1
|
Kaminer D, Booysen D, Ellis K, Kristensen CH, Patel AR, Robjant K, Sardana S. Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries. J Trauma Stress 2024; 37:563-573. [PMID: 38459223 DOI: 10.1002/jts.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 03/10/2024]
Abstract
In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.
Collapse
Affiliation(s)
- Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Duane Booysen
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Kate Ellis
- Department of Psychology, American University in Cairo, New Cairo, Egypt
| | - Christian Haag Kristensen
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anushka R Patel
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Katy Robjant
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Srishti Sardana
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Papola D, Prina E, Ceccarelli C, Cadorin C, Gastaldon C, Ferreira MC, Tol WA, van Ommeren M, Barbui C, Purgato M. Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2024; 5:CD014300. [PMID: 38770799 PMCID: PMC11106803 DOI: 10.1002/14651858.cd014300.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health. OBJECTIVES To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour. MAIN RESULTS We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults. AUTHORS' CONCLUSIONS To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
Collapse
Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Madalena C Ferreira
- Public Health Unit, Médio Ave Local Health Unit, Vila Nova de Famalicão, Portugal
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mark van Ommeren
- Department of Mental Health, Brain Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Feinstein D. Using energy psychology to remediate emotional wounds rooted in childhood trauma: preliminary clinical guidelines. Front Psychol 2023; 14:1277555. [PMID: 37920741 PMCID: PMC10619750 DOI: 10.3389/fpsyg.2023.1277555] [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: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 11/04/2023] Open
Abstract
Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood, such as violence, abuse, severe neglect, or mental health problems in caregivers. The negative physical and mental health consequences of severe or multiple ACEs provide a major challenge for the health care community. Psychotherapies that utilize a mind-body approach in treating ACE-related conditions are seen by their proponents as having advantages for bringing healing and restoration compared with talk, introspective, interpersonal, and exposure therapies that do not intervene at the body level, as famously encapsulated by Bessel van der Kolk's observation that "the body keeps the score." A mind-body approach whose use has been rapidly increasing in clinical settings as well as on a self-help basis is called "energy psychology." Energy psychology combines conventional therapeutic techniques such as cognitive restructuring and psychological exposure with the stimulation of acupuncture points (acupoints) by tapping on them. A review of the development, efficacy, and plausible mechanisms of energy psychology is presented, and several strengths are enumerated, such as how integrating acupoint tapping into conventional exposure methods enhances the speed and power of outcomes. The impact of energy psychology protocols on the three brain networks most centrally involved with ACEs is also examined. Finally, recommendations are offered for using an energy psychology approach at each stage of therapy with individuals who have endured severe or multiple ACES, from establishing a therapeutic alliance to assessment to treatment to follow-up.
Collapse
|
4
|
Strupf M, Wiechers M, Bajbouj M, Böge K, Karnouk C, Goerigk S, Kamp-Becker I, Banaschewski T, Rapp M, Hasan A, Falkai P, Jobst-Heel A, Habel U, Stamm T, Heinz A, Hoell A, Burger M, Bunse T, Hoehne E, Mehran N, Kaiser F, Hahn E, Plener P, Übleis A, Padberg F. Predicting treatment outcomes of the Empowerment group intervention for refugees with affective disorders: Findings from the MEHIRA project. J Affect Disord 2023; 323:241-250. [PMID: 36427652 DOI: 10.1016/j.jad.2022.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research on outcome predictors in the field of transcultural treatment for refugees and asylum seekers (RAS) is scarce. We aimed to evaluate predictors of outcome of a group intervention (Empowerment) for RAS with affective disorders which was incorporated at level three of the stratified stepped-care model within the Mental Health in Refugees and Asylum Seekers (MEHIRA) project. METHODS A predictor analysis was performed at level three of the MEHIRA project, where 149 refugees with moderate depressive symptoms were treated either with Empowerment or Treatment-as-usual (TAU). Outcome measures were depression severity as assessed by patient-rated Patient Health Questionnaire 9 (PHQ-9) and clinician-rated Montgomery Asberg Depression Rating Scale (MADRS). Regression models with change scores (T1-T0) of PHQ-9 and MADRS as dependent variables were fit. Predictor selection was a mixed-method approach combining testing of literature-based hypotheses and explorative hypothesis-generating analyses of multiple baseline variables. RESULTS Intention-to-treat (ITT) analyses revealed significant linear relationships between change in PHQ-9 and baseline depression severity (β = -0.35, t = -3.27, p = .002) and perceived self-efficacy (β = -0.24, t = -2.26, p = .027) in the treatment (verum) condition. MADRS change scores were predicted by baseline depression severity (β = -0.71, t = -8.65, p < .001) in the treatment (verum) condition. LIMITATIONS Due to small cell numbers, single predictors could not be evaluated reliably. CONCLUSIONS Severity of depression and self-efficacy at baseline were predictors of symptom improvement at level three (Empowerment) of the MEHIRA project. Comorbidity and trauma indicators did not predict outcomes in the treatment (verum) condition, pointing towards broad applicability of the Empowerment intervention in refugee populations.
Collapse
Affiliation(s)
- Michael Strupf
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
| | - Maren Wiechers
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany; Charlotte Fresenius Hochschule, University of Applied Sciences, Munich, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Andrea Jobst-Heel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Ute Habel
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | | | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Andreas Hoell
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Max Burger
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Tilmann Bunse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany
| | - Edgar Hoehne
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nassim Mehran
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Franziska Kaiser
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Aline Übleis
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| |
Collapse
|
5
|
Scalable interventions for refugees. Glob Ment Health (Camb) 2023; 10:e8. [PMID: 36843882 PMCID: PMC9947626 DOI: 10.1017/gmh.2022.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 02/10/2023] Open
Abstract
Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.
Collapse
|
6
|
Witteveen A, Young S, Cuijpers P, Ayuso-Mateos J, Barbui C, Bertolini F, Cabello M, Cadorin C, Downes N, Franzoi D, Gasior M, John A, Melchior M, McDaid D, Palantza C, Purgato M, Van der Waerden J, Wang S, Sijbrandij M. Remote mental health care interventions during the COVID-19 pandemic: An umbrella review. Behav Res Ther 2022; 159:104226. [PMID: 36410111 PMCID: PMC9661449 DOI: 10.1016/j.brat.2022.104226] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.
Collapse
Affiliation(s)
- A.B. Witteveen
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands,Corresponding author
| | - S. Young
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - P. Cuijpers
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - J.L. Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - C. Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - F. Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - M. Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - C. Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - N. Downes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de Médecine St Antoine, Paris, France
| | - D. Franzoi
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - M. Gasior
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - A. John
- Health Data Science, Swansea University Medical School, Swansea, UK
| | - M. Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de Médecine St Antoine, Paris, France
| | - D. McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - C. Palantza
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - M. Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - J. Van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de Médecine St Antoine, Paris, France
| | - S. Wang
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - M. Sijbrandij
- Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Rostami R, Wells R, Solaimani J, Berle D, Hadzi-Pavlovic D, Silove D, Nickerson A, O'Donnell M, Bryant R, McFarlane A, Steel Z. The mental health of Farsi-Dari speaking asylum-seeking children and parents facing insecure residency in Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 27:100548. [PMID: 35935728 PMCID: PMC9352465 DOI: 10.1016/j.lanwpc.2022.100548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND This research examined the mental health of a cohort of asylum-seeking children, adolescents and their primary caregiver affected by insecure residency while living in the community, compared to refugees and immigrants. METHODS The project investigated the prevalence of psychosocial problems among Iranian and Afghani asylum seeker, refugee and immigrant children and adolescents, and their caregivers who arrived in Australia from 2010. In total, n=196 children and adolescents aged 5-18 years, and their primary caregiver were asked about family visa status, country of origin, level of education, parent symptoms of posttraumatic stress disorder (Harvard Trauma Questionnaire) and child wellbeing (Strengths and Difficulties Questionnaire). An additional n=362 Farsi and Dari speaking children, recruited through the Building a New Life in Australia (BNLA) study, a national comparison sample of families with permanent refugee visas, were included. FINDINGS Asylum seeker children and adolescents displayed significantly more psychosocial problems compared to those with full refugee protection and immigrant background within the current sample and when benchmarked against a national sample of Farsi-Dari speaking refugee children. Higher parental posttraumatic stress disorder symptoms was associated with poorer child and adolescent psychosocial functioning. This effect was more marked in families with insecure residency. INTERPRETATION Insecure visa status is associated with higher rates of children's mental health problems and a stronger association with parental PTSD symptoms compared to children with secure residency. This raises important questions about Australia's restrictive immigration policies. FUNDING This project was supported by an Australian Rotary Health Research Fund / Mental Health of Young Australians Research Grant and by the Australian Research Council (DP160104378).
Collapse
Affiliation(s)
- Reza Rostami
- Psychiatry and Mental Health, Medicine, UNSW Sydney, Sydney, Australia
| | - Ruth Wells
- Psychiatry and Mental Health, Medicine, UNSW Sydney, Sydney, Australia
| | - Jila Solaimani
- Psychiatry and Mental Health, Medicine, UNSW Sydney, Sydney, Australia
| | - David Berle
- Clinical Psychology, Graduate School of Health Disciplines, University of Technology, Sydney, Australia
| | | | - Derrick Silove
- Psychiatry and Mental Health, Medicine, UNSW Sydney, Sydney, Australia
| | | | - Meaghan O'Donnell
- Phoenix Australia, Psychiatry, University of Melbourne, Melbourne, Australia
| | - Richard Bryant
- School of Psychology, Science, UNSW Sydney, Sydney, Australia
| | | | - Zachary Steel
- Psychiatry and Mental Health, Medicine, UNSW Sydney, Sydney, Australia
| |
Collapse
|
8
|
Alzaghoul AF, McKinlay AR, Archer M. Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: systematic review. BJPsych Open 2022; 8:e153. [PMID: 35938530 PMCID: PMC9380009 DOI: 10.1192/bjo.2022.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Millions of children and adolescents are exposed to wars, affecting their psychological well-being. This review focuses on psychosocial interventions in low and middle-income countries (LMICs) in the Middle East, where mental health services are limited. AIMS Our primary aim was to evaluate the effectiveness of trial-assessed psychosocial interventions in reducing post-traumatic stress disorder (PTSD) symptoms in children and adolescents aged ≤18 years who were exposed to war in LMICs in the Middle East. Changes in other psychological conditions and symptoms were evaluated where reported. METHOD PubMed, Cochrane Library and Ovid were searched without year restriction, in December 2021. Previous review reference lists were also checked. Only studies published in English were included. Each study was evaluated for risk of bias and results are presented as a narrative synthesis. RESULTS Three group-based interventions were identified and evaluated across six studies: 'Teaching Recovery Techniques', 'Writing for Recovery' and 'Advancing Adolescents'. Two studies took place in post-war settings, and four in a context of ongoing conflict. Positive experiences and improved social skills were indicated following most interventions, but Teaching Recovery Techniques was the only programme associated with a statistically significant reduction in PTSD score. Differences in follow-up interval limited comparability of outcomes. CONCLUSIONS This review highlights a paucity of evidence for effective treatment options for children and adolescents affected by war from LMICs in the Middle East. Promising indications of reductions in PTSD symptoms, specifically from Teaching Recovery Techniques, require further rigorous evaluation and long-term follow-up.
Collapse
Affiliation(s)
- Aseel F Alzaghoul
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Alison R McKinlay
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Marc Archer
- Centre for Mental Health and Wellbeing, Department of Psychology, Faculty of Behavioural Sciences, HELP University, Malaysia
| |
Collapse
|
9
|
Using Imagery Rescripting to Treat Posttraumatic Stress Disorder in Refugees: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
10
|
Feinstein D. Uses of Energy Psychology Following Catastrophic Events. Front Psychol 2022; 13:856209. [PMID: 35548526 PMCID: PMC9084314 DOI: 10.3389/fpsyg.2022.856209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
Energy psychology, as most widely practiced, integrates the manual stimulation of acupuncture points with imaginal exposure, cognitive restructuring, and other evidence-based psychotherapeutic procedures. Efficacy for energy psychology protocols has been established in more than 120 clinical trials, with meta-analyses showing strong effect sizes for PTSD, anxiety, and depression. The approach has been applied in the wake of natural and human-made disasters in more than 30 countries. Four tiers of energy psychology interventions following the establishment of safety, trust, and rapport are described, including (1) immediate relief/stabilization, (2) reducing limbic arousal to trauma-based triggers, (3) overcoming complex psychological difficulties, and (4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. Advantages of adding the stimulation of acupuncture points to a conventional exposure approach are identified, and challenges around cultural sensitivities and unintended effects are discussed. After establishing a framework for introducing energy psychology in disaster relief efforts, reports from a sampling of settings are presented, based on interviews with this paper's author. These include accounts of relief work with survivors of mass shootings, genocide, ethnic warfare, earthquakes, hurricanes, tornadoes, floods, wildfires, and the COVID-19 pandemic. Hundreds of other reports from the field show a pattern of strong outcomes following the use of energy psychology in the days or weeks after a disaster and in the subsequent treatment of trauma-based psychological problems. Many of these accounts corroborate one another in terms of rapid relief and long-term benefits. Finally, examples of more efficient delivery methods utilizing large groups, lay counselors, digital technology, and cultivating community resilience are presented.
Collapse
|
11
|
Steil R, Fischer A, Gutermann J, Rosner R. Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls. BMC Psychiatry 2022; 22:64. [PMID: 35086493 PMCID: PMC8793273 DOI: 10.1186/s12888-022-03706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intrusive mental imagery (MI) plays a crucial role in the maintenance of posttraumatic stress disorder (PTSD) in adults. Evidence on the characteristics of MI in adolescents suffering from PTSD is sparse. The aim of this study was to thoroughly assess MI in an adolescent sample suffering from PTSD after the experience of childhood sexual abuse and/or childhood physical abuse (CA). METHODS Thirty-two adolescents with a primary diagnosis of PTSD after CA and 32 adolescents without any mental disorder and without a history of CA, matched for age and gender, completed questionnaires assessing the characteristics of negative and positive MI, as well as images of injury and death that lead to positive emotions (ID-images). RESULTS The PTSD group reported significantly more frequent, more vivid, more distressing and more strongly autobiographically linked negative MI compared to the control group. Although positive MI was highly present in both groups (PTSD: 65.6%; controls: 71.9%), no significant differences emerged between the two groups regarding the distinct characteristics of positive MI. The frequency of the ID-images did not significantly differ between the two groups (PTSD: 21.9%; controls: 9.4%), although the ID-images were more vivid in the PTSD group. DISCUSSION Negative MI appears to be crucial in adolescent PTSD, whilst positive MI are unexpectedly common in both the PTSD and the control group. The role of positive MI as well as that of ID-images remain unclear. Specific interventions for changing negative MI that are tailored to the developmental challenges in adolescents with PTSD should be developed. TRIAL REGISTRATION Some of the PTSD patients in this study were also part of a randomized controlled trial on Developmentally adapted Cognitive Processing Therapy (D-CPT). This trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787 , 18 March 2013.
Collapse
Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Anne Fischer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany
| |
Collapse
|
12
|
Akhtar A, Koyiet P, Rahman A, Schafer A, Hamdani SU, Cuijpers P, Sijbrandij M, Bryant RA. Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low- and middle-income countries: An individual-patient data meta-analysis. Depress Anxiety 2022; 39:71-82. [PMID: 34752690 PMCID: PMC9299611 DOI: 10.1002/da.23221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To address shortages of mental health specialists in low- and middle-income countries, task-shifting approaches have been employed to train nonspecialists to deliver evidence-based scalable psychosocial interventions. Problem Management Plus (PM+) is a brief transdiagnostic nontrauma focused intervention for people affected by adversity. This study reports on the capacity of PM+ to address specific symptoms of posttraumatic stress disorder (PTSD). METHODS Individual patient data from three randomised controlled trials were combined and analysed to observe the impacts of PM+ (n = 738) or enhanced treatment as usual (ETAU) (n = 742) interventions on specific PTSD symptoms at posttreatment and 3-month follow-up. The PTSD-Checklist for DSM-5 (PCL-5) was used to index PTSD symptoms, and presence of each symptom was defined as moderate severity (score ≥ 2 on individual items). RESULTS The average PCL-5 score at baseline was 26.1 (SD: 16.8) with 463 (31.3%) scoring above 33, indicative of a diagnosis of PTSD. Following intervention, 12.5% and 5.8% of participants retained a score greater than 33 at postassessment and follow-up, respectively. There was greater symptom reduction for PM+ than for ETAU for most symptoms. Hyperarousal symptoms were the most common residual symptoms after PM+, with more than 30% of participants reporting persistent sleep disturbance, concentration difficulties, and anger. CONCLUSION PM+ led to greater reduction in symptoms relating to re-experiencing and avoidance. The evidence indicates that strategies focusing on hyperarousal symptoms including sleep, concentration, and anger difficulties, could be strengthened in this brief intervention.
Collapse
Affiliation(s)
- Aemal Akhtar
- Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands.,School of Psychology, University of New South Wales, Sydney, Australia
| | | | | | | | - Syed Usman Hamdani
- University of Liverpool, Liverpool, England.,Human Development Research Foundation, Islamabad, Pakistan
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| |
Collapse
|
13
|
Beckmann J, Wenzel T, Hautzinger M, Kizilhan JI. Training of psychotherapists in post-conflict regions: A Community case study in the Kurdistan Region of Iraq. Front Psychiatry 2022; 13:947903. [PMID: 36072460 PMCID: PMC9442973 DOI: 10.3389/fpsyt.2022.947903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
The number of wars in the world is on the rise. A number of studies have documented the devastating impact on the public and especially public mental health. Health care systems in low- and lower-middle income countries that are frequently already challenged by the existing mental health services gap cannot provide the necessary care for those displaced by war with existing services. This is especially the case in the Kurdistan Region of Iraq (KRI) after the invasion of the terror organization ISIS in 2014. Most projects in post-conflict areas focus on short term basic psychological services and do not contribute to sustainable long-term capacity building of mental health services. An "Institute for Psychotherapy and Psychotraumatology" was therefore founded in order to train local specialists on a professional level with evidence-based methods adapted to culture and create sustainable long-term structures for psychotherapeutic treatment in the KRI. To achieve this, a number of measures were implemented, including the creation of a "Master of Advanced Studies of Psychotherapy and Psychotraumatology" in collaboration with local communities and the regional University. Two cohorts of students have successfully finished the master's program and a third cohort are expected to graduate in 2023. Improving the capacity of local health care services to provide low-barrier, professional psychotherapeutic care in post-conflict regions supported by the innovative model presented in this article can be expected to improve the burden of psychological problems and contribute to peacebuilding.
Collapse
Affiliation(s)
- Julia Beckmann
- Institute for Transcultural Health Science, Baden-Wuerttemberg Cooperative State University, Villingen-Schwenningen, Germany
| | - Thomas Wenzel
- Department of Social Psychiatry, University of Vienna, Vienna, Austria
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tüebingen, Tüebingen, Germany
| | - Jan Ilhan Kizilhan
- Institute for Transcultural Health Science, Baden-Wuerttemberg Cooperative State University, Villingen-Schwenningen, Germany.,Institute for Psychotherapy and Psychotraumatology, University of Duhok, Duhok, Iraq
| |
Collapse
|
14
|
Hoppen TH, Priebe S, Vetter I, Morina N. Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-006303. [PMID: 34321235 PMCID: PMC8319986 DOI: 10.1136/bmjgh-2021-006303] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/20/2021] [Indexed: 11/06/2022] Open
Abstract
Objective Extensive research has demonstrated high prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) in war-surviving populations. However, absolute estimates are lacking, which may additionally inform policy making, research and healthcare. We aimed at estimating the absolute global prevalence and disease burden of adult survivors of recent wars (1989–2019) affected by PTSD and/or MD. Methods We conducted a systematic literature search and meta-analysis of interview-based epidemiological surveys assessing the prevalence of PTSD and/or MD in representative samples from countries with a recent war history (1989–2019). Drawing on the war definition and geo-referenced data of the Uppsala Conflict Database Programme and population estimates of the United Nations for 2019, we extrapolated the meta-analytic results to absolute global numbers of affected people. Drawing on disability-adjusted life years (DALYs) data of the Global Burden of Diseases Study 2019, we further calculated the PTSD-associated and MD-associated DALYs. Results Twenty-two surveys (N=15 420) for PTSD, 13 surveys for MD (N=9836) and six surveys on the comorbidity of PTSD and MD (N=1131) were included. Random effects meta-analyses yielded point prevalences of 26.51% for PTSD and 23.31% for MD. Of those affected by PTSD, 55.26% presented with comorbid MD. Prevalence rates were not significantly associated with war intensity and length, time since war, response rate or survey quality. The extrapolation yielded 316 million adult war-survivors globally who suffered from PTSD and/or MD in 2019. War-survivors were almost exclusively living in low/middle-income countries (LMICs) and carried a burden of 3 105 387 and 4 083 950 DALYs associated with PTSD and MD, respectively. Conclusions Since LMICs lack sufficient funding and qualified professionals to provide evidence-based psychological treatments for such large numbers of affected people, alternative and scalable strategies using existing resources in primary care and communities are required. Research is required to assist upscaling.
Collapse
Affiliation(s)
- Thole H Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Inja Vetter
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| |
Collapse
|
15
|
Tay AK, Miah MAA, Khan S, Mohsin M, Alam AM, Ozen S, Mahmuda M, Ahmed HU, Silove D, Ventevogel P. A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh. EClinicalMedicine 2021; 38:100999. [PMID: 34505027 PMCID: PMC8413262 DOI: 10.1016/j.eclinm.2021.100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Studies of scalable psychological interventions in humanitarian setting are usually carried out when the acute emergency has stabilized. We report the first evaluation of an evidence-based group psychological intervention, Group Integrative Adapt Therapy (IAT-G), during the emergency phase of a mass humanitarian crisis amongst Rohingya refugees in Cox's Bazar, Bangladesh. Methods: We did a pragmatic naturalistic evaluation (2018-2020) of a seven-session group intervention with adult Rohingya refugees with elevated symptoms of depression (≥10 on the Patient Health Questionnaire) and/or posttraumatic stress disorder, PTSD, (≥3 on the Posttraumatic Stress Disorder-8), and functional impairment (≥17 on WHO Disability Assessment Schedule or WHODAS-brief). Screening was done across the most densely populated campsites. Blind assessments were completed at baseline, posttreatment, and at 3-month follow-up using culturally adapted measures of depression, anxiety, posttraumatic stress symptoms, complicated bereavement, adaptive stress associated with disrupted psychosocial support systems, functional impairment, and resilience. Findings: 383 persons were screened and of the 144 persons who met inclusion criteria all participated in the group intervention. Compared to baseline scores, IAT-G participants recorded significantly lower mean scores on key outcome indices (mental health symptoms, adaptive stress, and functional impairment) at posttreatment and 3-month follow-up (all pairwise tests significant Ps<.05). From baseline to 3-month follow-up, score changes were greatest for functional impairment (d = 2.24), anxiety (d = 2.15) and depression (d = 1.9), followed by PTSD symptoms (d = 1.17). Interpretation: A group-based intervention designed specifically to reflect the refugee experience and adapted to the language and culture, showed positive outcomes in the context of a pragmatic, naturalistic trial implemented in a mass humanitarian emergency. Funding: United Nations High Commissioner for Refugees; National Health and Medical Research Council Australia.
Collapse
Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
- Correspondence: Alvin Kuowei Tay, : School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.
| | | | - Sanjida Khan
- Independent Researcher, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - A.N.M. Mahmudul Alam
- Mental Health and Psychosocial Support Subunit, Public Health & Nutrition Unit, United Nations High Commissioner for Refugees, Cox's Bazar, Bangladesh
| | - Sanem Ozen
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | | | - Helal U. Ahmed
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Peter Ventevogel
- National Institute of Mental Health, Dhaka, Bangladesh
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| |
Collapse
|
16
|
Weber M, Schumacher S, Hannig W, Barth J, Lotzin A, Schäfer I, Ehring T, Kleim B. Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis. Psychol Med 2021; 51:1420-1430. [PMID: 34176532 PMCID: PMC8311818 DOI: 10.1017/s003329172100163x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/11/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Abstract
Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.
Collapse
Affiliation(s)
- Maxi Weber
- Division of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Department of Psychology, Philips University of Marburg, Marburg, Germany
| | - Wiebke Hannig
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
17
|
Morina N, Hoppen TH, Kip A. Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials. Psychol Med 2021; 51:1260-1270. [PMID: 33975654 PMCID: PMC8223238 DOI: 10.1017/s0033291721001641] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/09/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Research indicates that higher study quality may be associated with smaller treatment effects. Yet, knowledge about the association between study quality and treatment efficacy for posttraumatic stress disorder (PTSD) is limited. We aimed at evaluating the efficacy of psychological interventions for adult PTSD and the association between study quality and treatment effects. METHODS We conducted a systematic search to identify randomized controlled trials (RCTs) that examined the efficacy of psychological interventions for chronic PTSD symptoms in adult samples with at least 70% of patients being diagnosed with PTSD by means of a structured interview. We assessed study quality using the following eight criteria from prior research: N ⩾ 50, all patients met criteria for PTSD, a treatment manual was used, therapists were trained, treatment integrity was checked, intent-to-treat analyses were applied, randomization was conducted by an independent party, and treatment outcome was conducted by blind assessors. RESULTS The search resulted in 136 RCTs with 8978 patients. Active treatment conditions were largely effective in reducing PTSD symptoms at posttreatment and follow-up (Hedges' g = 1.09 and 0.81, respectively) when compared to passive control conditions. The comparison to active control conditions at posttreatment and follow-up resulted in medium effect sizes. A total of 14 trials met all study quality criteria and these trials produced large effect sizes when compared to passive control conditions at posttreatment and follow-up. CONCLUSIONS Overall, study quality was not significantly associated with effect size. The findings indicate that psychological interventions can effectively reduce PTSD symptoms irrespective of study quality.
Collapse
Affiliation(s)
- Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Thole H. Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | - Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| |
Collapse
|
18
|
Connolly SM, Vanchu-Orosco M, Warner J, Seidi PA, Edwards J, Boath E, Irgens AC. Mental health interventions by lay counsellors: a systematic review and meta-analysis. Bull World Health Organ 2021; 99:572-582. [PMID: 34354312 PMCID: PMC8319860 DOI: 10.2471/blt.20.269050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries. Methods We searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model. Findings We identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges' g for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was -0.616 (95% confidence interval: -0.866 to -0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results. Conclusion The use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.
Collapse
Affiliation(s)
- Suzanne M Connolly
- 70 Payne Place, Suite 6, Sedona, AZ 86446, United States of America (USA)
| | | | - Jan Warner
- Department of Social Work Services, Veterans Affairs Medical Center, Cleveland, USA
| | | | - Jenny Edwards
- School of Leadership Studies, Fielding Graduate University, Santa Barbara, USA
| | - Elisabeth Boath
- Department of Social Work and Social Welfare, Staffordshire University, Stoke-on-Trent, England
| | - A C Irgens
- Department of Psychiatry, Sørlandet Hospital, Arendal, Norway
| |
Collapse
|
19
|
Ryan GK, Bauer A, Endale T, Qureshi O, Doukani A, Cerga-Pashoja A, Brar SK, Eaton J, Bass JK. Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries. Confl Health 2021; 15:30. [PMID: 33892755 PMCID: PMC8062937 DOI: 10.1186/s13031-021-00363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Published by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations. METHODS Seven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov . We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed. RESULTS We identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies. CONCLUSION Although results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis. TRIAL REGISTRATION PROSPERO registration number: CRD42017058287 .
Collapse
Affiliation(s)
- Grace K Ryan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.
| | - Andreas Bauer
- Department of Psychology, University of Bath, Bath, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College of Columbia University, New York City, New York, USA
| | - Onaiza Qureshi
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Asmae Doukani
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Arlinda Cerga-Pashoja
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Global Health Training, Public Health England, London, UK
| | - Savvy K Brar
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, New York, USA
| | - Julian Eaton
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Mental Health, CBM Global, Laudenbach, Germany
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
20
|
Smith L, Il Shin J, McDermott D, Jacob L, Barnett Y, López-Sánchez GF, Veronese N, Yang L, Soysal P, Oh H, Grabovac I, Koyanagi A. Association between food insecurity and depression among older adults from low- and middle-income countries. Depress Anxiety 2021; 38:439-446. [PMID: 33687122 DOI: 10.1002/da.23147] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/14/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). METHODS Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. RESULTS In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression. CONCLUSIONS In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.
Collapse
Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Daragh McDermott
- School of Psychology & Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | | | - Guillermo F López-Sánchez
- School of Medicine, Vision and Eye Research Institute, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research and Departments of Oncology and Prevention Research, Alberta Health Services, University of Calgary, Calgary, Canada
| | - Pinar Soysal
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,ICREA, Barcelona, Spain
| |
Collapse
|
21
|
Steil R, Lechner-Meichsner F, Johow J, Krüger-Gottschalk A, Mewes R, Reese JP, Schumm H, Weise C, Morina N, Ehring T. Brief imagery rescripting vs. usual care and treatment advice in refugees with posttraumatic stress disorder: study protocol for a multi-center randomized-controlled trial. Eur J Psychotraumatol 2021; 12:1872967. [PMID: 34992749 PMCID: PMC8725706 DOI: 10.1080/20008198.2021.1872967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Many refugees have experienced multiple traumatic events in their country of origin and/or during flight. Trauma-related disorders such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD) are prevalent in this population, which highlights the need for accessible and effective treatment. Imagery Rescripting (ImRs), an imagery-based treatment that does not use formal exposure and that has received growing interest as an innovative treatment for PTSD, appears to be a promising approach. Objective: This randomized-controlled trial aims to investigate the efficacy of ImRs for refugees compared to Usual Care and Treatment Advice (UC+TA) on (C)PTSD remission and reduction in other related symptoms. Method: Subjects are 90 refugees to Germany with a diagnosis of PTSD according to DSM-5. They will be randomly allocated to receive either UC+TA (n = 45) or 10 sessions of ImRs (n = 45). Assessments will be conducted at baseline, post-intervention, three-month follow-up, and 12-month follow-up. Primary outcome is the (C)PTSD remission rate. Secondary outcomes are severity of PTSD and CPTSD symptoms, psychiatric symptoms, dissociative symptoms, quality of sleep, and treatment satisfaction. Economic analyses will investigate health-related quality of life and costs. Additional measures will assess migration and stress-related factors, predictors of dropout, therapeutic alliance and session-by-session changes in trauma-related symptoms. Results and Conclusions: Emerging evidence suggests the suitability of ImRs in the treatment of refugees with PTSD. After positive evaluation, this short and culturally adaptable treatment can contribute to close the treatment gap for refugees in high-income countries such as Germany. Trial registration: German Clinical Trials Register under trial number DRKS00019876, registered prospectively on 28 April 2020.
Collapse
Affiliation(s)
- Regina Steil
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | | | - Johannes Johow
- Coordinating Centre for Clinical Trials (KKS), Philipps-University of Marburg, Marburg, Germany
| | | | - Ricarda Mewes
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Jens-Peter Reese
- Coordinating Centre for Clinical Trials (KKS), Philipps-University of Marburg, Marburg, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität of Würzburg, Würzburg, Germany
| | - Hannah Schumm
- Department of Psychology, LMU Munich, Munich, Germany
| | - Cornelia Weise
- Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| |
Collapse
|
22
|
Akhtar A, Giardinelli L, Bawaneh A, Awwad M, Al-Hayek H, Whitney C, Jordans MJD, Sijbrandij M, Cuijpers P, Dawson K, Bryant R. Feasibility trial of a scalable transdiagnostic group psychological intervention for Syrians residing in a refugee camp. Eur J Psychotraumatol 2021; 12:1932295. [PMID: 34262668 PMCID: PMC8253196 DOI: 10.1080/20008198.2021.1932295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Approximately 10% of Syrian refugees currently reside in camp settings, which can impose additional post-migration stressors. With elevated rates of psychological distress and few available resources, task-shifting psychosocial programmes are necessary to provide adequate care. One such programme developed by the World Health Organization (WHO) is Group Problem Management Plus (GroupPM+). Objective: This study aimed to test the safety and acceptability of GroupPM+ in a refugee camp and to identify areas for adaptation in preparation for a definitive RCT. Method: A feasibility randomized controlled trial (RCT) was conducted in Azraq refugee camp in Jordan. Inclusion criteria were: (1) Syrian adults aged ≥18 years, (2) parent of a child aged 10-16 years, (3) experiencing psychological distress as defined by a score of ≥16 on the Kessler Distress Scale, and (4) ≥17 on the WHO Disability Assessment Schedule 2.0. Following baseline assessments, participants were randomized to receive GroupPM+ or enhanced treatment-as-usual. Post-assessments were conducted one week following the last GroupPM+ session. Primary outcomes were feasibility and acceptance of GroupPM+; symptoms of anxiety, depression, PTSD, prodromal psychosis, grief, and child's self-reported psychological distress were also assessed. Results: Of the 207 persons screened, 64 (31%) screened positive for psychological distress. Of the 35 randomized into the GroupPM+ intervention, 24 (69%) completed the intervention. No adverse events were reported throughout the trial. Children whose parents received GroupPM+ had greater reductions in internalizing and externalizing symptoms at posttreatment. 55 (86%) participants completed the post-assessment follow-up. These results demonstrate both the feasibility of conducting the trial in a camp and acceptance of the GroupPM+ intervention by Syrian refugees. Conclusions: Following the feasibility trial, both the implementation procedures and intervention were safe and culturally acceptable. The results support the readiness for a definitive RCT to determine the effectiveness and cost-effectiveness of the intervention in camp settings.
Collapse
Affiliation(s)
- Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Ahmad Bawaneh
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Manar Awwad
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Hadeel Al-Hayek
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Claire Whitney
- Technical Unit, International Medical Corps, Washington, DC, USA
| | - Mark J D Jordans
- Research and Development Department, War Child, Amsterdam, The Netherlands.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| |
Collapse
|
23
|
Applying Cognitive Behavioral Therapy and Thought Field Therapy in Kurdistan region of Iraq: A retrospective case series study of mental-health interventions in a setting of political instability and armed conflicts. Explore (NY) 2021; 17:84-91. [DOI: 10.1016/j.explore.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2020] [Accepted: 06/21/2020] [Indexed: 11/18/2022]
|
24
|
Impact of the Healing in Harmony program on women's mental health in a rural area in South Kivu province, Democratic Republic of Congo. Glob Ment Health (Camb) 2021; 8:e13. [PMID: 34026242 PMCID: PMC8127635 DOI: 10.1017/gmh.2021.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 03/06/2021] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess whether Healing in Harmony (HiH), a form of music therapy, improved women's mental health following conflict-related trauma and sexual violence in the Democratic Republic of Congo. METHODS This study used a step-wedged design and included 167 women, who completed up to two pre-tests, a post-test, and up to two follow-up interviews at 3 and 6 months after completing the program. The Hopkins Symptoms Checklist was used to measure anxiety and depression. The Harvard Trauma Questionnaire was used to measure post-traumatic stress disorder (PTSD). Generalized estimating equations with unstructured covariance were used to estimate mean change in mental health scores and relative risks (RRs) for screening positive. RESULTS Prior to starting the HiH program, 73.9, 84.2, and 68.5% screened positive with median scores being 2.20, 2.70, and 2.06 for depression, anxiety, and PTSD, respectively. The RR for screening positive declined significantly (RR = 0.49 for depression, 0.61 for anxiety, and 0.54 for PTSD) and mean scores declined significantly by -0.54, -0.67, and -0.53 points, respectively, from the pre- to the post-test, declines that were sustained at the 3-month and 6-month follow-up interviews. CONCLUSION The HiH program was associated with significant improvement in women's mental health that was sustained up to 6 months post completion of the program despite instability in the region and evidence of continued experience of conflict-related trauma during the study. These data support the value of providing psychological care in the context of ongoing humanitarian crises.
Collapse
|
25
|
Akhtar A, Giardinelli L, Bawaneh A, Awwad M, Naser H, Whitney C, Jordans MJD, Sijbrandij M, Bryant RA. Group problem management plus (gPM+) in the treatment of common mental disorders in Syrian refugees in a Jordanian camp: study protocol for a randomized controlled trial. BMC Public Health 2020; 20:390. [PMID: 32216762 PMCID: PMC7098148 DOI: 10.1186/s12889-020-08463-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 02/03/2023] Open
Abstract
Background Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. To mitigate this, the World Health Organization has developed group problem management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. gPM+ is a group-based intervention consisting of five-sessions, and can be delivered by non-specialist providers. This paper outlines the study protocol for a trial of gPM+ in Jordan. Methods We will conduct a single-blind, two-arm, randomized controlled trial in a Syrian refugee camp in Jordan. We aim to enrol 480 adults into the trial. Participants will be eligible for the trial if they screen positive for levels of psychological distress. Following screening, those eligible will be randomly assigned to receive the gPM+ intervention or enhanced treatment as usual. The primary outcome is reduction in levels of psychological distress at 3-months post-treatment. Secondary outcomes include anxiety, depression, prodromal psychotic symptoms, posttraumatic stress disorder, prolonged grief, daily functioning, economic effectiveness, and change in parenting behaviour. Secondary outcomes also include the reduction in psychological distress of the participant’s child. Discussion The trial aims to deliver a template for affordable and scalable psychosocial interventions that can readily be implemented in refugee settings, and that can benefit both the participant and their child. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619001386123. Registered prospectively on 10/10/2019.
Collapse
Affiliation(s)
- Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.,Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | | | - Ahmad Bawaneh
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Manar Awwad
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Hadeel Naser
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | | | - Mark J D Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
| | | |
Collapse
|
26
|
Kip A, Priebe S, Holling H, Morina N. Psychological interventions for posttraumatic stress disorder and depression in refugees: A meta-analysis of randomized controlled trials. Clin Psychol Psychother 2020; 27:489-503. [PMID: 32191370 DOI: 10.1002/cpp.2446] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
Millions of refugees around the globe suffer from posttraumatic stress disorder (PTSD) and/or depression. We conducted a meta-analysis of randomized controlled trials (RCTs) to determine the efficacy of psychological interventions for PTSD and/or depression in refugees. The meta-analysis was registered on the PROSPERO database (CRD42017071384). A search using the Medline, PsycINFO, and PILOTS databases was conducted in January 2019, resulting in 17 RCTs, of which 14 were conducted with adult refugees (1,108 participants) and 3 with young refugees (<18 years; 151 participants). Further inclusion criteria were at least 10 participants completing an active psychological intervention for PTSD, depression, or both and less than 50% of participants receiving concurrent psychotropic drugs. Random effects models showed that active interventions for adult PTSD yielded a medium to large aggregated effect size (g = 0.77; 95% confidence interval [CI] [0.26, 1.28]) at posttreatment when compared with passive and active control conditions. Active interventions for adult depression also produced large controlled effect sizes at posttreatment (g = 0.82; 95% CI [0.24, 1.40]). The effects appeared to persist over the average follow-up period of 6 months. The findings suggest that psychological interventions can effectively reduce symptoms of both PTSD and depression in adult refugees. However, the considerable heterogeneity between studies indicates that the efficacy may vary significantly. Future studies should aim to explore the substantial heterogeneity in effect sizes between studies with adult refugees. Additionally, more trials with young refugees suffering from PTSD or depression are needed to determine treatment efficacy for this population.
Collapse
Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Heinz Holling
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| |
Collapse
|
27
|
Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review. Lancet Psychiatry 2020; 7:162-172. [PMID: 31948935 DOI: 10.1016/s2215-0366(19)30511-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/04/2019] [Accepted: 11/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes. METHODS We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711. FINDINGS 123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy. INTERPRETATION A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base. FUNDING University of Verona.
Collapse
|
28
|
Morina N, Hoppen TH, Priebe S. Out of Sight, Out of Mind: Refugees Are Just the Tip of the Iceberg. An Illustration Using the Cases of Depression and Posttraumatic Stress Disorder. Front Psychiatry 2020; 11:179. [PMID: 32210856 PMCID: PMC7068215 DOI: 10.3389/fpsyt.2020.00179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Thole H Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
| |
Collapse
|
29
|
Cooper DK, Wieling E, Pfeiffer A. Bioecological Implications of Narrative Exposure Therapy in Low-Resource Settings: Individual, Family, Community, and Socio-Political Contexts. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 2019; 40:353-367. [PMID: 34334934 PMCID: PMC8323547 DOI: 10.1002/anzf.1392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative Exposure Therapy (NET) is an evidence-based intervention for decreasing individuals' posttraumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post-conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this manuscript was to examine some of the ecological implications of using NET with trauma-affected populations in low-resource settings. We highlight select implications of NET that extend beyond the individual to systemic effects at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.
Collapse
Affiliation(s)
| | - Elizabeth Wieling
- Department of Human Development and Family Science, University of Georgia
| | - Anett Pfeiffer
- vivo Outpatient Clinic for Survivors of Trauma and Torture in Uganda
| |
Collapse
|
30
|
Bryant RA. Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges. World Psychiatry 2019; 18:259-269. [PMID: 31496089 PMCID: PMC6732680 DOI: 10.1002/wps.20656] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its formal introduction in the DSM-III in 1980, knowledge has grown significantly regarding its causes, maintaining mechanisms and treatments. Despite this increased understanding, however, the actual definition of the disorder remains controversial. The DSM-5 and ICD-11 define the disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations that arise after trauma or should be focused more specifically on trauma memory phenomena. This controversy over clarifying the phenotype of PTSD has limited the capacity to identify biomarkers and specific mechanisms of traumatic stress. This review provides an up-to-date outline of the current definitions of PTSD, its known prevalence and risk factors, the main models to explain the disorder, and evidence-supported treatments. A major conclusion is that, although trauma-focused cognitive behavior therapy is the best-validated treatment for PTSD, it has stagnated over recent decades, and only two-thirds of PTSD patients respond adequately to this intervention. Moreover, most people with PTSD do not access evidence-based treatment, and this situation is much worse in low- and middle-income countries. Identifying processes that can overcome these major barriers to better management of people with PTSD remains an outstanding challenge.
Collapse
|
31
|
Bangpan M, Felix L, Dickson K. Mental health and psychosocial support programmes for adults in humanitarian emergencies: a systematic review and meta-analysis in low and middle-income countries. BMJ Glob Health 2019; 4:e001484. [PMID: 31646006 PMCID: PMC6782047 DOI: 10.1136/bmjgh-2019-001484] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Effective interventions in humanitarian settings are needed to support the mental health and psychosocial needs of affected populations. To fill this gap, this systematic review synthesises evidence on the effectiveness of a wide range of mental health and psychosocial support (MHPSS) programmes delivered to adults affected by humanitarian emergencies in low and middle-income countries (LMICs). METHODS A comprehensive search of 12 electronic databases, key websites and citation checking was undertaken in 2015 and updated in May 2018. We included controlled trials published in English from 1980. We extracted data and assessed risk of bias prior to performing a meta-analysis using random effects models. When meta-analysis was not used, we narratively described individual trial effect sizes using forest plots. RESULTS Thirty-five studies were included. Overall, MHPSS programmes show benefits in improved functioning and reducing post-traumatic stress disorder. There are also indications from a limited pool of evidence that cognitive-behavioural therapy and narrative exposure therapy may improve mental health conditions. Other psychotherapy modalities also showed a positive trend in favour of MHPSS programmes for improving several mental health outcomes. CONCLUSION In addition to MHPSS programme for improving mental health outcomes in adults affected by humanitarian emergencies in LMICs, there is also a need to generate robust evidence to identify potential impact on broader social dimensions. Doing so could aid the future development of MHPSS programmes and ensure their effective implementation across different humanitarian contexts in LMICs. Future research on MHPSS programmes which focus on basic services and security, community and family programmes, their cost-effectiveness and mechanisms of impact could also strengthen the MHPSS evidence base to better inform policy and practice decision-making in humanitarian settings. PROTOCOL REGISTRATION NUMBER CRD42016033578.
Collapse
Affiliation(s)
- Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinatng Centre (EPPI-Centre), Department of Social Science, University College London Institute of Education, London, UK
| | - Lambert Felix
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Kelly Dickson
- The Evidence for Policy and Practice Information and Co-ordinatng Centre (EPPI-Centre), Department of Social Science, University College London Institute of Education, London, UK
| |
Collapse
|
32
|
Hamid A, Patel N, Williams ACDC. Psychological, social, and welfare interventions for torture survivors: A systematic review and meta-analysis of randomised controlled trials. PLoS Med 2019; 16:e1002919. [PMID: 31550249 PMCID: PMC6759153 DOI: 10.1371/journal.pmed.1002919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/20/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Torture and other forms of ill treatment have been reported in at least 141 countries, exposing a global crisis. Survivors face multiple physical, psychological, and social difficulties. Psychological consequences for survivors are varied, and evidence on treatment is mixed. We conducted a systematic review and meta-analysis to estimate the benefits and harms of psychological, social, and welfare interventions for torture survivors. METHODS AND FINDINGS We updated a 2014 review with published randomised controlled trials (RCTs) for adult survivors of torture comparing any psychological, social, or welfare intervention against treatment as usual or active control from 1 January 2014 through 22 June 2019. Primary outcome was post-traumatic stress disorder (PTSD) symptoms or caseness, and secondary outcomes were depression symptoms, functioning, quality of life, and adverse effects, after treatment and at follow-up of at least 3 months. Standardised mean differences (SMDs) and odds ratios were estimated using meta-analysis with random effects. The Cochrane tool was used to derive risk of bias. Fifteen RCTs were included, with data from 1,373 participants (589 females and 784 males) in 10 countries (7 trials in Europe, 5 in Asia, and 3 in Africa). No trials of social or welfare interventions were found. Compared to mostly inactive (waiting list) controls, psychological interventions reduced PTSD symptoms by the end of treatment (SMD -0.31, 95% confidence interval [CI] -0.52 to -0.09, p = 0.005), but PTSD symptoms at follow-up were not significantly reduced (SMD -0.34, 95% CI -0.74 to 0.06, p = 0.09). No significant improvement was found for PTSD caseness at the end of treatment, and there was possible worsening at follow-up from one study (n = 28). Interventions showed no benefits for depression symptoms at end of treatment (SMD -0.23, 95% CI -0.50 to 0.03, p = 0.09) or follow-up (SMD -0.23, 95% CI -0.70 to 0.24, p = 0.34). A significant improvement in functioning for psychological interventions compared to control was found at end of treatment (SMD -0.38, 95% CI -0.58 to -0.18, p = 0.0002) but not at follow-up from only one study. No significant improvement emerged for quality of life at end of treatment (SMD 0.38, 95% CI -0.28 to 1.05, p = 0.26) with no data available at follow-up. The main study limitations were the difficulty in this field of being certain of capturing all eligible studies, the lack of modelling of maintenance of treatment gains, and the low precision of most SMDs making findings liable to change with the addition of further studies as they are published. CONCLUSIONS Our findings show evidence that psychological interventions improve PTSD symptoms and functioning at the end of treatment, but it is unknown whether this is maintained at follow-up, with a possible worsening of PTSD caseness at follow-up from one study. Further interventions in this population should address broader psychological needs beyond PTSD while taking into account the effect of multiple daily stressors. Additional studies, including social and welfare interventions, will improve precision of estimates of effect, particularly over the longer term.
Collapse
Affiliation(s)
- Aseel Hamid
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Nimisha Patel
- Clinical Psychology, School of Psychology, University of East London, London, United Kingdom
- International Centre for Health & Human Rights, London, United Kingdom
| | - Amanda C. de C. Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- International Centre for Health & Human Rights, London, United Kingdom
| |
Collapse
|
33
|
Abstract
Psychological trauma has developed into a very common concept in the scientific community, in mental health care, as well as in popular language and mass media. The purpose of this article is to show the relevance of the discipline of traumatic stress studies to the field of public mental health by examining central concepts and findings concerning trauma and its aftermath and examining implications for public mental health. Attention is paid to the diagnosis of posttraumatic stress disorder (PTSD) and the construct of resilience as well as to specific areas of public mental health activities. A public mental health perspective will help to develop preventive approaches to trauma and extend the impact of various forms of interventions. It will also make clear that trauma care will have to consider the community and the society at large.
Collapse
Affiliation(s)
- Rolf J. Kleber
- Utrecht University, Utrecht, Netherlands
- Arq Psychotrauma Expert Group, Diemen, Netherlands
| |
Collapse
|
34
|
Yrondi A, DerKasbarian R, Gallini A, Max V, Pauron C, Joubin A, Laguerre J, Virenque C, Birmes P. Symptoms of depression and post-traumatic stress in a group of lightning strike victims. J Psychosom Res 2019; 120:90-95. [PMID: 30929714 DOI: 10.1016/j.jpsychores.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lightning strike victims often suffer repercussions. Although a lightning strike constitutes a severe traumatic event, there is a lack of data about potential psychological sequelae. This is precisely the context in which we assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Episode (MDE) in a group of lightning strike victims. METHODS The symptoms of peritraumatic dissociation were evaluated on the basis of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) whilst the Peritraumatic Distress Inventory (PDI) was used to assess symptoms of distress. PTSD and MDE diagnoses were evaluated using the MINI (Mini International Neuropsychiatric Interview). Symptom intensity was assessed using the self-report PTSD Checklist-Specific (PCLS) and the Beck Depression Inventory II (BDI II), respectively. RESULTS Forty-nine patients were enrolled in the study. As regards symptoms of depression, 28 patients (57.1%) reported a major depressive episode (MINI) including 10 (20.4%) of moderate intensity and 5 (10.2%) of severe intensity (BDI). In terms of PTSD symptoms, 13 patients (26.5%) reported probable PTSD (MINI) with a PCL-S score ≥ 45. A significant correlation was established between PDEQ and BDI II (Spearman correlation coefficient = 0.36, p = .012). A significant correlation was also found between PDI and PCLS (Spearman correlation coefficient = 0.43, p = .002). A further significant correlation was noted between PDEQ and PCLS (Spearman correlation coefficient = 0.31, p = .028). DISCUSSION This study highlights the need for a multidisciplinary evaluation of lightning strike victims. Indeed, the prevalence of psychiatric disorders such as PTSD and MDE appears to be significant.
Collapse
Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, (Department of Adult Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental (Expert Anti-Depression Centre), CHRU de Toulouse (Regional University Hospital Centre), Hôpital Purpan, ToNIC, Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), Inserm, UPS, France.
| | - Raphael DerKasbarian
- Service de Psychiatrie et de Psychologie Médicale de l'adulte (Department of Adult Psychiatry and Medical Psychology), CHU Toulouse-Purpan (University Hospital Centre), Toulouse, France
| | - Adeline Gallini
- UMR1027, INSERM University of Toulouse, Toulouse, France; Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse (University Hospital Centre), Toulouse, France
| | - Vincent Max
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse (University Hospital Centre), Toulouse, France
| | - Christophe Pauron
- Service médecine d'urgence (Emergency Medicine Department), CHU-Toulouse (University Hospital Centre), Toulouse, France
| | - Audrey Joubin
- Centre Hospitalier de Mamoudzou (Hospital Centre), Mayotte, France
| | - Jacky Laguerre
- Service des grands brulés, pôle d'anesthésie-réanimation (Major Burns Unit, ICU Unit), CHU Toulouse-Rangueil (University Hospital Centre), Toulouse, France
| | | | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), Inserm, UPS, France
| |
Collapse
|
35
|
Hoppen TH, Morina N. The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. Eur J Psychotraumatol 2019; 10:1578637. [PMID: 30834069 PMCID: PMC6394282 DOI: 10.1080/20008198.2019.1578637] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background: Elevated prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) have been reported in populations exposed to war. However, no global estimates of war survivors suffering from PTSD and/or MD in absolute numbers have been reported. Objective: We made the first attempt to estimate in absolute numbers how many adult war survivors globally may suffer PTSD and/or MD, which should inform local and global mental health programmes. Method: Drawing on the Uppsala Conflict Database, we reviewed all countries that suffered at least one war within their own territory between 1989 and 2015 (time span chosen on availability of geo-referenced data and population estimates). We then conducted a meta-analysis of current randomized epidemiological surveys on prevalence of PTSD and/or MD among war survivors. Finally, we extrapolated our results from the meta-analysis on the global population of adult war survivors by means of using general population data from the United Nations. Results: We estimate that about 1.45 billion individuals worldwide have experienced war between 1989 and 2015 and were still alive in 2015, including one billion adults. On the basis of our meta-analysis, we estimate that about 354 million adult war survivors suffer from PTSD and/or MD. Of these, about 117 million suffer from comorbid PTSD and MD. Conclusions: Based on the slim available evidence base, the global number of adult war survivors suffering PTSD and/or MD is vast. Most war survivors live in low-to-middle income countries with limited means to handle the enormous mental health burden. Since representative high quality data is lacking from most of these countries, our results contain a large margin of uncertainty and should be interpreted with caution.
Collapse
Affiliation(s)
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| |
Collapse
|
36
|
Morina N, Stam K, Pollet TV, Priebe S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J Affect Disord 2018; 239:328-338. [PMID: 30031252 DOI: 10.1016/j.jad.2018.07.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/21/2018] [Accepted: 07/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions. METHODS To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions. RESULTS We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD. LIMITATIONS The findings are limited by poor psychometric reporting practices. CONCLUSIONS Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.
Collapse
Affiliation(s)
- Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany; Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Kimberly Stam
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas V Pollet
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, UK
| |
Collapse
|
37
|
Thompson CT, Vidgen A, Roberts NP. Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: A systematic review and meta-analysis. Clin Psychol Rev 2018; 63:66-79. [DOI: 10.1016/j.cpr.2018.06.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
|
38
|
Ryan GK, Bauer A, Bass JK, Eaton J. Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review. BMJ Open 2018; 8:e018193. [PMID: 29455163 PMCID: PMC5855449 DOI: 10.1136/bmjopen-2017-018193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION There is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC). METHODS AND ANALYSIS Qualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis. ETHICS AND DISSEMINATION Findings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users. PROSPERO REGISTRATION NUMBER CRD42017058287.
Collapse
Affiliation(s)
- Grace Kathryn Ryan
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Mental Health, London, UK
| | - Andreas Bauer
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Mental Health, London, UK
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julian Eaton
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Mental Health, London, UK
- CBM International, Bensheim, Germany
| |
Collapse
|
39
|
What are the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies? A qualitative evidence synthesis. Glob Ment Health (Camb) 2018; 5:e21. [PMID: 29997893 PMCID: PMC6036649 DOI: 10.1017/gmh.2018.12] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Humanitarian emergencies can impact people's psychosocial well-being and mental health. Providing mental health and psychosocial support (MHPSS) is an essential component of humanitarian aid responses. However, factors influencing the delivery MHPSS programmes have yet to be synthesised. We undertook a systematic review on the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies in low- and middle-income countries. METHODS A comprehensive search of 12 bibliographic databases, 25 websites and citation checking was undertaken. Studies published in English from 1980 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in or programmes providers involved in delivering, MHPSS programmes in humanitarian settings. Thirteen studies were critically appraised and analysed thematically. RESULTS Community engagement was a key mechanism to support the successful implementation and uptake of MHPSS programmes. Establishing good relationships with parents may also be important when there is a need to communicate the value of children and young people's participation in programmes. Sufficient numbers of trained providers were essential in ensuring a range of MHPSS programmes were delivered as planned but could be challenging in resource-limited settings. Programmes need to be socially and culturally meaningful to ensure they remain appealing. Recipients also valued engagement with peers in group-based programmes and trusting and supportive relationships with providers. CONCLUSION The synthesis identified important factors that could improve MHPSS programme reach and appeal. Taking these factors into consideration could support future MHPSS programmes achieve their intended aims.
Collapse
|
40
|
Sijbrandij M, Acarturk C, Bird M, Bryant RA, Burchert S, Carswell K, de Jong J, Dinesen C, Dawson KS, El Chammay R, van Ittersum L, Jordans M, Knaevelsrud C, McDaid D, Miller K, Morina N, Park AL, Roberts B, van Son Y, Sondorp E, Pfaltz MC, Ruttenberg L, Schick M, Schnyder U, van Ommeren M, Ventevogel P, Weissbecker I, Weitz E, Wiedemann N, Whitney C, Cuijpers P. Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries. Eur J Psychotraumatol 2017; 8:1388102. [PMID: 29163867 PMCID: PMC5687806 DOI: 10.1080/20008198.2017.1388102] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/22/2017] [Indexed: 11/15/2022] Open
Abstract
The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.
Collapse
Affiliation(s)
- Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands
| | - Ceren Acarturk
- Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - Martha Bird
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sebastian Burchert
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Joop de Jong
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Cecilie Dinesen
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Rabih El Chammay
- Ministry of Public Health, Beirut, Lebanon
- Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | - Mark Jordans
- Department of Research and Development, War Child, Amsterdam, the Netherlands
- Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - David McDaid
- Department of Health Policy, Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Kenneth Miller
- Department of Research and Development, War Child, Amsterdam, the Netherlands
| | - Naser Morina
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A-La Park
- Department of Health Policy, Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Yvette van Son
- Region Netherlands Centre and North, i-Psy Mental Health Care, Almere, the Netherlands
| | - Egbert Sondorp
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Monique C. Pfaltz
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Matthis Schick
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Erica Weitz
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands
| | - Nana Wiedemann
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | | | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands
| |
Collapse
|
41
|
Schnurr PP, Bryant R, Berliner L, Kilpatrick DG, Rizzo A, Ruzek JI. What I have changed my mind about and why: public health and technology perspectives in the field of trauma studies. Eur J Psychotraumatol 2017; 8:1372007. [PMID: 29075427 PMCID: PMC5632765 DOI: 10.1080/20008198.2017.1372007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/16/2017] [Indexed: 12/04/2022] Open
Abstract
Background: This paper is based on a panel discussion at the 32nd annual meeting of the International Society for Traumatic Stress Studies in Dallas, Texas, in November 2016. Objective: Paula Schnurr convened a panel of experts in the fields of public health and technology to address the topic: 'What I have changed my mind about and why.' Method: The panel included Richard Bryant, Lucy Berliner, Dean Kilpatrick, Albert ('Skip') Rizzo, and Josef Ruzek. Results: Panellists discussed innovative strategies for the dissemination of scientific knowledge and evidence-based treatment. Conclusions: Although there are effective treatments, there is a need to enhance the effectiveness of these treatments. There also is a need to develop simpler, low-cost strategies to disseminate effective treatments. However, technology approaches also offer pathways to increased dissemination. Researchers must communicate scientific findings more effectively to impact public opinion and public policy.
Collapse
Affiliation(s)
- Paula P. Schnurr
- National Center for PTSD, White River Junction, VT, USA
- Geisel School of Medicine, Hanover, NH, USA
| | | | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, Seattle, WA, USA
| | | | - Albert Rizzo
- University of Southern California, Los Angeles, CA, USA
| | - Josef I. Ruzek
- National Center for PTSD, White River Junction, VT, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|