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Ahmed DR, Mesbah SM, Al Diab Al Azzawi M, Heun R. Trauma and mental health problems among Iraqi IDPs following the 2014 ISIS Invasion: a systematic review. Med Confl Surviv 2024:1-22. [PMID: 39420181 DOI: 10.1080/13623699.2024.2411651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 09/29/2024] [Indexed: 10/19/2024]
Abstract
This study aimed to examine the mental health issues and trauma faced by Iraqi IDPs post-2014. Adhering to PRISMA guidelines, we conducted a literature search in PubMed, Scopus, and Google Scholar, identifying 208 articles. After excluding 190 articles for duplication and ineligibility, we ultimately included 18 studies. The Joanna Briggs Institute critical evaluation checklist was used for quality assessment. Studies involved 5,764 participants from diverse ethno-religious groups including Arabs, Kurds, Christians, and Yazidis. Participants were mostly female (55.5%), male (38.4%), and the smallest and largest study samples were 29 and 1,256, respectively. Ages ranged from 12.18 to 43.34 years. The results revealed a high prevalence of PTSD at 61.9%, with depression and anxiety rates at 49% and 51%, respectively, and suicidal behaviours at 67.5%. Among IDP subgroups, PTSD and suicidal behaviours were particularly high among Yazidi-enslaved girls and women, at 90.6% and 67.55% respectively. Major trauma exposures included forced displacement, encounters with combat and violence, enslavement, and witnessing the death or abuse of relatives. Critical contributing factors to mental health problems were gender (being female), economic instability, prolonged displacement, exposure to combat, experiences of rape and torture, and limited access to services. The mental health support of this vulnerable population is critical.
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Affiliation(s)
- Darya Rostam Ahmed
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koya, Iraq
- Department of Medical Laboratory Science, College of Science, Knowledge University, Erbil, Iraq
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Anisman H, Doubad D, Asokumar A, Matheson K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. Neurosci Biobehav Rev 2024; 165:105859. [PMID: 39159733 DOI: 10.1016/j.neubiorev.2024.105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/06/2024] [Accepted: 08/15/2024] [Indexed: 08/21/2024]
Abstract
Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.
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Affiliation(s)
- H Anisman
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada.
| | - D Doubad
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada
| | - A Asokumar
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada
| | - K Matheson
- Carleton University, Department of Neuroscience, Ottawa, Ontario K1S 5B6, Canada
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Ibrahim H, Goessmann K, Neuner F, Iffland B. Continuous chains: childhood maltreatment and intimate partner violence victimization among displaced women in a war context. BMC Womens Health 2024; 24:319. [PMID: 38824574 PMCID: PMC11143579 DOI: 10.1186/s12905-024-03156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Childhood victimization has been associated with long-term psychological effects and an increased risk of being victimized in later life. Previous research has primarily focused on sexual abuse during childhood, and a wide range of consequences have been identified. However, a significant gap remains in our understanding of the complex interaction between different forms of childhood abuse and violence in later life, particularly in the context of broader social stressors such as armed conflict and displacement. METHODS This study examines the association between exposure to different types of childhood maltreatment in the context of family and intimate partner violence (IPV) among displaced women living in refugee camps in northern Iraq. Structured interviews were conducted by trained female psychologists with 332 women aged between 20 and 62 years. RESULTS Results indicated that over one-third of the participating women reported experiencing at least one occurrence of IPV by their husbands within the past year. In addition, participants reported experiences of different types of maltreatment (physical, emotional, and sexual violence and physical and emotional neglect) perpetrated by family members in their childhood. While all forms of childhood maltreatment showed an association with IPV within the past year, only emotional childhood maltreatment was found to be a significant predictor of IPV in a multivariate analysis. CONCLUSION The study highlights the ongoing impact of child maltreatment and its contribution to increased vulnerability to IPV victimization in later life. In addition, this study describes the specific cultural and contextual elements that contribute to IPV in refugee camps.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.
- vivo international e.V., Konstanz, Germany.
| | - Katharina Goessmann
- Department of Clinical Psychology and Violence Research, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
- vivo international e.V., Konstanz, Germany
| | - Benjamin Iffland
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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DiClemente-Bosco K, Binyungu A, Shabani C, Pellowski JA, Operario D, Nugent N, Harrison A. 'I am because you are': Community support as a bridge to mental wellbeing for resettled African refugee women living in Rhode Island. Glob Public Health 2024; 19:2314106. [PMID: 38334139 PMCID: PMC10966713 DOI: 10.1080/17441692.2024.2314106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.
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Affiliation(s)
- Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
| | | | | | - Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine at the Warren Alpert Medical School of Brown University, Providence, RI
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
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Ahmed DR, Heun R. The prevalence of psychiatric disorders among Yazidi people results from ISIS invasion and consecutive trauma: A systematic review. Asian J Psychiatr 2023; 88:103703. [PMID: 37517332 DOI: 10.1016/j.ajp.2023.103703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The Yazidi community is a Kurdish minority of the population that lives mainly in Iraq. In history, they suffered from many problems and disasters, including the most recent brutal invasion by ISIS, which significantly impacted their mental health. AIMS Our objective is to examine the prevalence of psychiatric disorders among Yazidi people resulting from the invasion of ISIS in 2014. METHODS A systematic review was performed using the PRISMA protocol. 252 publications were initially identified in PubMed, EMBASE, Scopus, and Google Scholar using relevant keywords. Finally, 23 full articles were included for data extraction. The inclusion criteria were English papers that investigated Yazidi's psychiatric problems, regardless of gender, or age. However, letters to editors, systematic reviews, and studies that examine general physical health were excluded. RESULTS A total of 252 publications were identified; 217 were assessed for eligibility, of which 23 studies met eligibility criteria and were included in the present systematic review. According to the findings, the Yazidi people were severely affected by persecution, forced migration, massacres, and ISIS violence in the recent period and suffered from a variety of mental and psychiatric problems. The most prevalent mental disorders among Yazidi people of all ages and sexes are PTSD, depression, and anxiety disorders. CONCLUSION This study indicates that the Yazidi minority is a traumatized population. According to the results of the current systematic review, the Yazidi have suffered from a variety of mental and psychological disorders, most commonly PTSD, depression, and anxiety. Eventually, addressing these challenges should be prioritized to improve the quality of life of Yazidis through implications for intervention.
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Affiliation(s)
- Darya Rostam Ahmed
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koya KOY45, Kurdistan Region - F.R. Iraq.
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Fisseha G, Gebrehiwot TG, Gebremichael MW, Wahdey S, Meles GG, Gezae KE, Legesse AY, Asgedom AA, Tsadik M, Woldemichael A, Gebreyesus A, Abebe HT, Haile YA, Gezahegn S, Aregawi M, Berhane KT, Godefay H, Mulugeta A. War-related sexual and gender-based violence in Tigray, Northern Ethiopia: a community-based study. BMJ Glob Health 2023; 8:e010270. [PMID: 37479499 PMCID: PMC10364179 DOI: 10.1136/bmjgh-2022-010270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 07/01/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Sexual and gender-based violence (SGBV) during armed conflicts has serious ramifications with women and girls disproportionally affected. The impact of the conflict that erupted in November 2020 in Tigray on SGBV is not well documented. This study is aimed at assessing war-related SGBV in war-affected Tigray, Ethiopia. METHODS A community-based survey was conducted in 52 (out of 84) districts of Tigray, excluding its western zone and some districts bordering Eritrea due to security reasons. Using a two-stage multistage cluster sampling technique, a total of 5171 women of reproductive age (15-49 years) were randomly selected and included in the study. Analysis used weighted descriptive statistics, regression modelling and tests of associations. RESULTS Overall, 43.3% (2241/5171) of women experienced at least one type of gender-based violence. The incidents of sexual, physical and psychological violence, and rape among women of reproductive age were found to be 9.7% (500/5171), 28.6% (1480/5171), 40.4% (2090/5171) and 7.9% (411/5171), respectively. Of the sexual violence survivors, rape accounted for 82.2% (411/500) cases, of which 68.4% (247) reported being gang raped. Young women (aged 15-24 years) were the most affected by sexual violence, 29.2% (146/500). Commonly reported SGBV-related issues were physical trauma, 23.8% (533/2241), sexually transmitted infections, 16.5% (68/411), HIV infection, 2.7% (11/411), unwanted pregnancy, 9.5% (39/411) and depression 19.2% (431/2241). Most survivors (89.7%) did not receive any postviolence medical or psychological support. CONCLUSIONS Systemic war-related SGBV was prevalent in Tigray, with gang-rape as the most common form of sexual violence. Immediate medical and psychological care, and long-term rehabilitation and community support for survivors are urgently needed and recommended.
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Affiliation(s)
- Girmatsion Fisseha
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | | | | | - Shishay Wahdey
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | | | - Kebede Embaye Gezae
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - Awol Yemane Legesse
- School of Medicine, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - Akeza Awealom Asgedom
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - Mache Tsadik
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - Abraha Woldemichael
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - Aregawi Gebreyesus
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - Haftom Temesgen Abebe
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | | | - Selome Gezahegn
- Hennepin Healthcare, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maru Aregawi
- Global Malaria Program, World Health Organization, Geneve, Switzerland
| | | | | | - Afework Mulugeta
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
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Veronese G, Mahmid FA, Bdier D. Gender-Based Violence, Subjective Quality of Life, and Mental Health Outcomes Among Palestinian Women: The Mediating Role of Social Support and Agency. Violence Against Women 2023; 29:925-948. [PMID: 36042012 DOI: 10.1177/10778012221099988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We tested the association between gender-based violence (GBV), subjective quality of life, and mental distress manifested by anxiety, depression, and stress among Palestinian women exposed to political and military violence. Depression, Anxiety and Stress Scale-21, Berlin Social Support Scales, WHO-5 subjective Quality of Life Scale, Women's Agency Scale 61, and Violence Against Women Questionnaire were administered to 332 purposely selected participants. Structural equation modeling was applied to address the study hypothesis. A conceptual model depicting GBV as a predictor, mental distress as an outcome variable, and agency and social support as mediators was confirmed.
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Affiliation(s)
- Guido Veronese
- 189822University of Milano-Bicocca, Milan, Italy.,Stellenbosch University, Stellenbosch, South Africa
| | - Fayez Azez Mahmid
- 189822University of Milano-Bicocca, Milan, Italy.,61284An-Najah National University, Nablus, Palestine
| | - Dana Bdier
- 189822University of Milano-Bicocca, Milan, Italy.,61284An-Najah National University, Nablus, Palestine
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Hodes M. Thinking about young refugees' mental health following the Russian invasion of Ukraine in 2022. Clin Child Psychol Psychiatry 2023; 28:3-14. [PMID: 36071016 DOI: 10.1177/13591045221125639] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Russian invasion of Ukraine on 24th February 2022 has prompted this article to summarise some of the salient mental health issues experienced by young asylum seekers and refugees focussing on resettlement countries, drawing on the substantial literature, for Child and Adolescent Mental Health Practitioners. Firstly, the various UNHCR categories of persons affected by war and persecution and statistics are described. By July 2022, over 100 million people globally were of concern to UNHCR, a number increased by the many millions of refugees fleeing Ukraine to neighbouring countries. Selected findings on the psychiatric epidemiology of young refugees are summarised, and some principles of Child and Adolescent Mental Health Service delivery and treatments are outlined. The research on Ukrainian refugees' mental health is limited and this is an area that requires further investigation alongside active attempts to meet their mental health needs.
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Affiliation(s)
- Matthew Hodes
- Division of Psychiatry, Imperial College London, London, UK; Westminster Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
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Rofo S, Gelyana L, Moramarco S, Alhanabadi LHH, Basa FB, Dellagiulia A, Emberti Gialloreti L. Prevalence and risk factors of posttraumatic stress symptoms among Internally Displaced Christian couples in Erbil, Iraq. Front Public Health 2023; 11:1129031. [PMID: 37033064 PMCID: PMC10076725 DOI: 10.3389/fpubh.2023.1129031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Research about the impact of war and displacement experiences on the mental health of Internally Displaced People (IDPs) has recently grown. However, a limited number of studies focus on minorities. The objective of the present preliminary study was to estimate the prevalence of posttraumatic stress symptoms (PTSSs) among IDPs who live outside camps and belong to the Christian minority in Iraq, and to identify possible predictors. Methods Overall, 108 internally displaced Christians (54 married couples) participated in the study. Traumatic events and PTSSs were assessed using the Harvard Trauma Questionnaire. Multivariable linear regression models were used to investigate possible predictors of PTSSs. Multivariable logistic regression models have been developed to estimate the odds of presenting PTSSs. Results Results demonstrated high rates of trauma exposure, with all participants having experienced at least three traumatic events. The estimated prevalence of PTSSs was 20.3%. A low economic status, the number of traumatic events, and a second experience of displacement were associated with increased PTSSs. Five traumatic events were identified as the main predictors of PTSSs. Conclusion Findings from the current preliminary study indicated the impact of war-related traumatic events on IDPs' mental health and the negative effects of post-displacement experiences. These findings may have important implications for setting up psychosocial interventions, as well as for further promoting physical and mental health services among these populations.
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Affiliation(s)
- Sana Rofo
- Department of Psychology, Salesian University of Rome, Rome, Italy
| | - Lina Gelyana
- Department of Psychology, Salesian University of Rome, Rome, Italy
| | - Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luma H. H. Alhanabadi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Primary Health Care, Preventive Health Affairs Directorate, Duhok, Iraq
| | - Faiq B. Basa
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Department, Rizgary Teaching Hospital, Erbil, Iraq
| | | | - Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: Leonardo Emberti Gialloreti
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Giordano V, Giordano C, Lopes IM, Pires RE, Godoy-Santos A, Giannoudis PV. Orthopaedic surgeons can play important role in identifying victims of domestic violence in the emergency department - narrative review of Brazilian literature. Medicine (Baltimore) 2022; 101:e31461. [PMID: 36550911 PMCID: PMC9771306 DOI: 10.1097/md.0000000000031461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic violence, in accordance with Brazilian legislation. The main objective of the study was to show the role of this specialist in identifying victims of domestic violence by recognizing their profiles and associated risk factors. The secondary objectives were to demonstrate the most common skeletal and non-skeletal injuries in this type of violence and to present a quick and practical guide on how to identify, approach, and manage cases of domestic violence against women. The findings revealed that the main aggressors were close partners, such as spouses and ex-spouses. Young adult women, black or multiracial, and low socioeconomic status are major risk factors for intimate partner violence. Head and neck injuries are the most frequently observed lesions in this population, with more than one-third of victims reporting falls. Musculoskeletal injuries are present in up to 42% of victims of domestic violence, occurring predominantly in the upper limbs and chest, and are the leading cause of death in women aged 1 to 34 years. A practical guide for orthopedic surgeons who work in emergency departments is proposed, with basic information about their role and responsibility in identifying potential victims of intimate partner violence.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
- Clínica São Vicente, Rede D’or São Luiz, Rio de Janeiro, Brazil
- *Correspondence: Vincenzo Giordano, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, 22430-160, Rio DE Janeiro, RJ, Brazil (e-mail: )
| | - Carolina Giordano
- Clínica da Família Maria do Socorro Silva e Souza, Secretaria Municipal de Saúde do Rio de Janeiro, Clínica da Família Estácio de Sá, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isadora Maria Lopes
- Clínica da Família Maria do Socorro Silva e Souza, Secretaria Municipal de Saúde do Rio de Janeiro, Clínica da Família Estácio de Sá, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Alexandre Godoy-Santos
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom
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Vivalya BMN, Vagheni MM, Kitoko GMB, Vutegha JM, Kalume AK, Piripiri AL, Masika YD, Mbeva JBK. Developing mental health services during and in the aftermath of the Ebola virus disease outbreak in armed conflict settings: a scoping review. Global Health 2022; 18:71. [PMID: 35836283 PMCID: PMC9281256 DOI: 10.1186/s12992-022-00862-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background Mental health is mostly affected by numerous socioeconomic factors that need to be addressed through comprehensive strategies. The aftermath of armed conflict and natural disasters such as Ebola disease virus (EVD) outbreaks is frequently associated with poor access to mental healthcare. To design the basis of improving mental health services via the integration of mental health into primary health care in the Democratic Republic of Congo (DRC), we conducted a scoping review of available literature regarding mental illness in armed conflict and EVD outbreak settings. Methods This scoping review of studies conducted in armed conflict and EVD outbreak of DRC settings synthesize the findings and suggestions related to improve the provision of mental health services. We sued the extension of Preferred Reporting Items for Systematic Reviews and Meta-Analyses to scoping studies. A mapping of evidence related to mental disorders in the eastern part of DRC from studies identified through searches of electronic databases (MEDLINE, Scopus, Psych Info, Google Scholar, and CINAHL). Screening and extraction of data were conducted by two reviewers independently. Results This review identified seven papers and described the findings in a narrative approach. It reveals that the burden of mental illness is consistent, although mental healthcare is not integrated into primary health care. Access to mental healthcare requires the involvement of affected communities in their problem-solving process. This review highlights the basis of the implementation of a comprehensive mental health care, through the application of mental health Gap Action Program (mhGAP) at community level. Lastly, it calls for further implementation research perspectives on the integration of mental healthcare into the health system of areas affecting by civil instability and natural disasters. Conclusion This paper acknowledges poor implementation of community mental health services into primary health care in regions affected by armed conflict and natural disasters. All relevant stakeholders involved in the provision of mental health services should need to rethink to implementation of mhGAP into the emergency response against outbreaks and natural disasters.
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Affiliation(s)
- Bives Mutume Nzanzu Vivalya
- Department of Psychiatry, Kampala International University Western Campus, P.O BOX 71, Bushenyi, Uganda. .,Department of Internal Medicine, Masereka General Referral Hospital, Goma, North-Kivu, Democratic Republic of the Congo.
| | | | | | | | - Augustin Kensale Kalume
- Department of Psychiatry, Kampala International University Western Campus, P.O BOX 71, Bushenyi, Uganda
| | - Astride Lina Piripiri
- Kinshasa School of Public Health, Faculty of Medicine University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yvonne Duagani Masika
- Faculté de Psychologie et des Sciences de l'Education, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Jean-Bosco Kahindo Mbeva
- Department of Public Health, Official University of Ruwenzori, Goma, North-Kivu, Democratic Republic of the Congo
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12
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Rivara FP, Haneuse SJPA, Morris AM, Fihn SD. Call for Papers on the Effects of War on Health and Health Care Delivery, Access, and Equity. JAMA Netw Open 2022; 5:e2217872. [PMID: 35622371 DOI: 10.1001/jamanetworkopen.2022.17872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle
- Editor, JAMA Network Open
| | - Sebastien J P A Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Statistical Editor, JAMA Network Open
| | - Arden M Morris
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- Associated Editor, JAMA Network Open
| | - Stephan D Fihn
- Department of Medicine, University of Washington, Seattle
- Deputy Editor, JAMA Network Open
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13
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The mental health and well-being of internally displaced female Yazidis in the Kurdistan Region of Iraq: a realist review of psychosocial interventions and the impact of COVID-19. Glob Ment Health (Camb) 2022; 9:508-520. [PMID: 36618744 PMCID: PMC9806966 DOI: 10.1017/gmh.2022.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Yazidis in the Kurdistan Region of Iraq have been exposed to recurrent traumatic experiences associated with genocide and gender-based violence (GBV). In 2014, ISIS perpetrated another genocide against the Yazidi community of Sinjar. Women and girls were held captive, raped and beaten. Many have been forced into displacement. Rates of post-traumatic stress disorder (PTSD) and suicide are high. Limited research has evaluated interventions delivered to this population. METHODS This review explores how the global evidence on psychosocial interventions for female survivors of conflict-related sexual violence applies to the context of the female Yazidi population. We used a realist review to explore mechanisms underpinning complex psychosocial interventions delivered to internally displaced, conflict-affected females. Findings were cross-referenced with eight realist, semi-structured interviews with stakeholders who deliver interventions to female Yazidis in the Kurdistan Region of Iraq. Interviews also allowed us to explore the impact of COVID-19 on effectiveness of interventions. RESULTS Seven mechanisms underpinned positive mental health outcomes (reduced PTSD, depression, anxiety, suicidal ideation): safe spaces, a strong therapeutic relationship, social connection, mental health literacy, cultural-competency, gender-matching and empowerment. Interviews confirmed relevance and applicability of mechanisms to the displaced female Yazidi population. Interviews also reported increased PTSD, depression, suicide and flashbacks since the start of the COVID-19 pandemic, with significant disruptions to interventions. CONCLUSION COVID-19 is just one of many challenges in the implementation and delivery of interventions. Responding to the mental health needs of female Yazidis exposed to chronic collective violence requires recognition of their sociocultural context and everyday experiences.
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Meagher K, Attal B, Patel P. Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review. Global Health 2021; 17:88. [PMID: 34348740 PMCID: PMC8334332 DOI: 10.1186/s12992-021-00738-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.
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Affiliation(s)
- Kristen Meagher
- Research for Health Systems Strengthening in northern Syria, Conflict and Health Research Group (CHRG), Department of War Studies, King's College London, London, UK.
| | - Bothaina Attal
- Faculty of Medicine and Health Sciences, Sana'a University, Yemen and Centre for Business Research, University of Cambridge, Cambridge, UK
| | - Preeti Patel
- Research for Health Systems Strengthening in northern Syria, Conflict and Health Research Group (CHRG), Department of War Studies, King's College London, London, UK
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Meinhart M, Seff I, Troy K, McNelly S, Vahedi L, Poulton C, Stark L. Identifying the Impact of Intimate Partner Violence in Humanitarian Settings: Using an Ecological Framework to Review 15 Years of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6963. [PMID: 34209746 PMCID: PMC8297014 DOI: 10.3390/ijerph18136963] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational impact of IPV in humanitarian settings. However, findings highlighted a glaring gap in evidence examining the non-health impact of IPV for survivors in humanitarian settings and across levels of the ecological framework. Without enhanced research of women and girls and the violence they experience, humanitarian responses will continue to underachieve, and the needs of women and girls will continue to be relegated as secondary interests. Investment should prioritize addressing the range of both health and non-health impacts of IPV among individuals, families, and communities, as well as consider how the humanitarian environment influences these linkages.
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Affiliation(s)
- Melissa Meinhart
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Ilana Seff
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Katrina Troy
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Samantha McNelly
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | - Luissa Vahedi
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
| | | | - Lindsay Stark
- Brown School of Social Work, Washington University, in St. Louis 1 Brookings Drive, St. Louis, MO 63130, USA; (M.M.); (I.S.); (K.T.); (S.M.); (L.V.)
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Denkinger JK, Rometsch C, Engelhardt M, Windthorst P, Graf J, Pham P, Gibbons N, Zipfel S, Junne F. Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence. JAMA Netw Open 2021; 4:e2111120. [PMID: 34047793 PMCID: PMC8164098 DOI: 10.1001/jamanetworkopen.2021.11120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking. OBJECTIVE To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019). EXPOSURES Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State. MAIN OUTCOMES AND MEASURES Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised. RESULTS A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms. CONCLUSIONS AND RELEVANCE These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.
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Affiliation(s)
- Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Alice Salomon University Berlin, University of Applied Science, Berlin, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Hospital Havelhöhe, Berlin, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
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