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Manafe N, Ismael-Mulungo H, Ponda F, Dos Santos PF, Mandlate F, Cumbe VFJ, Mocumbi AO, Oliveira Martins MR. Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study. Front Public Health 2024; 12:1371598. [PMID: 38689772 PMCID: PMC11058794 DOI: 10.3389/fpubh.2024.1371598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] 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. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Fábio Ponda
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Flávio Mandlate
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Vasco F. J. Cumbe
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Maria R. Oliveira Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Bowling AR, Klein AB, Sheikh IS, Dolezal ML, Alsubaie MK, Rosencrans PL, Walker RS, Bentley JA, Zoellner LA, Feeny NC. Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims. COGENT MENTAL HEALTH 2024; 3:1-18. [PMID: 38550624 PMCID: PMC10972603 DOI: 10.1080/28324765.2024.2305417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/09/2024] [Indexed: 04/01/2024]
Abstract
Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.
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Affiliation(s)
- Alexandra R. Bowling
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Alexandra B. Klein
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Ifrah S. Sheikh
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Michael L. Dolezal
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | | | | | | | - Jacob A. Bentley
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | - Lori A. Zoellner
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Norah C. Feeny
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
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Zavos HMS, Riddleston L, Jayaweera K, Dissanayake L, Jabir S, Pannala G, Hotopf M, Siribaddana S, Sumathipala A, Rijsdijk FV. Frequency of Consumption of Food Groups and Cardio-Metabolic Risk Factors: A Genetically Informative Twin Study in Sri Lanka. Behav Genet 2024; 54:73-85. [PMID: 38135768 PMCID: PMC10822787 DOI: 10.1007/s10519-023-10165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/17/2023] [Indexed: 12/24/2023]
Abstract
Low- and middle-income countries (LMICs) globally have undergone rapid urbanisation, and changes in demography and health behaviours. In Sri Lanka, cardio-vascular disease and diabetes are now leading causes of mortality. High prevalence of their risk factors, including hypertension, dysglycaemia and obesity have also been observed. Diet is a key modifiable risk factor for both cardio-vascular disease and diabetes as well as their risk factors. Although typically thought of as an environmental risk factor, dietary choice has been shown to be genetically influenced, and genes associated with this behaviour correlate with metabolic risk indicators. We used Structural Equation Model fitting to investigate the aetiology of dietary choices and cardio-metabolic phenotypes in COTASS, a population-based twin and singleton sample in Colombo, Sri Lanka. Participants completed a Food Frequency Questionnaire (N = 3934) which assessed frequency of intake of 14 food groups including meat, vegetables and dessert or sweet snacks. Anthropometric (N = 3675) and cardio-metabolic (N = 3477) phenotypes were also collected including weight, blood pressure, cholesterol, fasting plasma glucose and triglycerides. Frequency of consumption of most food items was found to be largely environmental in origin with both the shared and non-shared environmental influences indicated. Modest genetic influences were observed for some food groups (e.g. fruits and leafy greens). Cardio-metabolic phenotypes showed moderate genetic influences with some shared environmental influence for Body Mass Index, blood pressure and triglycerides. Overall, it seemed that shared environmental effects were more important for both dietary choices and cardio-metabolic phenotypes compared to populations in the Global North.
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Affiliation(s)
- Helena M S Zavos
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Laura Riddleston
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kaushalya Jayaweera
- Institute for Research and Development in Health and Social Care, Colombo, Sri Lanka
| | - Lasith Dissanayake
- Institute for Research and Development in Health and Social Care, Colombo, Sri Lanka
| | - Sameeha Jabir
- Institute for Research and Development in Health and Social Care, Colombo, Sri Lanka
| | - Gayani Pannala
- Institute for Research and Development in Health and Social Care, Colombo, Sri Lanka
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | | | - Athula Sumathipala
- Institute for Research and Development in Health and Social Care, Colombo, Sri Lanka
- Faculty of Medicine & Health Sciences, Research Institute for Primary Care & Health Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Frühling V Rijsdijk
- Psychology Department, Faculty of Social Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
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Mohammadi M, Jafari H, Etemadi M, Dalugoda Y, Mohtady Ali H, Phung H, Ahmadvand A, Dwirahmadi F, Barnes P, Chu C. Health Problems of Increasing Man-Made and Climate-Related Disasters on Forcibly Displaced populations: A Scoping Review on Global Evidence. Disaster Med Public Health Prep 2023; 17:e537. [PMID: 37994107 DOI: 10.1017/dmp.2023.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Forcibly displaced populations are among the most vulnerable groups in disasters. They experience poorer health conditions compared with nondisplaced individuals. However, a clear picture is lacking regarding the overall health problems encountered by disaster-induced mid- to long-term displaced people. This study investigated these disorders prevalence and identified their correlates among long-settled displaced populations worldwide. The current scoping review follows the PRISMA-ScR guidelines; a systematic search was conducted on PubMed, Web of Science, and CINAHL and included original peer-reviewed studies, commentary, reviews, and grey literature published in English between January 1990 to June 2022. In the thematic and content analysis, the authors applied the narrative review approach to identify themes and sub-themes. Forty-eight documents were identified as fully relevant to this study. The largest number of published papers were from Asia, followed by the Middle East, the United States, and Europe. IDPs in developed countries were the most researched populations. Human-made disasters were addressed by 89% of the included studies. The four main thematic categories included were "physical health," "mental health," "inadequate facilities," and "lack of healthy behaviour." The worsening of noncommunicable diseases had the highest prevalence, followed by communicable diseases. Due to their condition, forcibly displaced migrants face a triple burden of communicable diseases and noncommunicable diseases such as mental health issues. Health-related research and policy need to consider the links among disasters, health problems, and forced migration as a determinant of health in the new era of climate change-driven displacements.
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Affiliation(s)
- Mahan Mohammadi
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Hamid Jafari
- Department of Medical Emergencies, School of Medical Sciences, Sirjan, Iran
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Yohani Dalugoda
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Heba Mohtady Ali
- Cities Research Institute & School of Engineering and Built Environment, Griffith University, Gold Coast, Australia
| | - Hai Phung
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Alireza Ahmadvand
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Febi Dwirahmadi
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Paul Barnes
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Cordia Chu
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
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Somasundaram D, Jayasuriya R, Perera R, Thamotharampillai U, Wickremasinghe R, Tay AK. Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka. BJPsych Open 2023; 9:e180. [PMID: 37818719 PMCID: PMC10594160 DOI: 10.1192/bjo.2023.563] [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: 09/19/2022] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Daily stressors have been shown to mediate the relationship of war trauma and trauma-related distress among refugees and internally displaced persons exposed to war and conflict. AIMS To examine the extent to which the relationship between war-related trauma and mental distress was mediated by daily stressors and collective efficacy among internally displaced communities a decade after exposure to war. METHOD In a cross-sectional study, we recruited a random sample of residents in villages severely affected by conflict in five districts in the Northern Province of Sri Lanka. Measures of war trauma, daily stressors, collective efficacy and post-traumatic stress symptoms (PTSS) were examined. Statistical analyses of the mediating and moderating effects of daily stressors were conducted using regression based methods. RESULTS Daily stressors mediated the association of war trauma and PTSS, as both paths of the indirect effect, war trauma to daily stressors and daily stressors to PTSS, were significant. The predictive effect of war trauma on PTSS was positive and significant at moderate and high levels of daily stressors but not at low levels. Higher levels of neighbourhood informal social control, a component of collective efficacy, function as a protective factor to reduce effects of war trauma and daily stressors on mental distress in this population. CONCLUSIONS Daily stressors are an important mediator in the well-established relationship between war exposure and traumatic stress among internally displaced persons, even a decade after the conflict. Mental health and psychosocial support programmes that aim to address mental distress among war-affected communities could reduce daily stressors and enhance collective efficacy in this context.
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Affiliation(s)
| | - Rohan Jayasuriya
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ruwanthi Perera
- Department of Rogavijnana, Faculty of Indigenous Medicine, Gampaha Wickramarachchi University of Indigenous Medicine, Yakkala, Sri Lanka
| | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Alvin Kuowei Tay
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Acolin J, Fishman P. Beyond the biomedical, towards the agentic: A paradigm shift for population health science. Soc Sci Med 2023; 326:115950. [PMID: 37148746 PMCID: PMC10154061 DOI: 10.1016/j.socscimed.2023.115950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. In this paper, we argue that the biomedical model and its underlying scientific paradigm of causal determinism, which currently dominate population health, cannot meet population health needs. While criticism of the biomedical model is not new, this paper advances the field by going beyond criticism to recognize the need for a paradigm shift. In the first half of the paper, we present a critical analysis of the biomedical model and the paradigm of causal determinism. In the second half, we outline the agentic paradigm and present a structural model of health based on generalizable, group-level processes. We use the experience of the COVID-19 pandemic to illustrate the practical applications of our model. It will be important for future work to investigate the empirical and pragmatic applications of our structural model of population health.
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Affiliation(s)
- Jessica Acolin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Paul Fishman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Miller ME, Nwosu CO, Nyamwanza AM, Jacobs PT. Assessing Psychosocial Health Impacts of Climate Adaptation: A Critical Review. New Solut 2023; 33:37-50. [PMID: 37227805 DOI: 10.1177/10482911231173068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The urgency of dealing with risks associated with climate change and the need for effective response measures to their impacts are increasing daily the world over. Literature abounds regarding the impacts of climate change on physical, psychosocial, and other health outcomes. In contrast, little research exists on the health impacts of response measures to climate change. This critical review seeks to contribute towards closing this gap through a synthesis of current literature on the psychosocial health outcomes of climate adaptation actions. Our results found both positive and negative outcomes associated with psychosocial health that may result from climate adaptation actions. We propose the utilization of well-developed conceptual frameworks and evaluation tools in assessment and analysis of these outcomes. Ultimately, there is need to expand similar and related areas of research more broadly and on psychosocial effects, specifically.
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Affiliation(s)
- Mary E Miller
- School of Public Health, Division of Environmental Health, University of Cape Town, Cape Town, South Africa
- Human Sciences Research Council, Equitable Education and Economies Division, Cape Town, South Africa
| | - Chijioke O Nwosu
- Department of Economics and Finance, University of the Free State, Bloemfontein, South Africa
| | - Admire M Nyamwanza
- Climate Action and Sustainability Research, Institute of Natural Resources, Pietermaritzburg, South Africa
| | - Peter T Jacobs
- Human Sciences Research Council, Equitable Education and Economies Division, Cape Town, South Africa
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8
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, García T, González-Uribe C, Moreno-Serra R, Bernal O. Mental health disorders in population displaced by conflict in Colombia: Comparative analysis against the National Mental Health Survey 2015. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:121-129. [PMID: 37453820 DOI: 10.1016/j.rcpeng.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/21/2021] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. METHODS Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire-25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. RESULTS 1089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. CONCLUSIONS The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.
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Affiliation(s)
| | - Germán Casas
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | | | - Tatiana García
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Universidad Autónoma de Barcelona, Barcelona, Spain
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Makango B, Alemu ZA, Solomon T, Lemma N, Girma T, Mohammednur T, Alayu M, Fufa Y. Prevalence and factors associated with post-traumatic stress disorder among internally displaced people in camps at Debre Berhan, Amhara Region, Ethiopia: a cross-sectional study. BMC Psychiatry 2023; 23:81. [PMID: 36717807 PMCID: PMC9887899 DOI: 10.1186/s12888-023-04570-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a common mental disorder after traumatic exposure that can have long-lasting physical and mental health consequences. In 2021, Ethiopia saw the highest number of internally displaced people (IDP) due to conflict and war with the scope of the internal displacement being very high in the study area and less attention has been given to mental health. OBJECTIVE To determine the prevalence and associated factors of PTSD among internally displaced people in camps at Debre Berhan, Ethiopia. METHODS A cross-sectional study was conducted from December 1-30, 2021 among 406 IDPs, who were selected by random systematic sampling from the registration and proportionally allocated to three IDP camps in Debre Berhan. Post-traumatic stress disorder was measured by the PTSD checklist (DSM-5). Data were collected through an interviewer-administered pre-tested questionnaire, entered into EpiData version 3.1, and analyzed by Statistical Package for Social Sciences version 25. Bivariate binary logistic regression was used to select candidate variables with p < 0.25. Multicollinearity was checked by using the variance inflation factor and it was less than 10. Model adequacy was checked by Hosmer & Lemeshow goodness of test (p > 0.05). In the multivariable binary logistic regression, the association between outcome and independent variables was declared at p < 0.05 with its adjusted odds ratio (AOR) at a 95% confidence level. RESULTS The prevalence of PTSD among the respondents was 67.5% (95% CI: 63-72). Being a merchant (AOR = 0.41 [95% CI: 0.02-0.85]), witnessing the destruction of property (AOR = 1.67 [95% CI: 1.01-2.74]), facing trauma during displacement (AOR = 6.00 [95% CI: 2.75-13.10]), frequency of displacement (AOR = 0.31 [95% CI: 0.11-0.85]), being distressed (AOR = 5.42 [95% CI: 3.25-9.05]), and unemployment (AOR = 2.09 [95% CI: 1.24-3.54]) were factors significantly associated with PTSD. CONCLUSION This study provides evidence of the high prevalence of PTSD among internally displaced people. Therefore, mental health and psychosocial support are urgently required to address the identified factors and help the displaced people against long-term avoidable suffering.
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Affiliation(s)
- Belay Makango
- Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia.
| | - Zewdie Aderaw Alemu
- Department of Public Health, GAMBY Medical and Business College, Addis Ababa, Ethiopia ,grid.449044.90000 0004 0480 6730Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfaye Solomon
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Nigussie Lemma
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Tewodros Girma
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Tijani Mohammednur
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Mikias Alayu
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Yaregal Fufa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
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10
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Nguyen AJ, Lasater ME, Lee C, Mallawaarachchi IV, Joshua K, Bassett L, Gelsdorf K. Psychosocial support interventions in the context of forced displacement: A systematic review and meta-analysis. J Migr Health 2023; 7:100168. [PMID: 36816445 PMCID: PMC9932448 DOI: 10.1016/j.jmh.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Background Forced displacement is associated with elevated risk for poor psychosocial wellbeing, yet there remains a lack of clarity around the effectiveness of commonly implemented psychosocial support interventions focused on preventing disorder and promoting wellbeing. This study aimed to synthesize the literature on evaluations of psychosocial support interventions for populations affected by forced displacement. Methods We searched for peer reviewed and gray literature in seven databases (PubMed, Embase, Global Health, CINAHL, SocIndex, PsychInfo, PILOTS), fifteen organizational websites, and via solicitation through multiple networks. Various study designs were included, with the criteria that they report an evaluation of a psychosocial intervention delivered to populations affected by forced displacement, and included quantitative or qualitative data on psychosocial outcomes. Records were screened independently by two reviewers at both title/abstract and full-text review; data was double-extracted and study quality assessed, with discrepancies resolved by consensus. Meta-analyses for seven outcomes were conducted on a subset of 33 studies. Results We identified 162 reports. Over half (55%) used a single-group study design, with fewer using non-random (19%) or randomized (21%) comparisons. Study designs incorporating comparison conditions were less likely to report positive findings than single-group studies. In the meta-analyses, a moderately strong overall effect was found for psychosocial wellbeing (ES: -0.534, 95% CI: [-0.870, -0.197], p=.005); small effects on both internalizing (ES: -0.152, 95% CI: [-0.310, 0.005], p= .057) and externalizing (ES: -0.249, 95% CI: [-0.515, 0.016], p=.064) problems were promising but not conclusive. Subgroup analysis suggested differential impacts on internalizing problems for adults (improvement; ES: -0.289, 95% CI: [-0.435, -0.143], p=.001) and children (worsening; ES: 0.129, 95% CI: [.054, 0.204], p=.002). Other subgroup analyses showed little meaningful variation by context, population, or intervention characteristics. Conclusion Pragmatic, field-driven program evaluations are dominated by single-group designs with significant risk of bias. Findings from controlled studies are promising but highlight a need for more rigorous research to support causal inference, align outcomes with theories of change, improve measurement of more positive or wellbeing-focused outcomes, examine subgroup differences, and report potentially negative impacts.
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Affiliation(s)
- Amanda J. Nguyen
- School of Education and Human Development, University of Virginia, PO Box 400281, 417 Emmet St S., Charlottesville, VA 22904, United States,Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States,Corresponding author at: School of Education and Human Development, University of Virginia, PO Box 400281, 417 Emmet St S., Charlottesville, VA 22904, United States.
| | - Molly E. Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, United States
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, United States
| | - Indika V. Mallawaarachchi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22904, United States
| | - Kate Joshua
- Claude Moore Health Sciences Library, University of Virginia, 1350 Jefferson Park Avenue, PO Box 800722, Charlottesville, VA 22908, United States
| | - Lucy Bassett
- Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States
| | - Kirsten Gelsdorf
- Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States
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Rasheed OS, López-Rodríguez L, Navas M. Withstanding psychological distress among internally displaced Yazidis in Iraq: 6 years after attack by the Islamic State of Iraq and the Levant. BMC Psychol 2022; 10:262. [DOI: 10.1186/s40359-022-00973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Insurgents of the Islamic State of Iraq and the Levant created a crisis that has had immediate and long-term consequences for the population in Iraq. Yazidis are among the most affected ethnos religious groups in the region. The current study focuses on investigating the level of psychological distress and its association with subjective resilience among the Yazidi minority 6 years after the attack by the Islamic State of Iraq and the Levant.
Methods
The present study recruited four hundred and twenty-two Yazidi individuals (50.8% female) residing in two camps in the Iraqi Kurdistan region. In face-to-face interviews, each participant replied to different scales to measure psychological distress (i.e., depression, anxiety, and stress), perceived stress, and subjective resilience. In addition, they were asked questions about mental health and psychosocial service acquisition.
Results
The results indicate that levels of psychological distress were high among the target population; around 65% of respondents reported having some level of psychological distress. Moreover, women showed not only higher level of psychological distress but also revealed slightly lower subjective resilience as compared to male participants. Hierarchical regressions showed that subjective resilience significantly contributed to the predictive model of distress beyond demographics and having received or not mental health and psychosocial support. Subjective resilience was significantly associated to less anxiety (R2adj = .157, ΔR2 = .022, p = .010) and stress (R2adj = .083, ΔR2 = .026, p = .008) in Mam-Rashan camp; and to less depression (R2adj = .184, ΔR2 = .095, p < .001), anxiety (R2adj = .140, ΔR2 = .024, p = .034), stress (R2adj = .046, ΔR2 = .047, p = .005), and perceived stress (R2adj = .024, ΔR2 = .032, p = .022) in Shekhan camp.
Conclusions
Conflict and displacement contribute to high level of psychological distress. Resilience, however, seem to have a negative association with psychological distress. Additionally, living conditions and sex also played an important role in both psychological distress and resilience. Consequently, Yazidi community residing in camps are in need of further support to alleviate the consequences of displacement. We critically discuss the differences in the results among participants per camp and by sex, and its implications.
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Madill A, Shloim N, Brown B, Hugh‐Jones S, Plastow J, Setiyawati D. Mainstreaming global mental health: Is there potential to embed psychosocial well-being impact in all global challenges research? Appl Psychol Health Well Being 2022; 14:1291-1313. [PMID: 35040529 PMCID: PMC9786259 DOI: 10.1111/aphw.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/14/2021] [Indexed: 12/30/2022]
Abstract
We explore if there is potential to embed psychosocial well-being impact in global challenges research where the primary aims are not mental health related. We are interested in the use of material practices to deliver impact through routine project activities of working with concrete things together. The UK Research and Innovation (UKRI) gateway to research was searched for information on Global Challenges Research Fund (GCRF) grants from 2015 to May 2020. Analysis shows that only 3 per cent of projects self-categorise as engaging with mental health. Thirty-six non-mental health GCRF grants were purposefully sampled for diversity, and each was coded independently by two researchers for relevant information. Findings suggest that 50-70 per cent of non-mental health GCRF projects already engage implicitly, but nonstrategically, with psychosocial well-being impact; opportunities for psychosocial well-being impact, from most to least frequent, are community mobilisation, community building, skills development, positive sense of self, positive emotions and sociocultural identity; the presence of material practice from most to least frequent is as follows: (i) interactions between or enactments upon people, (ii) written materials or images, and (iii) objects; when a material practice was present, it was usually considered usable as a focus to enhance psychosocial well-being. Our study provides evidence that there are low hanging fruit opportunities to impact psychosocial well-being across Sustainable Development Goals (SDGs) through routine project activities.
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Affiliation(s)
- Anna Madill
- School of PsychologyUniversity of LeedsLeedsUK
| | | | - Brian Brown
- School of Applied Social SciencesDe Montfort UniversityLeicesterUK
| | | | | | - Diana Setiyawati
- Center for Public Mental Health, Faculty of PsychologyUniversitas Gadjah MadaYogyakartaIndonesia
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13
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Zaid SM, Fadel AM, Taresh SM, Mohammed LA, Fitriana N. Psychologists' perspective of mental health in Yemen during the civil war and COVID-19: a qualitative inquiry. CURRENT PSYCHOLOGY 2022:1-12. [PMID: 36258893 PMCID: PMC9560880 DOI: 10.1007/s12144-022-03617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/25/2022]
Abstract
In comparison to other Middle Eastern nations that are experiencing conflicts and wars, Yemen has the greatest rate of mental health issues since the war was accompanied by distressing experiences and severe chronic psychological crises. This study aims to examine the current state of psychological problems from the perspectives of psychologists and psychiatrists in light of the ongoing civil war and the COVID-19 pandemic. This study included 20 psychologists and psychiatrists in total. Semi-structured face-to-face interviews with the psychologists and psychiatrists were done between October 2021 and December 2021 and between May 2022 and June 2022. Handwritten notes and field notes were used to record the interview process. The transcripts were inductively analysed using Braun and Clarke's thematic analytic approach to get the main themes and subthemes. The four major themes that emerged from the emerging codes are the impact of war on mental health, the impact of COVID-19 on mental health, the healthcare system, and the lack of awareness about mental health. These themes reveal how the civil war and COVID-19 contributed to Yemenis' mental health issues and resulting psychological disorders. Yemenis' mental health and well-being are under several threats; thus, the government and other relevant authorities must take urgent measures to lessen the impact of mental illness on society.
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Affiliation(s)
- Sumaia Mohammed Zaid
- Department of Psychology, Faculty of Art and Human Science, Sana’a University, Sana’a, Yemen
| | - Ahlam Mohammed Fadel
- Department of Psychology, Faculty of Art and Human Science, Sana’a University, Sana’a, Yemen
| | | | - Lubna Ali Mohammed
- Department of TESL, Faculty of Social Sciences, Arts, and Humanities, Lincoln University College (LUC), Kelantan, Malaysia
| | - Nina Fitriana
- Department of Psychology, Faculty of Psychology, Mercu Buana University of Yogyakarta, Yogyakarta, Indonesia
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14
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Indicators of Mental Health Disorder, COVID-19 Prevention Compliance and Vaccination Intentions among Refugees in Kenya. Medicina (B Aires) 2022; 58:medicina58081032. [PMID: 36013499 PMCID: PMC9413478 DOI: 10.3390/medicina58081032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: COVID-19 remains a major development challenge in many developing countries. This study analysed the effect of mental health disorder and indicators of COVID-19 preventive practices on vaccination intentions among refugees in Kenya. Materials and Methods: The data were the fourth and fifth waves of the High Frequency Phone Surveys on the impacts of COVID-19 that were collected by the Kenyan National Bureau of Statistics (KNBS) between May 2020 and June 2021. The data were collected from Kakuma, Kalobeyei, Dadaab and Shona camps using the stratified random sampling method. The data were analysed with random effects instrumental variable Probit regression model. Results: The results showed that 69.32% and 93.16% of the refugees were willing to be vaccinated during the 4th and 5th waves, respectively. The fear of dying was reported by 85.89% and 74.19% during the 4th and 5th waves, respectively. COVID-19 contact prevention and immune boosting indicators were differently influenced by some demographic and anxiety index variables, while being endogenous influenced vaccine hesitancy along with urban residence, age, knowing infected persons, days of depression, days of anxiety, days of physical reactions, members losing job, searching for jobs, accepting job offers and being employed. Conclusions: It was concluded that efforts to promote COVID-19 vaccination should address mental health disorder and compliance with existing COVID-19 contact and immune boosting behaviour with a focus on urban residents and youths.
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15
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Lawrance EL, Thompson R, Newberry Le Vay J, Page L, Jennings N. The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications. Int Rev Psychiatry 2022; 34:443-498. [PMID: 36165756 DOI: 10.1080/09540261.2022.2128725] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.
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Affiliation(s)
- Emma L Lawrance
- Institute of Global Health Innovation, Imperial College London, UK.,Mental Health Innovations, UK.,Grantham Institute of Climate and the Environment, Imperial College London, UK
| | | | | | - Lisa Page
- Brighton & Sussex Medical School, UK
| | - Neil Jennings
- Grantham Institute of Climate and the Environment, Imperial College London, UK
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16
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Sustainable Livelihood for Displaced Rohingyas and Their Resilience at Bhashan Char in Bangladesh. SUSTAINABILITY 2022. [DOI: 10.3390/su14106374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The livelihood sustainability of the Rohingya refugees relocated in Bhashan Char, Bangladesh, has been questioned by various international stakeholders due to the remoteness and perceived vulnerabilities of the island. The Bangladesh government, a few international organizations, and some non-government organizations are working on developing livelihood opportunities in there. But there is scarce study about the livelihood opportunities and challenges of the Rohingyas living there. This study explores the vulnerabilities and livelihood opportunities of Rohingyas in Bhashan Char so as to help increase their resilience. The vulnerabilities include natural, geographical, and climatic shocks and stresses (e.g., cyclone, floods, storm surge, sea-level rise, geographical position). However, there are ample opportunities for their livelihood development, despite some challenges which can be overcome with concerted efforts. The opportunities include intensification and extensification of livelihood activities, such as modern agriculture, fish farming, livestock rearing, small business, handicraft, fishing net mending, crab fattening, biofloc aquaculture, and fish cage culture, but turning these opportunities into reality requires sufficient investment and internationally positive attitude. Better shelter, better disaster preparedness, cultural practices, education, and skill development can increase their capacity to bounce back, absorb shocks, and make them more resilient. National and international humanitarian organizations should plan to enhance the resilience of the Rohingya communities living in Bhashan Char and the island itself so that they can sustain in the long run, even after their anticipated repatriation to Myanmar.
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Luo J, Zamar DS, Ogwang MD, Muyinda H, Malamba SS, Katamba A, Jongbloed K, Schechter MT, Sewankambo NK, Spittal PM. Cango Lyec (Healing the Elephant): Probable post-traumatic stress disorder (PTSD) and depression in Northern Uganda five years after a violent conflict. J Migr Health 2022; 6:100125. [PMID: 35832466 PMCID: PMC9272377 DOI: 10.1016/j.jmh.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/04/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background From 1986 to 2006, Northern Uganda experienced an atrocious civil war between the Lord's Resistance Army (LRA) and the Ugandan government. Acholi people living in the region continue to be impacted by trauma sequelae of the war and a wide range of daily stressors including poverty, hunger, and high rates of HIV infection. To date, there is a dearth of gender-differentiated mental health research in this post-conflict setting. The current study aimed to estimate the prevalence of probable post-traumatic stress disorder (PTSD) and depression in three districts most affected by the Northern Ugandan conflict and examine socio-structural, war-related, and sexual vulnerability factors associated with mental health. Methods Cango Lyec (Healing the Elephant) is an open cohort study involving participants from eight randomly selected communities in Amuru, Gulu, and Nwoya districts of Northern Uganda. Between November 2011 and July 2012, the baseline cohort (N = 2,458) completed the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptom Checklist-25 (HSCL-25) for screening PTSD and depression, in addition to a detailed questionnaire assessing socio-demographic-behavioral characteristics. Baseline categorical variables were compared between males and females using Fisher's exact test. Multivariate logistic regression was used to model correlates of probable PTSD and depression. All analyses were stratified by gender. Results The overall prevalence of probable PTSD and depression was 11.7% and 15.2% respectively. Among former abductees, the prevalence was 23.2% for probable PTSD and 26.6% for probable depression. Women were significantly more likely to experience mental distress than men. Factors associated with mental distress included wartime trauma (adjusted odds ratios ranging from 2.80 to 7.19), experiences of abduction (adjusted odds ratios ranging from 1.97 to 3.03), and lack of housing stability and safety (adjusted odds ratios ranging from 1.95 to 4.59). Additional risk factors for women included HIV infection (AOR=1.90; 95% CI: 1.29–2.80), sexual abuse in the context of war (AOR=1.58; 95% CI: 1.02–2.45), and intimate partner violence (AOR=2.45; 95% CI: 1.07–5.63). Conclusion Cango Lyec participants displayed lower than previously reported yet significant levels of probable PTSD and depression. Based on findings from this study, providing trauma-informed care, ensuring food and housing security, eliminating gender-based violence, and reintegrating former abductees remain important tasks to facilitate post-conflict rehabilitation in Northern Uganda.
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Monsalve SD, Vargas-Monroy AM, Ariza JE, Oñate Cuello AM, Ropero Vera AR, Bermudez Cuello JC, Arzuaga Zuleta L, Cubillos Novella AF, Peñaloza Quintero E, Fernández Ortiz YN, Carrillo MA, Kroeger A. Mental health among displaced and non-displaced populations in Valledupar, Colombia: do inequalities continue? Pathog Glob Health 2021; 116:305-318. [PMID: 34689701 DOI: 10.1080/20477724.2021.1989186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
During the long-lasting civil war in Colombia, thousands of people were displaced mainly from rural to urban areas, causing social disruption and prolonged poverty. This study aimed at analyzing the traumatic experience many years ago on the current psycho-emotional status of displaced families as well as the ongoing inequalities regarding displaced and non-displaced communities in one of the most affected areas by the armed conflict. An interview survey was conducted among 211 displaced families and 181 non-displaced families in 2 adjacent compounds in Valledupar, Colombia. The questionnaire used questions from the validated national survey and was revised and applied by staff members of the departmental secretary of health who conducted additional in-depth interviews. The study showed that the living conditions of the displaced community were precarious. The past traumatic events many years ago and the current difficult living conditions are associated with psychological problems being more frequent among the displaced people. The displaced people had experienced more violent acts and subsequently had a larger number of emotional symptoms (fright, headache, nervousness, depression, and sleeplessness). Other stress factors like economic problems, severe disease or death of family members and unemployment prevailed among displaced persons. The non-displaced lived in a more protected environment with less exposure to violence and stress, although belonging to a similarly low socio-economic stratum. It is recommended to take measures for a better protection of the displaced community, improve their access to the job market, offer different leisure activities and facilitate public transport.
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Affiliation(s)
- Sonia Diaz Monsalve
- Albert-Ludwigs Universitaet Freiburg, Centre for Medicine and Society, Freiburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Axel Kroeger
- Albert-Ludwigs Universitaet Freiburg, Centre for Medicine and Society, Freiburg, Germany
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19
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Zamora-Moncayo E, Burgess RA, Fonseca L, González-Gort M, Kakuma R. Gender, mental health and resilience in armed conflict: listening to life stories of internally displaced women in Colombia. BMJ Glob Health 2021; 6:bmjgh-2021-005770. [PMID: 34620613 PMCID: PMC8499256 DOI: 10.1136/bmjgh-2021-005770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/29/2021] [Indexed: 11/05/2022] Open
Abstract
For over 60 years, Colombia has endured violent civil conflict forcibly displacing more than 8 million people. Recent efforts have begun to explore mental health consequences of these contexts, with an emphasis on national surveys. To date few Colombian studies explore mental health and well-being from a lived experience perspective. Those that do, overlook processes that enable survival. In response to this gap, we conducted a life history study of seven internally displaced Colombian women in the Cundinamarca department, analysing 18 interview sessions and 36 hours of transcripts. A thematic network analysis, informed by Latin-American perspectives on gender and critical resilience frameworks, explored women’s coping strategies in response to conflict-driven hardships related to mental well-being. Analysis illuminated that: (1) the gendered impacts of the armed conflict on women’s emotional well-being work through exacerbating historical gendered violence and inequality, intensifying existing emotional health challenges, and (2) coping strategies reflect women’s ability to mobilise cognitive, bodied, social, material and symbolic power and resources. Our findings highlight that the sociopolitical contexts of women’s lives are inseparable from their efforts to achieve mental well-being, and the value of deep narrative and historical work to capturing the complexity of women’s experiences within conflict settings. We suggest the importance of social interventions to support the mental health of women in conflict settings, in order to centre the social and political contexts faced by such marginalised groups within efforts to improve mental health.
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Affiliation(s)
- Emilia Zamora-Moncayo
- Escuela de Psicología, Universidad de Las Americas Facultad de Ciencias de la Salud, Quito, Pichincha, Ecuador
| | - Rochelle A Burgess
- Institute for Global Health, UCL, London, UK .,Department of Social Work, University of Johannesburg, Auckland Park, South Africa
| | - Laura Fonseca
- Facultad de Psicología, Universidad de La Sabana, Chia, Colombia.,Department of Psychological and Behavioural Sciences, The London School of Economics and Political Science, London, UK
| | | | - Ritsuko Kakuma
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
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20
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Vergunst F, Berry HL. Climate Change and Children’s Mental Health: A Developmental Perspective. Clin Psychol Sci 2021; 10:767-785. [PMID: 35846172 PMCID: PMC9280699 DOI: 10.1177/21677026211040787] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/20/2021] [Indexed: 12/03/2022]
Abstract
Climate change is a major global public-health challenge that will have wide-ranging impacts on human psychological health and well-being. Children and adolescents are at particular risk because of their rapidly developing brain, vulnerability to disease, and limited capacity to avoid or adapt to threats and impacts. They are also more likely to worry about climate change than any other age group. Drawing on a developmental life-course perspective, we show that climate-change-related threats can additively, interactively, and cumulatively increase psychopathology risk from conception onward; that these effects are already occurring; and that they constitute an important threat to healthy human development worldwide. We then argue that monitoring, measuring, and mitigating these risks is a matter of social justice and a crucial long-term investment in developmental and mental health sciences. We conclude with a discussion of conceptual and measurement challenges and outline research priorities going forward.
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Affiliation(s)
- Francis Vergunst
- Department of Social and Preventive Medicine, University of Montreal
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
| | - Helen L. Berry
- Faculty of Medicine and Health, University of Sydney
- Australian Institute of Health Innovation, Macquarie University
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21
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Nagi Y, Sender H, Orcutt M, Fouad F, Burgess RA, Devakumar D. Resilience as a communal concept: Understanding adolescent resilience in the context of the Syrian refugee crisis in Bar Elias, Lebanon. J Migr Health 2021; 3:100046. [PMID: 34405191 PMCID: PMC8352196 DOI: 10.1016/j.jmh.2021.100046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background The conflict in Syria has led to the displacement of 1.5 million refugees into the neighboring country of Lebanon, with a majority that have yet to return to their homeland. Syrian adolescents in the town of Bar Elias in the Bekaa Valley, Lebanon have lived and grown in the face of resource-limited environments, restricted movement, and a longing for return. Resilience is manifested in the adaptation to such circumstances through close supportive relationships, social engagement, employment, and religion. There is a communal aspect to resilience that is important to the adolescent refugee experience and to the efforts supporting these communities. Methods Fifteen one-to-one interviews and two focus groups, with a total of eighteen Syrian adolescents, were analyzed using an inductive thematic analysis informed by grounded theory principles. Participants were recruited through partnering non-governmental organizations (NGOs) in the area, and ethical approval was granted through UCL and the American University in Beirut (AUB). Results Syrian adolescents highlighted supportive relationships, communal activities and spaces, memories of home, employment, and shared environments as integral elements to their personal adaptation. Methods of resilience involved social cohesion and establishing stability for one's family and close community. Adaptation to the present is intertwined with facing the consequences of displacement in this new context and maintaining aspirations for a bright future. Engaging with the environments they share and help create is an important facet of resilience and occurs through group gatherings , hobbies, and online communication. Additionally, inner strength can be derived from religious activities and empowers individual processing. Conclusion This study illuminates the elements and mechanisms embodied in these adolescents' communities and relationships that allow for adaptation to life in Bar Elias. These factors strengthen their approach to overcome social barriers and practice resilience. These communal aspects of the adolescents' lives also connect to their memories of home, current environment, and future aspirations.
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Affiliation(s)
- Y Nagi
- New York Medical College, Valhalla, NY, USA
| | - H Sender
- UCL Development Planning Unit/Institute for Global Prosperity, London, UK
| | - M Orcutt
- Institute for Global Health, University College London, London, UK
| | - F Fouad
- American University of Beirut, Beirut, Lebanon
| | - R A Burgess
- Institute for Global Health, University College London, London, UK
| | - D Devakumar
- Institute for Global Health, University College London, London, UK
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22
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, García T, González-Uribe C, Moreno-Serra R, Bernal O. Mental Health Disorders in Population Displaced by Conflict in Colombia: Comparative Analysis against the National Mental Health Survey 2015. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00089-5. [PMID: 34246471 DOI: 10.1016/j.rcp.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. METHODS Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire - 25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. RESULTS 1,089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. CONCLUSIONS The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.
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Affiliation(s)
- Sebastián León-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia; Centro de Estudios Sobre Desarrollo CIDER, Universidad de los Andes, Bogotá, Colombia.
| | - Germán Casas
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia; Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Tatiana García
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
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Madoro D. A Cross-Sectional Analysis of the Prevalence and Determinants of Mental Distress Among Ethiopian Returnees. Neuropsychiatr Dis Treat 2021; 17:2849-2857. [PMID: 34511916 PMCID: PMC8415761 DOI: 10.2147/ndt.s317803] [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: 05/13/2021] [Accepted: 08/21/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Returning internally displaced persons (IDPs) to their homes can be a difficult and traumatic experience, particularly after a long period of displacement. Furthermore, traumatic experiences encountered during displacement during the flight process may be replayed in the minds of IDP returnees when they return to their original locations, raising the risk of re-traumatization. This could have a detrimental impact on the mental health of returning IDPs. Despite this, the mental health of returnee IDPs in Ethiopia has received less consideration. As a result, the aim of this study was to determine the prevalence and determinants of mental distress among Ethiopian returnees. METHOD AND PARTICIPANTS A community-based cross-sectional study with 623 participants was conducted from January 1 to 30, 2021, using a systematic sampling technique. The Kessler psychological distress scale was used to assess mental distress (K-10). Bivariable and multivariable binary logistic regression is used to investigate the relationship between variables. Statistical significance was described as a P-value of less than 0.05 with a 95% confidence interval. RESULTS The total number of people interviewed was 623, with a 100% response rate. With a 95% confidence interval of 47 to 51.9, the prevalence of psychological distress was 49.4%. Unemployment (AOR=2.1, 95% CI 1.38 to 3.40), inadequate social support (AOR=1.92, 95% CI 1.53 to 2.56), having little knowledge of post-returnee life (AOR=2.17, 95% CI 1.23 to 3.37), and the number of traumatic events (AOR=1.92, 95% CI 1.53 to 2.56) were all found to be significant in the multivariate logistic regression. CONCLUSION Returnee IDPs have a high prevalence of psychological distress, according to this report. It is suggested that knowledge of how to adapt to a new life after returning to the original land be given, as well as consistent psychosocial help.
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Affiliation(s)
- Derebe Madoro
- Department of Psychiatry, Dilla University's College of Medicine and Health Sciences, Dilla, Ethiopia
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Baralla F, Ventura M, Negay N, Di Napoli A, Petrelli A, Mirisola C, Sarchiapone M. Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups. Front Psychiatry 2021; 12:529361. [PMID: 34630170 PMCID: PMC8492940 DOI: 10.3389/fpsyt.2021.529361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.
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Affiliation(s)
- Francesca Baralla
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Nikolay Negay
- Department of Psychiatry and Narcology of Asfendiyarov, Kazakh National Medical University, Almaty, Kazakhstan
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | | | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy
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Quintero-González SM, Madariaga-Orozco CA, Millán-de Lange AC, Castellar-Jiménez DM, Palacio-Sañudo JE. Moderating Effect of the Situation of Return or Relocation on the Well-Being and Psychosocial Trauma of Young Victims of the Armed Conflict in Colombia. Front Psychol 2020; 11:603964. [PMID: 33408669 PMCID: PMC7779608 DOI: 10.3389/fpsyg.2020.603964] [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] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/30/2020] [Indexed: 01/07/2023] Open
Abstract
Colombia is the second country with the highest number of internally displaced persons. In the last 10 years, more than 400,000 young people carry, in their life experiences, the title of victims. The psychological and social circumstances that determine the lives of displaced young people in the world are not unknown. Fear, the poor resources for social adaptation available to them, and the possible reproduction of the cycle of violence, represent psychosocial risk factors in the young and displaced population. In this context, the Victims Law in Colombia stipulated various measures of repairment, including Relocation (the person or household victim of forced displacement decides to settle in some place, other than the one they were forced to leave) and Return (the person or the household victim of forced displacement decides to return to the place from which they were displaced, in order to settle indefinitely) provided the conditions of voluntariness, security, and dignity are present. A hypothesis that well-being will be better in the returnees was set, since they would strengthen the social support networks between neighbors and other victims in their old spaces of life. To test the hypothesis, the scales of Psychological Well-being, Social Well-being, the Satisfaction with Life Scale, and the Psychosocial Trauma Scale were applied to young returnees (n = 129) and relocated (n = 259) in Colombia. The Exploratory and Confirmatory Factor Analysis was performed to extract the general measure of well-being and psychosocial trauma followed by the comparison between the groups. Significance, power, and effect size indicators were obtained, and finally, the partial correlation between the groups was made in relation to psychosocial trauma and well-being. Results showed that returnees have greater well-being and clearer indicators (d = 0.365, 1-β = 0.996), with respect to that of relocated. In addition, the well-being of returnees has fewer trauma factors, who in turn are quasi-moderated by the situation of return or relocation.
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Psychological Well-Being Among Internally Displaced Adolescents and the Effect of Psychopathology on PTSD Scores Depends on Gender. Community Ment Health J 2020; 56:1489-1495. [PMID: 32124156 DOI: 10.1007/s10597-020-00594-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
The purpose of this cross-sectional study was to investigate the post-traumatic symptoms and psychological well-being among internally displaced (ID) adolescents in the early phase of the conflict in the southeast part of Turkey and clarify the effect of psychopathology on PTSD scores depends on gender. With the help of the results of our study, we aimed to enhance our understanding of adolescent mental health. Our study was completed with 102 ID adolescents (42 boys, 60 girls). Our results showed that ID adolescents flee from conflict had significantly higher levels of mental disorders and PTSD. Girls show higher rates of PTSD symptoms than boys and there was no significant interactive effect of gender and emotional, behavioral and peer problems on PTSD. However, boys with ADHD seem to be more prone to develop PTSD than girls. We aimed to highlight the challenges facing adolescents forced to flee from conflict zones who were temporarily relocated. These results may help us to enlighten our understanding of ID adolescents and may suggest more studies to provide beneficial gender-specific intervention program.
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Han Y, Langston M, Fuzzell L, Khan S, Lewis-Thames MW, Colditz GA, Moore JX. Breast Cancer Mortality Hot Spots Among Black Women With de Novo Metastatic Breast Cancer. JNCI Cancer Spectr 2020; 5:pkaa086. [PMID: 33442659 PMCID: PMC7791608 DOI: 10.1093/jncics/pkaa086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 11/12/2022] Open
Abstract
Background Black women living in southern states have the highest breast cancer mortality rate in the United States. The prognosis of de novo metastatic breast cancer is poor. Given these mortality rates, we are the first to link nationally representative data on breast cancer mortality hot spots (counties with high breast cancer mortality rates) with cancer mortality data in the United States and investigate the association of geographic breast cancer mortality hot spots with de novo metastatic breast cancer mortality among Black women. Methods We identified 7292 Black women diagnosed with de novo metastatic breast cancer in Surveillance, Epidemiology, and End Results (SEER). The county-level characteristics were obtained from 2014 County Health Rankings and linked to SEER. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality between hot spot and non-hot spot counties. Results Among 7292 patients, 393 (5.4%) resided in breast cancer mortality hot spots. Women residing in hot spots had similar risks of breast cancer-specific mortality (aHR = 0.99, 95% CI = 0.85 to 1.15) and all-cause mortality (aHR = 0.97, 95% CI = 0.84 to 1.11) as women in non-hot spots after adjusting for individual and tumor-level factors and treatments. Additional adjustment for county-level characteristics did not impact mortality. Conclusion Living in a breast cancer mortality hot spot was not associated with de novo metastatic breast cancer mortality among Black women. Future research should begin to examine variation in both individual and population-level determinants, as well as in molecular and genetic determinants that underlie the aggressive nature of de novo metastatic breast cancer.
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Affiliation(s)
- Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Breast Surgery, First Hospital of China Medical University, Shenyang, China
| | - Marvin Langston
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Lindsay Fuzzell
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Saira Khan
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
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Sanhori Z, Hauff E, Eide AH, Mdala I, Abdelrahman A, Brunborg C, Lien L. Changes in prevalence of mental disorders among internally displaced persons in central Sudan: a 1-year follow-up study. Glob Ment Health (Camb) 2020; 7:e24. [PMID: 32963796 PMCID: PMC7490769 DOI: 10.1017/gmh.2020.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sudan has one of the largest numbers of internally displaced persons (IDPs) in the world, estimated at five million. The main cause of displacement was the civil war. Attention to the health and in particular the mental health of IDPs has been lacking. That includes limited population longitudinal data describing the "natural" fluctuations of mental morbidity among these groups. The aim of this study is to investigate the level and stability of mental disorders among IDPs over a 1-year period. METHOD In this 1-year follow-up of IDPs in two settlement areas in central Sudan, 1549 persons 18 years or older were interviewed twice using the MINI International Neuropsychiatric Interview. Trained psychologists collected the data in a random household survey in the selected IDP areas. RESULTS We found overall high stability among those having and those free of mental disorders in this 1-year follow-up study. There were, however, discernible and statistically significant increases in overall new cases of mental disorders from T1 to T2 as major depression increased by 1.4%, generalized anxiety by 2.8% and social phobia by 1.4%. CONCLUSION The study revealed continued high levels and increases of mental disorders over time, although with a pattern of substantial persistence among those initially ill and limited recovery. This might be due to a complex set of factors such as unavailability of mental health services, poverty, low educational level and social exclusion.
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Affiliation(s)
- Zienat Sanhori
- Federal Ministry of Health, Khartoum, Sudan, P.O. Box 303 Khartoum, Sudan
- Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Edvard Hauff
- Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
- Unit for Education and Professional Development, Oslo University Hospital, Norway
| | - Arne H. Eide
- SINTEF Digital, Health Research. P.O.Box 124, 0314 Blindern, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Norway, P.O. Box 1130, 0318 Blindern, Norway
| | - Abdullah Abdelrahman
- Department of Psychiatry, University of Khartoum. P.O. Box 102, Elgasr Street, Khartoum11115, Sudan
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University, Oslo, Norway
| | - Lars Lien
- Department of Health and Social Sciences, Innlandet University College, P.O. Box 400, 2418 Elverum, Norway
- Innlandet Hospital Trust, PO Box 104, 2381 Brumunddal, Norway
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Alduraidi H, Dardas LA, Price MM. Social Determinants of Resilience Among Syrian Refugees in Jordan. J Psychosoc Nurs Ment Health Serv 2020; 58:31-38. [PMID: 32609861 DOI: 10.3928/00989134-20200624-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
The current study explores the level and social determinants of resilience among Syrian refugees residing in Jordan. Having high levels of resilience can help refugees positively adapt to challenges and cope with the burden of stressors associated with warfare, turmoil, and displacement. A sample of 151 Syrian refugees ages 18 to 69 residing in Jordan completed the Arabic version of the Connor-Davidson Resilience Scale. Resilience scores among Syrian refugees in Jordan were generally low. Refugees' place of residence, educational level, employment status, and monthly income were significantly associated with lower resilience scores and together explain approximately 37% of variance in resilience scores. Tailored resilience-building and educational programs are needed to help Syrian refugees develop the ability to withstand, adapt to, and recover from stress and adversity, and maintain or return to healthy mental states. Future research involving longitudinal assessment of resilience is needed to fully understand the role and determinants of resilience in this population. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 31-38.].
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Gambaro E, Mastrangelo M, Sarchiapone M, Marangon D, Gramaglia C, Vecchi C, Airoldi C, Mirisola C, Costanzo G, Bartollino S, Baralla F, Zeppegno P. Resilience, trauma, and hopelessness: protective or triggering factor for the development of psychopathology among migrants? BMC Psychiatry 2020; 20:358. [PMID: 32641011 PMCID: PMC7346618 DOI: 10.1186/s12888-020-02729-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/12/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recently, many studies have investigated the role of migration on mental health. Nonetheless, only few focused on the consequences of childhood trauma, hopelessness, and resilience on migrants' psychopathology, including psychiatric disorders and symptoms. METHOD 119 migrants were recruited between May 2017 and April 2018, among those applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy. Assessment included the following: Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), Connor-Davidson Resilience Scale (CD-RISC), Childhood Trauma Questionnaire (CTQ), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Hopelessness Scale (BHS), Beck's Suicide Intent Scale (SIS), Brief Aggression Questionnaire (BAQ), Deliberate Self-Harm Inventory (DSHI). RESULTS 53.39% of migrants scored above the PCL-5 cut-off score (mean score was 39.45). SDS scores below the cutoff suggested the presence of depression in 42.37%, while According to SAS scores anxiety levels were low in 38.98% of migrants. During childhood, physical abuse and neglect were reported respectively by 56.78 and 69.49% of migrants. CONCLUSION We found that Post Traumatic Stress Disorders play the role of mediators for the relation between the childhood traumatic experiences and aggressiveness, anxious and depressive symptomatology, while hopelessness is a mediator between the childhood traumatic experiences and the development of depression in adulthood. Hopelessness seems to influence the strength of the relation between childhood traumatic experiences and the individual's current intensity of suicidal attitudes, plans, and behaviors. Further developments and future perspectives of the research project are to address key gaps in the field of resilience by means of a longitudinal evaluation study in migrants, including a native population control group, acceding to NIHMP.
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Affiliation(s)
- Eleonora Gambaro
- Department of Translational Medicine, Institute of Psychiatry, University of Western Piedmont, via Solaroli, 17, 28100, Novara, Italy.
- Psychiatric Ward, Maggiore della Carità University Hospital, Corso Mazzini 18, 28100, Novara, Italy.
| | - Martina Mastrangelo
- Department of Medicine and Health Science, University of Molise, Via De Santis, 86100, Campobasso, Italy
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Via De Santis, 86100, Campobasso, Italy
- National Institute of Migration and Poverty, Via San Gallicano 25, Rome, Italy
- National Medical University, Almaty, Kazakhstan
| | - Debora Marangon
- Psychiatric Ward, Maggiore della Carità University Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, University of Western Piedmont, via Solaroli, 17, 28100, Novara, Italy
- Psychiatric Ward, Maggiore della Carità University Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Camilla Vecchi
- Department of Translational Medicine, Institute of Psychiatry, University of Western Piedmont, via Solaroli, 17, 28100, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Institute of Psychiatry, University of Western Piedmont, via Solaroli, 17, 28100, Novara, Italy
| | - Concetta Mirisola
- National Institute of Migration and Poverty, Via San Gallicano 25, Rome, Italy
| | - Gianfranco Costanzo
- National Institute of Migration and Poverty, Via San Gallicano 25, Rome, Italy
| | - Silvia Bartollino
- Department of Medicine and Health Science, University of Molise, Via De Santis, 86100, Campobasso, Italy
| | - Francesca Baralla
- Department of Medicine and Health Science, University of Molise, Via De Santis, 86100, Campobasso, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, University of Western Piedmont, via Solaroli, 17, 28100, Novara, Italy
- Psychiatric Ward, Maggiore della Carità University Hospital, Corso Mazzini 18, 28100, Novara, Italy
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Lancaster SL, Gaede C. A test of a resilience based intervention for mental health problems in Iraqi internally displaced person camps. ANXIETY STRESS AND COPING 2020; 33:698-705. [PMID: 32496821 DOI: 10.1080/10615806.2020.1773446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Objectives: The mental health needs of those in internally displaced persons camps are significant and are compounded by a number of barriers to care. Traditional methods of mental health care are often not feasible and thus a need exists for interventions that can successfully meet these conditions. The current study introduces and tests a new positive-psychology intervention, GROW, which was designed specifically for use in internally displaced persons camps. Design: Pre-Post-Follow-up longitudinal examination of those who participated in the GROW intervention group (N = 766). Methods: The study includes three waves of data for the intervention, which was administered in a group format, using paraprofessionals, over a two-week period in internally displaced persons camps in Iraq. Results: The results indicate significant decreases in symptoms of PTSD for participants from pre- to post-intervention and demonstrates these changes were maintained at a three-month follow-up. Post hoc results indicated participants who were older, female, or who attended more sessions were more likely to respond to the intervention. Conclusions: These data provide initial support for the intervention and suggest additional research to more fully validate this intervention are warranted.
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PTSD in asylum-seekers: Manifestations and relevance to the asylum process. Psychiatry Res 2020; 284:112698. [PMID: 31822357 DOI: 10.1016/j.psychres.2019.112698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is common among asylum-seekers and manifests with symptoms uniquely problematic to the United States asylum-seeking process. Chiefly, hyper-vigilance, avoidance behavior, dissociative amnesia and a tendency towards non-linear narratives hinder the articulation of an effective asylum claim. Moreover, the format and environmental circumstances of the asylum-seeking process further heighten these difficulties.
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The Mental Health Implications of Living in the Shadows: The Lived Experience and Coping Strategies of Undocumented African Migrant Women. Behav Sci (Basel) 2019; 9:bs9120127. [PMID: 31779152 PMCID: PMC6960715 DOI: 10.3390/bs9120127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/08/2019] [Accepted: 11/23/2019] [Indexed: 01/03/2023] Open
Abstract
In the United States, undocumented immigrants often encounter complex challenges that impact their emotional well-being. Existing literature has primarily focused on Latino immigrants. Thus, little is known about the mental health needs of undocumented African immigrant women. To address this gap, we examined the stressors, mental health concerns and coping strategies of undocumented African migrant women in the United States. This qualitative study used a postcolonial feminist framework approach. Twenty-four undocumented African migrant women were interviewed, and data were analyzed using thematic analysis. Findings showed that the women dealt with complex stressors created by the sociopolitical environment. These stressors contributed to feelings of depression and anxiety which they coped with using social support and religion. The results uncover the need for culturally relevant tools for screening and addressing the mental health needs of undocumented women and increased awareness amongst healthcare providers on how social context and policies adversely impact the mental health of marginalized groups. Lastly, at a structural level, the need for policy and social change that fosters an inclusive and safe environment for undocumented persons.
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Dhungana RR, Aryal N, Adhikary P, Kc RK, Regmi PR, Devkota B, Sharma GN, Wickramage K, van Teijlingen E, Simkhada P. Psychological morbidity in Nepali cross-border migrants in India: a community based cross-sectional study. BMC Public Health 2019; 19:1534. [PMID: 31730454 PMCID: PMC6858657 DOI: 10.1186/s12889-019-7881-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India. METHODS A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis. RESULTS The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity. CONCLUSION This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.
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Affiliation(s)
- Raja Ram Dhungana
- Green Tara Nepal, Kathmandu, Nepal. .,Institute for Health & Sport (IHES), Victoria University, Melbourne, Australia.
| | - Nirmal Aryal
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Pratik Adhikary
- Green Tara Nepal, Kathmandu, Nepal.,School of Public Health, University of California, Berkeley, USA
| | | | - Pramod Raj Regmi
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | | | | | | | | | - Padam Simkhada
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.,International School of Health and Human Science, The University of Huddersfield, Huddersfield, UK
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Macleod CK, Binnawi KH, Elshafie BE, Sadig HE, Hassan A, Cocks N, Willis R, Chu B, Solomon AW. Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan. Trans R Soc Trop Med Hyg 2019; 113:599-609. [PMID: 31612959 PMCID: PMC6792159 DOI: 10.1093/trstmh/trz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/01/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose To estimate the proportion of children with trachomatous inflammation—follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. Methods IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014–2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. Results Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1–9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1–9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. Conclusion Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.
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Affiliation(s)
- Colin K Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Kamal Hashim Binnawi
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan.,Department of Ophthalmology, Al Neelain University, Khartoum, Sudan
| | - Balgesa Elkheir Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan
| | - Husam Eldin Sadig
- Faculty of Mathematical Sciences and Statistics, Al-Neelain University, Sudan
| | | | - Naomi Cocks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Rebecca Willis
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Brian Chu
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Patterns of somatic distress among internally displaced persons in Ukraine: analysis of a cross-sectional survey. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1265-1274. [PMID: 30805693 DOI: 10.1007/s00127-019-01652-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/07/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE There are often high rates of mental disorders in low- and middle-income countries during humanitarian crises, but the prevalence of somatic distress (SD) is underreported in the existing health service research. We aim to examine the patterns of SD among internally displaced persons (IDPs) in Ukraine, who were forcibly displaced due to the ongoing conflict in the country's eastern region. METHODS The study design was a cross-sectional survey of 2203 adult IDPs throughout Ukraine. The survey collected data on sociodemographic characteristics, traumatic life events (Life Events Checklist), utilisation of mental health care services, and self-reported outcomes of SD (Patient Health Questionnaire 15), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), and post-traumatic stress (PTSD Checklist). Descriptive and multivariate regression analyses were used. RESULTS Over half of respondents (n = 1142, 55%) were identified as being at risk of SD (PHQ-15 score ≥ 6), and the prevalence of moderate (n = 377, 18%) and high severity SD risk (n = 275, 13%) was substantial. There were significant associations (p < 0.05) between SD and age, female gender, economic status, self-reported depression and post-traumatic stress, and multiple trauma exposures. Being at risk of SD was also significantly associated with increased functional disability. Use of mental health care services was low across this population and only high SD risk seemed to be a reliable predictor of care-seeking behaviour. CONCLUSIONS There is a significant risk of SD among IDPs in Ukraine. Our results illustrate the need for targeted health service research and regional programs to ensure that mental health needs are appropriately met.
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Poudel-Tandukar K, Chandler GE, Jacelon CS, Gautam B, Bertone-Johnson ER, Hollon SD. Resilience and anxiety or depression among resettled Bhutanese adults in the United States. Int J Soc Psychiatry 2019; 65:496-506. [PMID: 31288604 DOI: 10.1177/0020764019862312] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Resilience, or an individual's positive response in managing life's adversities, is of increasing interest in addressing the mental health disparities in refugees. Although the link between stressful life events and poor mental health is established, research on the role of resilience on the mental health of refugees is limited. AIMS This study assessed the association between resilience and anxiety or depression in resettled Bhutanese adults in Western Massachusetts. METHODS A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20-65 residing in Massachusetts. Resilience was measured with the 25-item Wagnild and Young's Resilience Scale including two constructs as follows: a 17-item 'personal competence' that measures self-reliance, independence, determination, resourcefulness, mastery and perseverance and an 8-item 'acceptance of self and life' that measures adaptability, flexibility and a balanced perspective of life. Higher total scores indicate greater resilience. The Hopkins Symptom Checklist-25 was used to measure anxiety (10-item) and depression (15-item) with a cutoff mean score of ⩾1.75 for moderate to severe symptoms. Associations of resilience with anxiety or depression scores were assessed using multiple-linear and logistic regression analyses. RESULTS The proportion of participants with above threshold anxiety and depression were 34.2% and 24%, respectively. Resilience was inversely associated with both anxiety (beta for 1 unit change in resilience scores: β = -0.026; p = .037) and depression (β = -0.036, p = .041). 'Personal competence' resilience was inversely associated with both anxiety (β = -0.041 p = .017) and depression (β = -0.058, p = .019), but 'acceptance of self and life' resilience was not. Participants with the highest tertile of resilience scores had a significantly decreased risk of anxiety (ORs (95% CI): 0.13 (0.04-0.40)) and depression (0.16 (0.04-0.60)). CONCLUSION Higher resilience was associated with reduced anxiety and depression among Bhutanese with personal competence resilience accounting for most of the effects. These findings suggest the potential targets for mental-health intervention to improve resilience in refugees.
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Affiliation(s)
| | | | - Cynthia S Jacelon
- 1 College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
| | - Bhuwan Gautam
- 2 Bhutanese Society of Western Massachusetts, Springfield, MA, USA
| | | | - Steven D Hollon
- 4 Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Muir JA, Cope MR, Angeningsih LR, Jackson JE, Brown RB. Migration and Mental Health in the Aftermath of Disaster: Evidence from Mt. Merapi, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152726. [PMID: 31370162 PMCID: PMC6696464 DOI: 10.3390/ijerph16152726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/16/2022]
Abstract
Migration is a standard survival strategy in the context of disasters. While prior studies have examined factors associated with return migration following disasters, an area that remains relatively underexplored is whether moving home to one's original community results in improved health and well-being compared to other options such as deciding to move on. In the present study, our objective is to explore whether return migration, compared to other migration options, results in superior improvements to mental health. We draw upon data from a cross-sectional pilot study conducted 16 months after a series of volcanic eruptions in Merapi, Indonesia. Using ordinal logistic regression, we find that compared to respondents who were still displaced (reference category), respondents who had "moved home" were proportionally more likely to report good mental health (proportional odds ratios (POR) = 2.02 [95% CI = 1.05, 3.91]) compared to average or poor mental health. Likewise, respondents who had "moved on" were proportionally more likely to report good mental health (POR = 2.64 [95% CI = 0.96, 7.77]. The results suggest that while moving home was an improvement from being displaced, it may have been better to move on, as this yielded superior associations with self-reported mental health.
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Affiliation(s)
- Jonathan A Muir
- Department of Sociology, The Ohio State University, Columbus, OH 43210, USA.
| | - Michael R Cope
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA
| | | | - Jorden E Jackson
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA
| | - Ralph B Brown
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA
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McEniry M, Samper-Ternent R, Cano-Gutierrez C. Displacement due to armed conflict and violence in childhood and adulthood and its effects on older adult health: The case of the middle-income country of Colombia. SSM Popul Health 2019; 7:100369. [PMID: 30859118 PMCID: PMC6396198 DOI: 10.1016/j.ssmph.2019.100369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/21/2022] Open
Abstract
Large population displacement in developing economies due to internal armed conflict and violence is of international concern. There has been relatively little research on the long-term consequences of displacement on older adult health among populations characterized by rapid demographic, epidemiological, and nutritional transitions during the 20th century. We examine displacement in the middle-income country of Colombia, which experienced these rapid transitions and a large population displacement over the last 50-60 years due to internal armed conflict and violence. Using a nationally representative survey of adults 60 years and older, SABE-Colombia (2014-2015, n = 23,694), we estimate the degree to which displacement relative to those never displaced is associated with older adult health (self-reported health, major illness/stress, at least one chronic condition, heart disease), controlling for age, gender, SES (socioeconomic status), residence, early life conditions (infectious diseases, poor nutrition, health, SES, family violence), and adult behavior (smoking, exercise, nutrition). We found (1) strong associations between poor early life conditions and older adult health with little attenuation of effects after controlling for displacement, adult SES, and lifestyle; (2) strong associations between displacement and self-reported health; along with poor early life conditions, displacement increases the chances of poor health at older ages; (3) significant positive interaction effects between childhood infections and displacement during young adulthood for older adult stress/major illness, suggesting the importance of the timing of displacement; (4) significant interaction effects between childhood infections and being displaced during childhood, indicating lower levels of older adult stress/major illness and suggesting the possibility of resilience due to childhood adversity. We conclude that displacement compounds the effects of poor early life conditions and that timing of displacement can matter. The results raise the possibility of similar patterns in the health of aging populations in low-income countries that also experience displacement and rapid demographic and epidemiological transitions.
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Affiliation(s)
- Mary McEniry
- Center for Demography & Ecology, University of Wisconsin, Madison, United States
| | - Rafael Samper-Ternent
- Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, United States
| | - Carlos Cano-Gutierrez
- Aging Institute, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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40
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Hirani SAA, Richter S. Maternal and Child Health During Forced Displacement. J Nurs Scholarsh 2019; 51:252-261. [DOI: 10.1111/jnu.12460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Shela Akbar Ali Hirani
- Rho Delta, PhD Candidate, University of AlbertaFaculty of Nursing Edmonton Alberta Canada
| | - Solina Richter
- Mu Sigma, ProfessorUniversity of Alberta, Faculty of Nursing Edmonton Alberta Canada
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Duarte-Gómez MB, Cuadra-Hernández SM, Ruiz-Rodríguez M, Arredondo A, Cortés-Gil JD. Challenges of health services related to the population displaced by violence in Mexico. Rev Saude Publica 2018; 52:77. [PMID: 30066814 PMCID: PMC6063640 DOI: 10.11606/s1518-8787.2018052017094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/17/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. METHODS This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication (from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. RESULTS The main challenges are the intersectoral, participatory, and integral approach (with emphasis on mental health and sexual and reproductive health), ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. CONCLUSIONS The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico.
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Affiliation(s)
- María Beatriz Duarte-Gómez
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, Morelos, México
| | | | - Myriam Ruiz-Rodríguez
- Universidad Industrial de Santander. Escuela de Medicina. Departamento de Salud Pública. Bucaramanga, Santander, Colombia
| | - Armando Arredondo
- Instituto Nacional de Salud Pública. Centro de Investigación en Sistemas de Salud. Cuernavaca, Morelos, México
| | - Jesús David Cortés-Gil
- Universidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
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DeVylder JE, Kelleher I, Lalane M, Oh H, Link BG, Koyanagi A. Association of Urbanicity With Psychosis in Low- and Middle-Income Countries. JAMA Psychiatry 2018; 75:678-686. [PMID: 29799917 PMCID: PMC6145671 DOI: 10.1001/jamapsychiatry.2018.0577] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/21/2018] [Indexed: 12/16/2022]
Abstract
Importance Urban residence is one of the most well-established risk factors for psychotic disorder, but most evidence comes from a small group of high-income countries. Objective To determine whether urban living is associated with greater odds for psychosis in low- and middle-income countries (LMICs). Design, Setting, and Participants This international population-based study used cross-sectional survey data collected as part of the World Health Organization (WHO) World Health Survey from May 2, 2002, through December 31, 2004. Participants included nationally representative general population probability samples of adults (≥18 years) residing in 42 LMICs (N = 215 682). Data were analyzed from November 20 through December 5, 2017. Exposures Urban vs nonurban residence, determined by the WHO based on national data. Main Outcomes and Measures Psychotic experiences, assessed using the WHO Composite International Diagnostic Interview psychosis screen, and self-reported lifetime history of a diagnosis of a psychotic disorder. Results Among the 215 682 participants (50.8% women and 49.2% men; mean [SD] age, 37.9 [15.7] years), urban residence was not associated with psychotic experiences (odds ratio [OR], 0.99; 95% CI, 0.89-1.11) or psychotic disorder (OR, 0.89; 95% CI, 0.76-1.06). Results of all pooled analyses and meta-analyses of within-country effects approached a null effect, with an overall OR of 0.97 (95% CI, 0.87-1.07), OR for low-income countries of 0.98 (95% CI, 0.82-1.15), and OR for middle-income countries of 0.96 (95% CI, 0.84-1.09) for psychotic experiences and an overall OR of 0.92 (95% CI, 0.73-1.16), OR for low-income countries of 0.92 (95% CI, 0.66-1.27), and OR for middle-income countries of 0.92 (95% CI, 0.67-1.27) for psychotic disorder. Conclusions and Relevance Our results provide evidence that urbanicity, a well-established risk factor for psychosis, may not be associated with elevated odds for psychosis in developing countries. This finding may provide better understanding of the mechanisms by which urban living may contribute to psychosis risk in high-income countries, because urban-rural patterns of cannabis use, racial discrimination, and socioeconomic disparities may vary between developing and developed nations.
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Affiliation(s)
- Jordan E. DeVylder
- Graduate School of Social Service, Fordham University, New York, New York
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons, Dublin, Ireland
| | - Monique Lalane
- Graduate School of Social Service, Fordham University, New York, New York
| | - Hans Oh
- School of Social Work, University of Southern California, Los Angeles
| | - Bruce G. Link
- Department of Sociology, University of California, Riverside
- Department of Public Policy, University of California, Riverside
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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Hayes K, Blashki G, Wiseman J, Burke S, Reifels L. Climate change and mental health: risks, impacts and priority actions. Int J Ment Health Syst 2018; 12:28. [PMID: 29881451 PMCID: PMC5984805 DOI: 10.1186/s13033-018-0210-6] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article provides an overview of the current and projected climate change risks and impacts to mental health and provides recommendations for priority actions to address the mental health consequences of climate change. DISCUSSION AND CONCLUSION The authors argue the following three points: firstly, while attribution of mental health outcomes to specific climate change risks remains challenging, there are a number of opportunities available to advance the field of mental health and climate change with more empirical research in this domain; secondly, the risks and impacts of climate change on mental health are already rapidly accelerating, resulting in a number of direct, indirect, and overarching effects that disproportionally affect those who are most marginalized; and, thirdly, interventions to address climate change and mental health need to be coordinated and rooted in active hope in order to tackle the problem in a holistic manner. This discussion paper concludes with recommendations for priority actions to address the mental health consequences of climate change.
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Affiliation(s)
- Katie Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - G. Blashki
- Nossal Institute for Global Health, University of Melbourne, Carlton, VIC Australia
| | - J. Wiseman
- Melbourne Sustainable Society Institute, University of Melbourne, Carlton, VIC Australia
| | - S. Burke
- Australian Psychological Society, Level 11, 257 Collins St, Melbourne, VIC Australia
| | - L. Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC Australia
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SILVA JCARVALHOE, BUCHER-MALUSCHKE JSNF. Psychology of Forced Displacement and Migration: A systematic review of the scientific literature. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2018. [DOI: 10.1590/1982-02752018000200002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Forced displacement is a research field in specific social and cultural contexts. This systematic review aims to identify, describe and analyze the research in Psychology of Forced Displacement and Migration published between 2006 and 2016. The databases selected were PsycINFO, Lilacs and SciELO following the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2009. Content and methodology were assessed by Critical Appraisal Skill Programme. A total of 34 out of 491 articles fulfilled the eligibility criteria and were categorized in a framework that summarizes the main research questions and methodologies, including authors, research questions, units of analysis, dominant theories, and hypotheses. In conclusion, the framework helped to comprehend the general aspects of the existing research and pointed out interdisciplinary tendencies in the studies on this phenomenon.
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Chung MC, AlQarni N, Al Muhairi S, Mitchell B. The relationship between trauma centrality, self-efficacy, posttraumatic stress and psychiatric co-morbidity among Syrian refugees: Is gender a moderator? J Psychiatr Res 2017; 94:107-115. [PMID: 28697422 DOI: 10.1016/j.jpsychires.2017.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 11/27/2022]
Abstract
This study examined the inter-relationship between trauma centrality, self-efficacy, posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among a group of Syrian refugees living in Turkey, and whether gender would moderate the mediational effect of self-efficacy on the impact of trauma centrality on distress. Seven hundred and ninety-two Syrian refugees completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale and Generalized Self-Efficacy Scale. The results showed that 52% met the cutoff for PTSD. Trauma centrality was positively correlated with PTSD, psychiatric co-morbidity and self-efficacy. Self-efficacy was negatively correlated with PTSD only. Gender did not moderate the mediational effect of self-efficacy on the path between trauma centrality and distress outcomes. To conclude, following exposure to traumatic events, more than half reported PTSD. Perception of the future and identity construction was affected. Signs of psychological distress were evident, alongside resilience, regardless of gender.
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Affiliation(s)
- Man Cheung Chung
- The Chinese University of Hong Kong, Department of Educational Psychology, Ho Tim Building, Faculty of Education, Shatin, NT, Hong Kong.
| | - Nowf AlQarni
- Zayed University, Abu Dhabi, United Arab Emirates
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Jaung M, Jani S, Banu S, Mackey JM. International Emergency Psychiatry Challenges: Disaster Medicine, War, Human Trafficking, Displaced Persons. Psychiatr Clin North Am 2017; 40:565-574. [PMID: 28800810 DOI: 10.1016/j.psc.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mental health disorders are a major cause of morbidity and a growing burden in low-income and middle-income countries; but there is little existing literature on the detailed epidemiology, diagnosis, and treatment in low-resource settings. Special situations with vulnerable populations, such as those created by international humanitarian emergencies, refugees or internally displaced people, and victims of human trafficking, are increasing in prevalence. These victims are often resettled in developed countries and come to the emergency department seeking care. To better care for these populations, knowledge of specialized psychosocial and cultural considerations should inform the comprehensive psychiatric assessment and treatment plan.
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Affiliation(s)
- Michael Jaung
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA
| | - Suni Jani
- Massachusetts General Hospital, McLean Department of Child and Adolescent Psychiatry, Yawkey Center for Outpatient Care, 6A, 55 Fruit Street, Boston, MA 02114, USA
| | - Sophia Banu
- Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, BCM350, Houston, TX 77030, USA
| | - Joy M Mackey
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA.
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Gao T, Ding X, Chai J, Zhang Z, Zhang H, Kong Y, Mei S. The influence of resilience on mental health: The role of general well-being. Int J Nurs Pract 2017; 23. [DOI: 10.1111/ijn.12535] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Tingting Gao
- School of Public Health; Jilin University; Changchun China
| | - Xinna Ding
- School of Public Health; Jilin University; Changchun China
| | - Jingxin Chai
- School of Public Health; Jilin University; Changchun China
| | - Zhao Zhang
- School of Public Health; Jilin University; Changchun China
| | - Han Zhang
- School of Public Health; Jilin University; Changchun China
| | - Yixi Kong
- School of Public Health; Jilin University; Changchun China
| | - Songli Mei
- School of Public Health; Jilin University; Changchun China
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Siriwardhana C. Moderators of mental health of humanitarian migrants. Lancet Psychiatry 2017; 4:175-176. [PMID: 28161456 DOI: 10.1016/s2215-0366(17)30035-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Chesmal Siriwardhana
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
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Siriwardhana C. Mental health of displaced and returnee populations: Insight from the Sri Lankan post-conflict experience. Confl Health 2015; 9:22. [PMID: 26246853 PMCID: PMC4525724 DOI: 10.1186/s13031-015-0049-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/08/2015] [Indexed: 11/10/2022] Open
Abstract
The month of May 2015 marked the sixth year since the end of conflict in Sri Lanka. The cause of death, destruction and displacement, three decades of conflict has had a major impact on health, especially on mental health of those affected by forced displacement. Post-conflict regions of Sri Lanka has seen improvements in many areas, including resettlement of displaced populations and rebuilding of health-related infrastructure. However, substantial gaps exist around the management of health needs among returnee populations, especially in the area of psychosocial health. Long-term mental health and resilience trajectories of those affected by prolonged displacement and experiencing return migration during post-conflict periods remain important, yet critically understudied areas.
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Affiliation(s)
- Chesmal Siriwardhana
- Faculty of Medical Science, Anglia Ruskin University, Chelmsford, CM1 1SQ UK ; Institute of Psychiatry, King's College London, London, UK ; Institute for Research & Development, Sri Jayawardenepura Kotte, Sri Lanka
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Getanda EM, Papadopoulos C, Evans H. The mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya. BMC Public Health 2015; 15:755. [PMID: 26246147 PMCID: PMC4527222 DOI: 10.1186/s12889-015-2085-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internally displaced persons (IDPs) are among the most vulnerable people in the world today. Previous research highlights that conflict-induced forced displacement can cause problems with mental health and wellbeing. This study aimed to contribute to this body of knowledge by investigating the mental health, quality of life, and life satisfaction among IDPs living in Nakuru, Kenya. METHODS A questionnaire that included the General Health Questionnaire-12, Satisfaction with Life Scale, and a modified version of the WHO Quality of Life-BREF tool was used for data collection. The questionnaire also included an open-ended question inviting qualitative responses about their experience as an IDP. The questionnaire was distributed through a three-stage sampling approach across four refugee camps from four regions of the Nakuru County in Kenya. RESULTS One hundred IDPs participated in this study. All participants scored substantially higher than the applied GHQ-12 threshold for caseness (mean GHQ-12 score = 28.7, SD = 3.6). Quality of life and life satisfaction scores were also very poor (M = 10.24, SD = 1.9; M = 6.82, SD = 1.5 respectively). The qualitative results reflected these findings with statements reflecting suicidal thoughts, unhappiness with the government, lack of support, and fear for themselves and their children. Significantly higher GHQ-12 scores were found among older IDPs (rho = .202, sig = .046), widowers compared to married IDPs (mean difference = -2.41, SE = .885, sig = .027), while lower scores were found among IDPs who reported having friends as a source of support (U = 834, sig = .045), while quality of life scores were higher among IDPs who reported receiving governmental support (U = 248, sig = .018). CONCLUSION The findings revealed poor levels of mental health, quality of life and life satisfaction. Older, widowed IDPs and those who did not perceive support from friends or the government were found to be at the highest risk of poor health and wellbeing.
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Affiliation(s)
- Elijah Mironga Getanda
- University of Leicester, School of Psychology, The Greenwood Institute of Child Health, Leicester, LE3 0QU, UK.
| | - Chris Papadopoulos
- University of Bedfordshire, Institute for Health Research, Putteridge Bury Campus, Bedfordshire, LU2 8LE, UK.
| | - Hala Evans
- University of Bedfordshire, Institute for Health Research, Putteridge Bury Campus, Bedfordshire, LU2 8LE, UK.
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