Challenges in mental health and psychosocial care in conflict-affected low- and middle-income countries

Prevalence of mental disorders and psychological trauma among conflict- affected population in Somalia: a cross-sectional study

Background

Despite the longstanding psychosocial impact of the interactable conflict in Somalia for the last 30 years, there is lack of epidemiological studies of mental health conditions, especially at the population level.

Objectives

The aim of this study is to fill the epidemiological gap and provide population based data on mental health conditions in the South-Central region of Somalia. The specific objectives were: (1) To determine the epidemiological patterns of mental disorders in three sites; Baidoa, Dolow and Kismayo, (2) Understand the socio-demographic characteristics associated with mental health conditions in the study sites, and (3) To assess the correlates between psychological trauma and the mental wellbeing of the population.

Methods

This was a cross-sectional study of 713 respondents recruited from the three sites namely Dolow, Baidoa and Kismayo. Data on sociodemographic characteristics and mental disorders were collected using the MINI and sociodemographic questionnaire. Basic descriptive statistics were used to summarize sociodemographic characteristics. Univariable and multivariable logistic regressions were used to examine factors associated with common mental disorders. Statistical significance was considered at a value of p <0.05.

Results

Participants' mean age was 32.6 (±10.7) years. More than half (58.5%) of the respondents were male. The overall prevalence of common mental disorders was 557 (78.1%) with panic disorder (39.3%), generalized anxiety disorders (34.9%), major depressive episode current (32.1) and PTSD (29.9%). According to the multivariable logistic regression analysis, being male AOR = 1.74 (95%CI = 1.25, 2.42), having a family size of more than 10 members AOR =1.37 (95% CI = 1.00, 1.89), being unemployed AOR = 1.90 (95%CI = 1.18, 3.06), experienced starvation AOR =3.46 (95%CI = 2.23, 5.37), khat use AOR = 5.87 (955 CI, 1.75-19.65), were identified as predicting factors for the common mental disorders among the study participants.

Conclusion

There is a high prevalence of mental disorders with anxiety disorders being the commonest. Findings reflect earlier studies that showed higher rates in conflict and post-conflict settings. It also aligns with past studies in Somalia. As such, there is an urgent need to integrate mental health and psychosocial support within the primary healthcare and other service sectors such as education considering the vast majority of the population are young.

Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers and prospects

Telehealth is being broadly developed in all fields of medicine, and online visits seem a particularly suitable alternative to in-person visits in outpatient psychiatry especially in conflict setting. Telepsychiatry has numerous advantages over in-person visits.

Mental health services in conflict areas - An experience from Libya

The Libyan mental health system has long been seen as inefficient and insufficient for the demands of the country. Thousands of Libyans require mental health therapy now more than ever before. Libya's Ministry of Health has worked to improve access to mental health services. Despite international assistance, Libya continues to face issues due to stigma and a shortage of competent psychiatrists. The majority of Libyan individuals are unable to obtain private psychiatric care. This places the burden on the public sector to care for the majority's psychological pain and suffering and this needs to be addressed.

Nagorno-Karabakh conflict: Mental health repercussions and challenges in Azerbaijan

The Armenia-Azerbaijan Nagorno-Karabakh conflict has made many Azerbaijanis internally displaced (IDP), missing, wounded, disabled, or killed. The war and its aftermath have drastically impacted the mental health of these populations, leading to depression, anxiety, and stress-related psychosomatic illnesses such as dissociative disorder. However, their access to medical and psychological services is limited. Intervention in terms of policy making, healthcare services, information systems, and social support is required to promoting social integration and facilitate accessibility to mental healthcare. National and international organisations, foreign aids, and media support can contribute to this end. The psychological effects of the war on children, healthcare shortage associated with COVID-19, accommodation and welfare problems, limited access to vaccination, technology, and educational opportunities, dangerous explosive remnants, as well as isolation and marginalisation of the IDPs can all be challenges facing the mental health of these populations. Organising programs such as support groups to share wartime experience, resilience promotion, psychosocial support for healthcare providers, religious identification, integral COVID-19 management, beside accommodation and education support are recommended to enhance the condition of these Azerbaijani populations.

Sudan's unmet mental health needs: A call for action

Multiple humanitarian and economic crises in Sudan, including a 22-year civil war and the Darfur genocide in 2003, have resulted in over two million fatalities, food shortages, famine and widespread internal displacement. and the COVID-19 pandemic have culminated in the compromise of mental health services. The Sudanese government had declared a state of emergency on October 25th, 2021 which augmented the current humanitarian crises through further restriction of access to essential services. In an effort to curb the mental health crisis, new service delivery models led by educational institutions in collaboration with non-governmental, regional and international organisations.