological distress and increased daily functioning. Methods Between December 2018 and June 2020, 6,413 victims of violence received MHPSS through 32 community-level projects in the Democratic Republic of the Congo (DRC), Mali and Nigeria. Symptoms of psychological distress (IES-R or DASS21) and daily functioning (ICRC scale) were assessed before and after the intervention and logistical regression models were used to identify predictors of these symptoms. Findings Victims of the violence committed by weapon bearers were more likely to show high levels of anxiety prior to MHPSS (aOR 3.51; p < 0.0001). Also, victims of physical violence were more likely to show high levels of stress (aOR 1.49; p < 0.0001), whereas victims who had witnessed physical violence were more like to report high levels of depression (aOR 2.54; p < 0.0001). The most common perpetrators were weapon bearers (76%) and the most common type of violence was rape (46%). Lack of social support stood out as a predictor of both high anxiety (aOR 2.10; p < 0.0001) and post-traumatic stress (aOR 2.04; p < 0.0001) prior to MHPSS. Following MHPSS, the vast majority of beneficiaries reported a reduction in distress on the DASS21 (96.58%) and the IES-R scales (92.70%) as well as an increase of functioning (82.26%). Adherence to group therapy (seven sessions on average) was stronger than adherence to individual therapy (four sessions on average). A linear trend was found between length of treatment and likelihood of reporting reduced symptoms of depression. Having suffered destruction or loss of property or income predicted less improvement of functioning following MHPSS (aOR 0.90; p = 0.044). Conclusion Receiving community-level MHPSS is associated with increased wellbeing among the vast majority of beneficiaries. To further enhance the intended health outcomes, it is recommended to increase the length of treatment per beneficiary (30 days minimum) and address, where relevant, the financial consequences of violence. Also, a longitudinal study is recommended to assess longer-term changes in MHPSS symptoms.
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Affiliation(s)
- Ida Andersen
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland.,Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rodolfo Rossi
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
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10
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Gargano MC, Ajduković D, Vukčević Marković M. Mental Health in the Transit Context: Evidence from 10 Countries. Int J Environ Res Public Health 2022; 19:ijerph19063476. [PMID: 35329157 PMCID: PMC8954994 DOI: 10.3390/ijerph19063476] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Most interventions for mental health and psychosocial support (MHPSS) have been developed in contexts and with populations that differ significantly from the realities of migration. There is an urgent need for MHPSS in transit; however, transit-specific aspects of MHPSS provision are often neglected due to the inherent challenges transit poses to traditional conceptualizations of practice. The Delphi method, which consisted of three iterative rounds of surveys, was applied with the goal of identifying challenges to and adaptations of MHPSS in the transit context. Twenty-six MHPSS providers working with refugees in 10 European transit countries participated; 69% of participants completed all three survey rounds. There was consensus that a flexible model of MHPSS, which can balance low intensity interventions and specialized care, is needed. Agreement was high for practice-related and sociopolitical factors impacting MHPSS in transit; however, the mandate of MHPSS providers working in the transit context achieved the lowest consensus and is yet to be defined. There is a need to rethink MHPSS in the refugee transit context. Providing MHPSS to refugees on the move has specificities, most of which are related to the instability and uncertainty of the context. Future directions for improving mental health protection for refugees, asylum seekers, and migrants in transit are highlighted.
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Affiliation(s)
- Maria Caterina Gargano
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA;
| | - Dean Ajduković
- Department of Psychology, University of Zagreb, Ivana Lucica 3, 10000 Zagreb, Croatia;
| | - Maša Vukčević Marković
- Department of Psychology, Faculty of Philosophy, University of Belgrade, 11000 Belgrade, Serbia
- Psychosocial Innovation Network, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-63-723-4658
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Ibragimov K, Palma M, Keane G, Ousley J, Crowe M, Carreño C, Casas G, Mills C, Llosa A. Shifting to Tele-Mental Health in humanitarian and crisis settings: an evaluation of Médecins Sans Frontières experience during the COVID-19 pandemic. Confl Health 2022; 16:6. [PMID: 35164807 PMCID: PMC8845383 DOI: 10.1186/s13031-022-00437-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/01/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND 'Tele-Mental Health (MH) services,' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format. METHODS From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred. RESULTS Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure. CONCLUSION Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
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Affiliation(s)
| | - Miguel Palma
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France.
| | - Gregory Keane
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | - Janet Ousley
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | | | | | - German Casas
- Fundación Santa Fe University Hospital, Universidad de Los Andes, Bogotá, Colombia
| | - Clair Mills
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
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Travers Á, Abujaber N, McBride KA, Tingsted Blum P, Wiedemann N, Vallières F. Identifying best practice for the supervision of mental health and psychosocial support in humanitarian emergencies: a Delphi study. Int J Ment Health Syst 2022; 16:11. [PMID: 35130947 PMCID: PMC8822743 DOI: 10.1186/s13033-022-00515-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/12/2022] [Indexed: 12/21/2022] Open
Abstract
Background Supportive supervision has been shown to improve worker resilience and wellbeing, which are particularly important in the context of humanitarian emergency settings. Despite its noted importance however, supervision remains an under-prioritised area in mental health and psychosocial support (MHPSS). Method The present study used a Delphi consensus-building methodology to examine levels of agreement among a diverse sample of MHPSS stakeholders (n = 48) on key ideas and concepts relating to supervision in humanitarian settings. Results The majority of statements presented showed a high degree of consensus, with some receiving almost universal agreement, such as the importance of using active listening skills in the supervisory context and the need for supervisors to have access to their own supervisory support. However, disagreement on several points remained. For example, participants disagreed about whether the qualities required to be an effective supervisor can be taught, or whether they are more innate and should be screened for when recruiting supervisors. Gender differences in responses were also analysed, with potential associations between gender and level of agreement emerging in relation to statements about power dynamics, remote supervision, and intervention quality enhancement. Conclusions The findings of the present study are discussed in terms of their implications for a forthcoming set of guidelines for supervision of MHPSS in humanitarian settings: The Integrated Model for Supervision (IMS).
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Affiliation(s)
- Áine Travers
- Trinity Centre for Global Health (TCGH), School of Psychology, Trinity College Dublin, Dublin 2, College Green, Ireland.
| | - Nadeen Abujaber
- Trinity Centre for Global Health (TCGH), School of Psychology, Trinity College Dublin, Dublin 2, College Green, Ireland
| | - Kelly A McBride
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies (IFRC), Blegdamsvej 27, 2100, Copenhagen, Denmark
| | - Pia Tingsted Blum
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies (IFRC), Blegdamsvej 27, 2100, Copenhagen, Denmark
| | - Nana Wiedemann
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies (IFRC), Blegdamsvej 27, 2100, Copenhagen, Denmark
| | - Frédérique Vallières
- Trinity Centre for Global Health (TCGH), School of Psychology, Trinity College Dublin, Dublin 2, College Green, Ireland
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Schwartz L, Nakonechna M, Campbell G, Brunner D, Stadler C, Schmid M, Fegert JM, Bürgin D. Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border. Eur J Psychotraumatol 2022; 13:2101759. [PMID: 36212118 PMCID: PMC9543048 DOI: 10.1080/20008198.2022.2101759] [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] [Indexed: 12/02/2022] Open
Abstract
UNLABELLED Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being. HIGHLIGHTS The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.
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Affiliation(s)
- Lyla Schwartz
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Peace of Mind Afghanistan Global (PoMA Global), Longmeadow, MA, USA
| | - Mariia Nakonechna
- Department of General and Applied Psychology, Nizhyn Gogol State University, Nizhyn, Ukraine.,Unitatem Foundation ("Poland Welcomes"), Jarosław, Poland
| | | | - Donja Brunner
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Christina Stadler
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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Rodriguez IM, Dobler V. Survivors of Hell: Resilience Amongst Unaccompanied Minor Refugees and Implications for Treatment- a Narrative Review. J Child Adolesc Trauma 2021; 14:559-569. [PMID: 34820043 PMCID: PMC8586295 DOI: 10.1007/s40653-021-00385-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Approximately half of the world's displaced population are children and a significant proportion of these are unaccompanied asylum-seeking children (UASC). UASC are the most vulnerable of all refugee populations. Up to 90% of UASC have been subjected to exploitation, including trafficking or being drafted into military groups. Having survived the perils of flight, UASC are confronted with continued challenges, including the uncertainties regarding their residential rights in host counties. Unsurprisingly, the prevalence of mental health problems is higher amongst UASC than in any other refugee group. Yet, Mental Health and Psychosocial Support (MHPSS) appears to neither reach nor engage UASC. This begs for re-examination of what and how MHPSS is offered. Despite high levels of adversity, UASC often have considerable resilience, and make remarkable recoveries. However, literature exploring their resources or their own views of what helps or hinders recovery is scarce. In this narrative review, we explore individual and systemic factors promoting recovery in UASC. We consider theoretical understanding of resilience, emerging data and user perspectives. From these we deduct four areas of resilience in UASC: Individual factors - prosocial behaviour, problem-solving skills; Lifetime relationships - positive early family relationships, connection with family and country of origin, positive peer and adult relationships in host country; Acculturation - integration of own and new culture, positive relationships with prosocial institutions; Care arrangements - supported but less restrictive living arrangements. We suggest, MHPSS may need to focus on enhancing social networks, including connectedness with positive relationships in the home-country, life-history work with a focus on resource-building experiences in addition to trauma, and promoting integration of old and new cultural values. We also conclude that despite growing data, there is a gap in both eliciting user perspectives and understanding adaptive resources, especially those emerging during early development and within their cultural setting. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00385-7.
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Affiliation(s)
| | - Veronika Dobler
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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15
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Kahilogullari AK, Alatas E, Ertugrul F, Malaj A. Satisfaction with mental health and psycho-social support services provided to Syrians under temporary protection in Turkey, evidence from refugee health training centers. J Migr Health 2020; 1-2:100022. [PMID: 34405173 DOI: 10.1016/j.jmh.2020.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Aim The objectives of the study were to determine the level of satisfaction with Mental Health and Psycho-social Support Services (MHPSS) provided to Syrians under temporary protection (SuTP) in Turkey and identify predictors that significantly determine the satisfaction with the MHPSS. This study is part of an effort by Ministry of Health (MoH) and World Health Organization (WHO) to evaluate the improvement in the MHPSS following capacity strengthening of social and health providers. Methods 357 Syrians under temporary protection were interviewed as they exited the Refugee Health Training Centers in 7 provinces in Turkey (Adana, Gaziantep, Hatay, Istanbul, Izmir and Sanliurfa), using patient exit interviews during mid-Oct – mid-Nov 2019. Uni and bivariate analysis for association was done using Chi square test for categorical variables, looking for significance at p < 0.05. Multivariate analysis (logistic regression) was used to determine the profile of service users and the predictors of satisfaction with MHPSS. Results Overall satisfaction with services was 93%. The profile of the MHPSS user suggests that the odds of using the service are twice as much for people aged 40+ years (OR 2.016, CI95% [1.129–3.601]), and five times less for married women (OR 0.180, CI95% [0.083–0.391]). The service characteristics that can predict service satisfaction are “having the needs met” (OR 138.73, CI95% [27.99–687.54]) and “satisfaction with the length of the appointments” (OR 54.50, CI95% [6.07–489.57]). There was no multicollinearity detected between the predictors. Conclusions MHPSS services provided by professionals trained by MoH and WHO, have a high satisfaction rate and are serving the SuTP population in need. The high satisfaction rate is predicted by having MHPSS needs met, which is a key indication of the usefulness of these services.
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Miller KE, Jordans MJD, Tol WA, Galappatti A. A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings. Epidemiol Psychiatr Sci 2021; 30:e5. [PMID: 33413736 PMCID: PMC8057504 DOI: 10.1017/s2045796020001110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. METHODS We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. RESULTS Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. CONCLUSIONS Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
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Affiliation(s)
| | - M. J. D. Jordans
- War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - W. A. Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Turki Y, Saleh S, Albaik S, Barham Y, van de Vrie D, Shahin Y, Hababeh M, Armagan M, Seita A. Assessment of the knowledge, attitudes, and practices (KAP) among UNRWA* health staff in Jordan concerning mental health programme pre-implementation: a cross-sectional study. Int J Ment Health Syst 2020; 14:54. [PMID: 32760442 PMCID: PMC7392824 DOI: 10.1186/s13033-020-00386-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental health is a major public health priority, especially among refugees. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary healthcare services in Jordan in late 2017. In this study, we aimed to assess of the knowledge, attitudes, and practices (KAP) among UNRWA health staff (HS) in Jordan concerning mental health programme pre-implementation, and their perceived barriers about this MHPSS programme. METHODS A cross-sectional study was conducted among doctors, dentists, nurses, and midwives who work at 16 of the 25 UNRWA health centres in Jordan. The assessment was made using a validated self-administered questionnaire. Data analysis was performed using SPSS (version 22). RESULTS Of the participants, 73% (161 of 220) believed that their knowledge of MHPSS programmes was insufficient, with no significant difference (p = 0·116) between different categories of staff. Furthermore, 88% (194 of 220) said that they needed more training, 67% (147 of 220) reported that the number of mental health cases is increasing, and 50% (110 of 220) that dealing with these cases is difficult. Reflecting on the past 12 months, 31% of staff (69 out of 220) reported meeting between one and ten children, and 45% (100 out of 220) reported meeting between one and ten adults suspected of having mental illnesses. The most suspected condition was depression (84%; 150 of 220), followed by epilepsy (64%; 140 of 220). The main perceived barriers to implementation included the limited availability of MHPSS policies (87%; 192 of 220), MH professionals (86%; 190 of 220), resources (86%; 189 out of 220), and lack of privacy (14%; 31 out of 220). CONCLUSIONS Most health staff had positive attitudes towards MHPSS programme implementation but felt they lacked the required knowledge. There is a need for training and clear technical guidelines. Perceived barriers to MHPSS programme implementation were consistent with the previous studies and need to be tackled with a structured plan of action.
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Affiliation(s)
- Yassir Turki
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Suha Saleh
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Shatha Albaik
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Yasmeen Barham
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Dorien van de Vrie
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Yousef Shahin
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Majed Hababeh
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
| | - Merve Armagan
- College of Fine Arts, Humanities and Social Sciences, The University of Massachusetts Lowell, Lowell, United States
| | - Akihiro Seita
- Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan
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Seto M, Nemoto H, Kobayashi N, Kikuchi S, Honda N, Kim Y, Kelman I, Tomita H. Post-disaster mental health and psychosocial support in the areas affected by the Great East Japan Earthquake: a qualitative study. BMC Psychiatry 2019; 19:261. [PMID: 31455275 PMCID: PMC6712862 DOI: 10.1186/s12888-019-2243-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few studies exploring the actual practices implemented for long-term mental health and psychosocial support after a natural disaster have been published. This study aimed to reveal (1) the types of activities that were actually provided as mental health and psychosocial support (MHPSS) in the long-term phase after the Great East Japan Earthquake (GEJE) and (2) the problems that must be addressed to provide post-disaster MHPSS activities. METHODS An open-ended questionnaire was sent to organizations in the Iwate, Miyagi and Fukushima prefectures that were potentially involved in providing MHPSS to communities affected by the GEJE. The organizations were asked to describe their activities and the problems that needed to be addressed to provide these support activities. The collected statements were analysed using content analysis with NVivo11. RESULTS The support activities conducted to provide MHPSS in the long-term phase after the catastrophe were diverse and classified into 7 major categories, namely, (1) one-on-one support for individuals in need of assistance, (2) support for collective activities, (3) support around living conditions and income, (4) increasing public awareness about mental health, (5) human resource development to improve response capabilities for MHPSS, (6) support for MHPSS providers, and (7) facilitating collaborations among the MHPSS activities provided to affected communities. Problems with human resources and funding were the most frequently mentioned concerns among the organizations participating in the survey. CONCLUSIONS The establishment of systems to collect and share sufficient and relevant knowledge and to coordinate organizations for long-term post-disaster postventions would be desirable.
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Affiliation(s)
- Moe Seto
- Department of Disaster Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8573, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Harumi Nemoto
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8573, Japan
| | | | - Saya Kikuchi
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Nami Honda
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yoshiharu Kim
- Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- National Information Center of Disaster Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction and Institute for Global Health, University College London, London, UK
- University of Agder, Kristiansand, Norway
| | - Hiroaki Tomita
- Department of Disaster Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan.
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8573, Japan.
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan.
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Decosimo CA, Hanson J, Quinn M, Badu P, Smith EG. Playing to live: outcome evaluation of a community-based psychosocial expressive arts program for children during the Liberian Ebola epidemic. Glob Ment Health (Camb) 2019; 6:e3. [PMID: 31143464 PMCID: PMC6521133 DOI: 10.1017/gmh.2019.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 03/19/2018] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results. METHODS There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups. RESULTS Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time. CONCLUSIONS Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.
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Affiliation(s)
- C. A Decosimo
- Playing to Live, East Tennessee State University, Johnson City, TN, USA
| | - J. Hanson
- University of Pittsburg, Pittsburgh, PA, USA
| | - M. Quinn
- East Tennessee State University, Johnson City, TN, USA
| | - P. Badu
- Playing to Live, Renewed Energy Serving Humanity, Paynesville, Liberia
| | - E. G. Smith
- Renewed Energy Serving Humanity, Monrovia, Liberia
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Satinsky E, Fuhr DC, Woodward A, Sondorp E, Roberts B. Mental health care utilisation and access among refugees and asylum seekers in Europe: A systematic review. Health Policy 2019; 123:851-863. [PMID: 30850148 DOI: 10.1016/j.healthpol.2019.02.007] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Refugees and asylum seekers often have increased mental health needs, yet may face barriers in accessing mental health and psychosocial support (MHPSS) services in destination countries. The aim of this systematic review is to examine evidence on MHPSS service utilisation and access among refugees and asylum seekers in European Union Single Market countries. METHODS Four peer-reviewed and eight grey literature databases were searched for quantitative and qualitative literature from 2007 to 2017. Access was categorised according to Penchansky and Thomas' framework and descriptive analyses were conducted. Quality of studies was assessed by the Newcastle-Ottawa scale and the Critical Appraisal Skills Programme checklist. RESULTS Twenty-seven articles were included. The findings suggest inadequate MHPSS utilisation. Major barriers to accessing care included language, help-seeking behaviours, lack of awareness, stigma, and negative attitudes towards and by providers. CONCLUSIONS Refugees and asylum seekers have high mental health needs but under-utilise services in European host countries. This underutilisation may be explained by cultural-specific barriers which need to be tackled to increase treatment demand. Training health providers on cultural models of mental illness may facilitate appropriate identification, referral, and care. Based on these findings, it is crucial to review policies regarding MHPSS provision across the EU.
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Affiliation(s)
- Emily Satinsky
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, United Kingdom.
| | - Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, United Kingdom
| | - Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Egbert Sondorp
- KIT Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, United Kingdom
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Troya MI, Greene MC, Santos CG, Shultz JM. Conducting a desk review to inform the mental health and psychosocial support response to the 2016 Ecuador earthquake. Disaster Health 2016; 3:90-101. [PMID: 28265485 DOI: 10.1080/21665044.2016.1261598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
Following the 7.8 magnitude earthquake that struck Ecuador on 16 April 2016, multiple salient public health concerns were raised, including the need to provide mental health and psychosocial support for individual survivors and their communities. The World Health Organization and the United Nations High Commissioner for Refugees recommend conducting a desk review to summarize existing information, specific to the affected communities, that will support timely, culturally-attuned assessment and delivery of mental health and psychosocial support shortly after the onset of a disaster or humanitarian emergency. The desk review is one component of a comprehensive toolkit designed to inform and support humanitarian actors and their responders in the field. This commentary provides a case example of the development of a desk review that was used to inform personnel responding to the 2016 earthquake in Ecuador. The desk review process is described in addition to several innovations that were introduced to the process during this iteration. Strengths and limitations are discussed, as well as lessons learned and recommendations for future applications.
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Affiliation(s)
- M Isabela Troya
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - M Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | - James M Shultz
- Center for Disaster & Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine , Miami FL, USA
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