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Dehghani A, Sahebi A, Mazaheri E, Vaziri MH, Masoumi G, Jahangiri K. Design and psychometric evaluation of health system intervention assessment tools for children in floods. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:278. [PMID: 37849861 PMCID: PMC10578527 DOI: 10.4103/jehp.jehp_523_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/06/2022] [Indexed: 10/19/2023]
Abstract
BACKGROUND Flood is one of the most frequent disasters in Iran, which has highly affected the population and consequences on the health system. Children as the most vulnerable group too need to receive health services during floods. The aim of the present study was to develop a national tool for evaluating the provision of health services to children in floods. MATERIAL AND METHODS This study is a sequential-exploratory mixed method study that consists of two qualitative and quantitative stages. The qualitative part includes the analysis of documents and panel of experts while the quantitative part includes the design and validation of the tools. RESULTS In this study, organizations providing health services to children were first identified, and according to their mission the relevant items were extracted and the initial checklist was designed. Then validity and reliability of the tools were done. The content validity ratio and content validity index for the tool were 59 and 98%, respectively. Cronbach's alpha and intraclass correlation coefficient were determined as 0.7 and 0.964, respectively. The final tool was presented with 64 items. CONCLUSIONS The response program, the scope of interventions, service coverage, and the effectiveness of the response after the flood can help reduce the risk of disasters in children. Using the assessment tool of evaluating the health services to children can assist the stakeholder organizations to meet the standards and best quality of services. Assessing the needs of the children affected by floods, identifying the strengths and weaknesses of health services, and proposing corrective strategies according to the information extracted from this tool are other achievements of this study.
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Affiliation(s)
- Arezoo Dehghani
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sahebi
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Elaheh Mazaheri
- Health Information Technology Research Center, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Vaziri
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health, Safety and Environment, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Masoumi
- Health in Emergencies and Disasters Department, School of Health Management and Information Services, Iran University of Medical Sciences, Tehran, Iran
- Emergency Management Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Katayoun Jahangiri
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Arega NT. Mental Health and Psychosocial Support Interventions for Children Affected by Armed Conflict in low-and middle-income Countries: A Systematic Review. CHILD & YOUTH CARE FORUM 2023:1-26. [PMID: 37360764 PMCID: PMC9990564 DOI: 10.1007/s10566-023-09741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 06/28/2023]
Abstract
Background . Armed conflicts continue to threaten a vast number of children across the world, especially in low-and middle-income countries (LMICs). Evidence-based interventions are vital to adequately address the mental health needs in these groups. Objective . This systematic review aims to provide a comprehensive update of the most current developments in mental health and psychosocial support (MHPSS) interventions for children affected by armed conflict in LMICs, since 2016. Such an update may be useful in determining where the current focus of interventions lies and whether there are changes in types of interventions that are commonly implemented. Methods . The main medical, psychological and social sciences databases (PubMed, PsycINFO, Medline) were searched to identify interventions aimed at improving or treating mental health problems in conflict-affected children in LMICs. For the period 2016-2022, a total of 1243 records were identified. Twenty-three articles met the inclusion criteria. A bio-ecological lens was used to organize the interventions and the presentation of findings. Results . Seventeen forms of MHPSS interventions with a wide range of treatment modalities were identified in this review. The reviewed articles focused mainly on family-based interventions. Very few studies empirically evaluated community-level interventions. Conclusion . Current focus of interventions is family-based; the addition of caregiver wellbeing and parenting skills components had the potential to enhance the effects of interventions designed to improve children's mental health. Future trials for MHPSS interventions need to give more attention to community-level interventions. Community-level supports such as person-to-person support, solidarity groups, and dialogue groups stand to reach large numbers of children and families.
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Affiliation(s)
- Natnael Terefe Arega
- PhD in Applied Developmental Psychology, Institute of Education and Behavioral Sciences, Ambo University, Ambo, Ethiopia
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Thomas FC, Puente-Duran S, Mutschler C, Monson CM. Trauma-focused cognitive behavioral therapy for children and youth in low and middle-income countries: A systematic review. Child Adolesc Ment Health 2022; 27:146-160. [PMID: 33216426 DOI: 10.1111/camh.12435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Trauma-focused cognitive behavioral therapy (TF-CBT) has been identified as a gold standard treatment for childhood posttraumatic stress disorder (PTSD) in Western countries. More recently, TF-CBT has emerged in the literature as an area of interest for children and youth affected by conflict and war in low- and middle-income countries (LMIC). METHODS The present systematic review assesses the current evidence base of TF-CBT for children and youth in LMIC, with a focus on conflict-affected countries. A total of 143 articles were identified, of which 11 articles, representing 1,354 participants, met the proposed inclusion criteria. RESULTS Results showed that the majority of the studies identified were conducted in low-resource community settings in East or Central Africa (n = 8). It was also found that cultural considerations were taken into account in TF-CBT delivery to meet the needs of local populations. Additionally, measures were translated and validated for local use. CONCLUSIONS Findings of outcome data indicated that TF-CBT was effective in treating trauma-related symptoms and improving psychosocial functioning in children and adolescents in LMICs. Given the limited number of published literature available in this area, further studies are needed to conclude when and for whom trauma-focused interventions are most relevant.
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Affiliation(s)
- Fiona C Thomas
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Sofia Puente-Duran
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, ON, Canada
| | | | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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Piñeros-Ortiz S, Moreno-Chaparro J, Garzón-Orjuela N, Urrego-Mendoza Z, Samacá-Samacá D, Eslava-Schmalbach J. Mental health consequences of armed conflicts in children and adolescents: An overview of literature reviews. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:424-448. [PMID: 34559491 PMCID: PMC8525875 DOI: 10.7705/biomedica.5447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors. Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents. Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict. Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the postconflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society. Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.
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Affiliation(s)
- Sandra Piñeros-Ortiz
- Grupo de Investigación Violencia y Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Psiquiatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Jaime Moreno-Chaparro
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Escuela de Medicina, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D. C., Colombia.
| | - Nathaly Garzón-Orjuela
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Zulma Urrego-Mendoza
- Grupo de Investigación Violencia y Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia,Bogotá, D.C., Colombia.
| | - Daniel Samacá-Samacá
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Javier Eslava-Schmalbach
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Bogotá, D. C., Colombia.
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Pfefferbaum B, Nitiéma P, Newman E. A Critical Review of Effective Child Mass Trauma Interventions: What We Know and Do Not Know from the Evidence. Behav Sci (Basel) 2021; 11:bs11020025. [PMID: 33670239 PMCID: PMC7916921 DOI: 10.3390/bs11020025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022] Open
Abstract
Over the last 20 years, numerous interventions have been developed and evaluated for use with children exposed to mass trauma with six publications reporting meta-analyses of randomized controlled trials of child mass trauma interventions using inactive controls to examine intervention effects on posttraumatic stress, depression, anxiety, and functional impairment. The current report reviews the results of these meta-analytic studies to examine the status of the evidence for child mass trauma mental health interventions and to evaluate potential moderators of intervention effect and implications for practice. The meta-analyses reviewed for the current report revealed a small to medium overall effect of interventions on posttraumatic stress, a non-statistically significant to small overall effect on depression, a non-statistically significant overall effect on anxiety, and a small overall effect on functional impairment. The subgroup analyses suggest that interventions should be matched to the populations being served and to the context. Additional research is needed to tailor future interventions to further address outcomes other than posttraumatic stress including depression, anxiety, and functional impairment.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP3217, Oklahoma City, OK 73126, USA
- Correspondence: ; Tel.: +1-405-271-5121
| | - Pascal Nitiéma
- Department of Management Information Systems, Price College of Business, University of Oklahoma, Norman, OK 73069, USA;
| | - Elana Newman
- Dart Center for Journalism and Trauma, Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA;
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Pfefferbaum B, Nitiéma P, Newman E. A Meta-analysis of Intervention Effects on Depression and/or Anxiety in Youth Exposed to Political Violence or Natural Disasters. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09494-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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A review of non-specialised, group-based mental health and psychosocial interventions in displaced populations. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2018. [DOI: 10.1108/ijmhsc-02-2018-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to describe non-specialised, group-based interventions in displaced populations from reviewed literature, and to explore their outcomes.
Design/methodology/approach
A literature review was conducted using the PubMed database, Web of Science, The Cochrane Library of Systematic Reviews, and defined “grey literature”. Characteristics of the interventions were summarised into a table under key categories such as targeted persons, study setting, level of evidence, outcome measures, assessment tools used and summary of results.
Findings
In total, 11 articles were identified stemming from nine separate interventions. Three of these were considered level 1 evidence as they were randomised controlled trials. The described interventions were markedly heterogeneous in nature and produced diverse findings. There were noted methodological issues in the majority of interventions reviewed.
Originality/value
This original research has demonstrated clear need for research that uses robust methodology accounting for the complex and challenging nature of this context.
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Arbour M, Murray KA, Yoshikawa H, Arriet F, Moraga C, Vega MAC. Emotional, physical, and social needs among 0-5-year-old children displaced by the 2010 Chilean earthquake: associated characteristics and exposures. DISASTERS 2017; 41:365-387. [PMID: 27170477 DOI: 10.1111/disa.12197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An 8.8-magnitude earthquake occurred off the coast of Chile on 27 February 2010, displacing nearly 2,000 children aged less than five years to emergency housing camps. Nine months later, this study assessed the needs of 140 displaced 0-5-year-old children in six domains: caregiver stability and protection; health; housing; nutrition; psychosocial situation; and stimulation. Multivariate regression was applied to examine the degree to which emotional, physical, and social needs were associated with baseline characteristics and exposure to the earthquake, to stressful events, and to ongoing risks in the proximal post-earthquake context. In each domain, 20 per cent or fewer children had unmet needs. Of all children in the sample, 20 per cent had unmet needs in multiple domains. Children's emotional, physical, and social needs were associated with ongoing exposures amenable to intervention, more than with baseline characteristics or epicentre proximity. Relief efforts should address multiple interrelated domains of child well-being and ongoing risks in post-disaster settings.
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Affiliation(s)
- MaryCatherine Arbour
- MD, MPH is Associate Physician for Research in the Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Kara A Murray
- MPH is Research Assistant in the Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Hirokazu Yoshikawa
- PhD is University Professor at New York University, New York, NY, United States
| | - Felipe Arriet
- BA is Technical Advisor at Chile Crece Contigo, Ministry of Social Development, Santiago, Chile
| | - Cecilia Moraga
- MA is Technical Advisor at Chile Crece Contigo, Ministry of Health, Santiago, Chile
| | - Miguel Angel Cordero Vega
- MSc is Associate Academic at the Psychiatry Training Program, Universidad Diego Portales Medical School, Santiago, Chile
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Psychological interventions for children and young people affected by armed conflict or political violence. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2016. [DOI: 10.1097/wtf.0000000000000110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Henderson SEK, Elsass P, Berliner P. Mental and social health in disasters: the Sphere standards and post-tsunami psychosocial interventions in Asia. DISASTERS 2016; 40:432-451. [PMID: 26574293 DOI: 10.1111/disa.12159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project's Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long-term humanitarian psychosocial programmes in different countries in post-tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long-term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long-term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication.
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Affiliation(s)
| | - Peter Elsass
- Professor of Clinical Psychology, Department of Psychology, University of Copenhagen, Denmark
| | - Peter Berliner
- Professor, Department of Education, University of Aarhus, Denmark
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Jordans MJD, Pigott H, Tol WA. Interventions for Children Affected by Armed Conflict: a Systematic Review of Mental Health and Psychosocial Support in Low- and Middle-Income Countries. Curr Psychiatry Rep 2016; 18:9. [PMID: 26769198 PMCID: PMC4713453 DOI: 10.1007/s11920-015-0648-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over one billion children under the age of 18 live in countries affected by armed conflict. This systematic review replicates an earlier study, aiming to provide a comprehensive update of the most current developments in interventions for children affected by armed conflict. For the period 2009-2015, a total of 1538 records were collected from PubMed, PsycINFO, and PILOTS. Twenty-four studies met the inclusion criteria, and the included interventions involve data from 4858 children. Although the number of publications and level of evidence has improved since the previous review, there is still a general lack of rigor and clarity in study design and reported results. Overall, interventions appeared to show promising results demonstrating mostly moderate effect sizes on mental health and psychosocial well-being. However, these positive intervention benefits are often limited to specific subgroups. There is a need for increased diversification in research focus, with more attention to interventions that focus at strengthening community and family support, and to young children, and improvements in targeting and conceptualizing of interventions.
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Affiliation(s)
- Mark J D Jordans
- Center for Global Mental Health, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK.
- Research and Development Department, War Child Holland, Amsterdam, the Netherlands.
| | - Hugo Pigott
- Center for Global Mental Health, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
- Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Stough LM. World Report on Disability, Intellectual Disabilities, and Disaster Preparedness: Costa Rica as a Case Example. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ng GT. Tears, fears and cheers: responses to the post-disaster school relocation policy in China. DISASTERS 2014; 38:310-328. [PMID: 24601919 DOI: 10.1111/disa.12042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper reports on the results of a qualitative study on the responses of Chinese school children in one junior middle school and their parents to China's post-disaster school relocation policy. The sample comprised 22 pairs of parent-child dyads and two pupils whose parents could not be contacted. The study results were reported using Chambers and Wedel's (2009) conceptual framework, which delineates the fundamental elements of a policy. Content analysis was used to generate themes related to policy elements, such as goals, benefits and services. Both repetitive themes and idiosyncratic perspectives were reported so as to present a diversity of views. Despite adjustment difficulties and administrative problems reported by the study participants, the policy attention given to the rapid restoration of formal schooling for children was generally appreciated. The move back to the new school was greeted with cheer.
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Affiliation(s)
- Guat Tin Ng
- Assistant Professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong
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Fu C, Leoutsakos JM, Underwood C. Moderating effects of a postdisaster intervention on risk and resilience factors associated with posttraumatic stress disorder in Chinese children. J Trauma Stress 2013; 26:663-70. [PMID: 24490242 DOI: 10.1002/jts.21871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study is an evaluation of a psychosocial intervention involving child and adolescent survivors of the 2008 Sichuan China earthquake. Sociodemographics, earthquake-related risk exposure, resilience using the Connor-Davidson Resilience Scale, and posttraumatic stress disorder (PTSD) using the UCLA-PTSD Index were collected from 1,988 intervention participants and 2,132 controls. Mean resilience scores and the odds of PTSD did not vary between groups. The independent factors for risk and resilience and the dependent variable, PTSD, in the measurement models between control and intervention groups were equivalent. The structural model of risk and 2 resilience factors on PTSD was examined and found to be unequivalent between groups. In contrast to controls, risk exposure (B = −0.32, p <.001) in the intervention group was negatively associated with PTSD. Rational thinking (B = −0.48, p < .001), a resilience factor, was more negatively associated with PTSD in the intervention group. The second resilience factor explored, self-awareness, was positively associated with PTSD in both groups (B = 0.46 for controls, p < .001, and B = 0.69 for intervention, p < .001). Results highlight the need for more cross-cultural research in resilience theory to develop culturally appropriate interventions and evaluation measures.
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Affiliation(s)
- Christine Fu
- Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland USA
| | - Jeannie-Marie Leoutsakos
- Division of Geriatric Psychiatry; Department of Psychiatry and Behavioral Science; Johns Hopkins School of Medicine; Baltimore Maryland USA
| | - Carol Underwood
- Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland USA
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Prevalence and Predictors of Mental Health Distress Post-Katrina: Findings From the Gulf Coast Child and Family Health Study. Disaster Med Public Health Prep 2013; 2:77-86. [DOI: 10.1097/dmp.0b013e318173a8e7] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACTBackground: Catastrophic disasters often are associated with massive structural, economic, and population devastation; less understood are the long-term mental health consequences. This study measures the prevalence and predictors of mental health distress and disability of hurricane survivors over an extended period of recovery in a postdisaster setting.Methods: A representative sample of 1077 displaced or greatly affected households was drawn in 2006 using a stratified cluster sampling of federally subsidized emergency housing settings in Louisiana and Mississippi, and of Mississippi census tracts designated as having experienced major damage from Hurricane Katrina in 2005. Two rounds of data collection were conducted: a baseline face-to-face interview at 6 to 12 months post-Katrina, and a telephone follow-up at 20 to 23 months after the disaster. Mental health disability was measured using the Medical Outcome Study Short Form 12, version 2 mental component summary score. Bivariate and multivariate analyses were conducted examining socioeconomic, demographic, situational, and attitudinal factors associated with mental health distress and disability.Results: More than half of the cohort at both baseline and follow-up reported significant mental health distress. Self-reported poor health and safety concerns were persistently associated with poorer mental health. Nearly 2 years after the disaster, the greatest predictors of poor mental health included situational characteristics such as greater numbers of children in a household and attitudinal characteristics such as fatalistic sentiments and poor self-efficacy. Informal social support networks were associated significantly with better mental health status. Housing and economic circumstances were not independently associated with poorer mental health.Conclusions: Mental health distress and disability are pervasive issues among the US Gulf Coast adults and children who experienced long-term displacement or other serious effects as a result of Hurricanes Katrina and Rita. As time progresses postdisaster, social and psychological factors may play greater roles in accelerating or impeding recovery among affected populations. Efforts to expand disaster recovery and preparedness policies to include long-term social re-engagement efforts postdisaster should be considered as a means of reducing mental health sequelae. (Disaster Med Public Health Preparedness. 2008;2:77–86)
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Fisher JRW, Cabral de Mello M. Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings. Int J Ment Health Syst 2011; 5:23. [PMID: 21923901 PMCID: PMC3182992 DOI: 10.1186/1752-4458-5-23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 09/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most adolescents live in resource-constrained countries and their mental health has been less well recognised than other aspects of their health. The World Health Organization's 4-S Framework provides a structure for national initiatives to improve adolescent health through: gathering and using strategic information; developing evidence-informed policies; scaling up provision and use of health services; and strengthening linkages with other government sectors. The aim of this paper is to discuss how the findings of a recent systematic review of mental health problems in adolescents in resource-constrained settings might be applied using the 4-S Framework. METHOD Analysis of the implications of the findings of a systematic search of the English-language literature for national strategies, policies, services and cross-sectoral linkages to improve the mental health of adolescents in resource-constrained settings. RESULTS Data are available for only 33/112 [29%] resource-constrained countries, but in all where data are available, non-psychotic mental health problems in adolescents are identifiable, prevalent and associated with reduced quality of life, impaired participation and compromised development. In the absence of evidence about effective interventions in these settings expert opinion is that a broad public policy response which addresses direct strategies for prevention, early intervention and treatment; health service and health workforce requirements; social inclusion of marginalised groups of adolescents; and specific education is required. Specific endorsed strategies include public education, parent education, training for teachers and primary healthcare workers, psycho-educational curricula, identification through periodic screening of the most vulnerable and referral for care, and the availability of counsellors or other identified trained staff members in schools from whom adolescents can seek assistance for personal, peer and family relationship problems. CONCLUSION The predominant endorsed action is not that dedicated mental health services for adolescents are required, but that mental health care should be integrated using cross-sectoral strategies into the communities in which adolescents live, the institutions they attend and the organisations in which they participate.
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Affiliation(s)
- Jane RW Fisher
- Jean Hailes Research Unit, Department of Public Health and Preventive Medicine, Monash University, Melbourne Australia
| | - Meena Cabral de Mello
- Department of Child and Adolescent Health and Development, World Health Organization, Avenue Appia, Geneva, Switzerland
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Panter-Brick C, Goodman A, Tol W, Eggerman M. Mental health and childhood adversities: a longitudinal study in Kabul, Afghanistan. J Am Acad Child Adolesc Psychiatry 2011; 50:349-63. [PMID: 21421175 PMCID: PMC3069303 DOI: 10.1016/j.jaac.2010.12.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 12/03/2010] [Accepted: 12/08/2010] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify prospective predictors of mental health in Kabul, Afghanistan. METHOD Using stratified random-sampling in schools, mental health and life events for 11-to 16-year-old students and their caregivers were assessed. In 2007, 1 year after baseline, the retention rate was 64% (n = 115 boys, 119 girls, 234 adults) with no evidence of selection bias. Self- and caregiver-rated child mental health (Strengths and Difficulties Questionnaire), depressive (Depression Self-Rating Scale), and posttraumatic stress (Child Revised Impact of Events Scale) symptoms and caregiver mental health (Self-Report Questionnaire) were assessed. Lifetime trauma and past-year traumatic, stressful, and protective experiences were assessed. RESULTS With the exception of posttraumatic stress, one-year trajectories for all mental health outcomes showed significant improvement (p < .001). Family violence had a striking impact on the Strengths and Difficulties Questionnaire data, raising caregiver-rated scores by 3.14 points (confidence interval [CI] 2.21-4.08) or half a standard deviation, and self-rated scores by 1.26 points (CI 0.50-2.03); past-year traumatic beatings independently raised self-rated scores by 1.85 points (CI 0.03-3.66). A major family conflict raised depression scores by 2.75 points (CI 0.89-4.61), two thirds of a standard deviation, whereas improved family life had protective effects. Posttraumatic stress symptom scores, however, were solely contingent on lifetime trauma, with more than three events raising scores by 5.38 points (CI 1.76-9.00). CONCLUSIONS Family violence predicted changes in mental health problems other than posttraumatic stress symptoms in a cohort that showed resilience to substantial socioeconomic and war-related stressors. The importance of prospectively identifying impacts of specific types of childhood adversities on mental health outcomes is highlighted to strengthen evidence on key modifiable factors for intervention in war-affected populations.
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Affiliation(s)
- Catherine Panter-Brick
- The Jackson Institute & Department of Anthropology, Yale University, New Haven, CT 06520, USA.
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Kithakye M, Morris AS, Terranova AM, Myers SS. The Kenyan Political Conflict and Children’s Adjustment. Child Dev 2010; 81:1114-28. [DOI: 10.1111/j.1467-8624.2010.01457.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jordans MJD, Komproe IH, Tol WA, Kohrt BA, Luitel NP, Macy RD, de Jong JTVM. Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial. J Child Psychol Psychiatry 2010; 51:818-26. [PMID: 20102428 DOI: 10.1111/j.1469-7610.2010.02209.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal. METHODS A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, posttraumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children (n = 325) (mean age = 12.7, SD = 1.04, range 11-14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group. RESULTS Comparisons of crude change scores showed significant between-group differences on several outcome indicators, with moderate effect sizes (Cohen d = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on prosocial behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (-2.19; 95% CI, -3.82 to -.56), and aggression (-4.42; 95% CI, -6.16 to -2.67). An age effect for treatment was found for hope (.90; 95% CI, -1.54 to -.26). CONCLUSIONS A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased prosocial behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms.
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Affiliation(s)
- Mark J D Jordans
- HealthNet TPO, Department of Research and Development, Amsterdam, The Netherlands.
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Jordans MJD, Tol WA, Komproe IH, Susanty D, Vallipuram A, Ntamatumba P, Lasuba AC, de Jong JTVM. Development of a multi-layered psychosocial care system for children in areas of political violence. Int J Ment Health Syst 2010; 4:15. [PMID: 20553603 PMCID: PMC2907307 DOI: 10.1186/1752-4458-4-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 06/16/2010] [Indexed: 10/29/2022] Open
Abstract
Few psychosocial and mental health care systems have been reported for children affected by political violence in low- and middle income settings and there is a paucity of research-supported recommendations. This paper describes a field tested multi-layered psychosocial care system for children (focus age between 8-14 years), aiming to translate common principles and guidelines into a comprehensive support package. This community-based approach includes different overlapping levels of interventions to address varying needs for support. These levels provide assessment and management of problems that range from the social-pedagogic domain to the psychosocial, the psychological and the psychiatric domains. Specific intervention methodologies and their rationale are described within the context of a four-country program (Burundi, Sri Lanka, Indonesia and Sudan). The paper aims to contribute to bridge the divide in the literature between guidelines, consensus & research and clinical practice in the field of psychosocial and mental health care in low- and middle-income countries.
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Affiliation(s)
- Mark JD Jordans
- Department of Research & Development, HealthNet TPO, Amsterdam, The Netherlands
| | - Wietse A Tol
- Department of Research & Development, HealthNet TPO, Amsterdam, The Netherlands
| | - Ivan H Komproe
- Department of Research & Development, HealthNet TPO, Amsterdam, The Netherlands
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Joop TVM de Jong
- VU University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
- School of Medicine, Boston University, Boston, USA
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Tol WA, Kohrt BA, Jordans MJ, Thapa SB, Pettigrew J, Upadhaya N, de Jong JT. Political violence and mental health: A multi-disciplinary review of the literature on Nepal. Soc Sci Med 2010; 70:35-44. [DOI: 10.1016/j.socscimed.2009.09.037] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Indexed: 11/26/2022]
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Combining qualitative and quantitative research methods to support psychosocial and mental health programmes in complex emergencies. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2009. [DOI: 10.1097/wtf.0b013e32833462f9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Studies in Afghanistan have shown substantial mental health problems in adults. We did a survey of young people (11-16 years old) in the country to assess mental health, traumatic experiences, and social functioning. METHODS In 2006, we interviewed 1011 children, 1011 caregivers, and 358 teachers, who were randomly sampled in 25 government-operated schools within three purposively chosen areas (Kabul, Bamyan, and Mazar-e-Sharif municipalities). We assessed probable psychiatric disorder and social functioning in students with the Strength and Difficulties Questionnaire multi-informant (child, parent, teacher) ratings. We also used the Depression Self-Rating Scale and an Impact of Events Scale. We assessed caregiver mental health with both international and culturally-specific screening instruments (Self-Reported Questionnaire and Afghan Symptom Checklist). We implemented a checklist of traumatic events to examine the exposure to, and nature of, traumatic experiences. We analysed risk factors for mental health and reports of traumatic experiences. FINDINGS Trauma exposure and caregiver mental health were predictive across all child outcomes. Probable psychiatric ratings were associated with female gender (odds ratio [OR] 2.47, 95% CI 1.65-3.68), five or more traumatic events (2.58, 1.36-4.90), caregiver mental health (1.11, 1.08-1.14), and residence areas (0.29, 0.17-0.51 for Bamyan and 0.37, 0.23-0.57 for Mazar-e-Sharif vs Kabul). The same variables predicted symptoms of depression. Two thirds of children reported traumatic experiences. Symptoms of post-traumatic stress were associated with five or more traumatic events (3.07, 1.78-5.30), caregiver mental health (1.06, 1.02-1.09), and child age (1.19, 1.04-1.36). Children's most distressing traumatic experiences included accidents, medical treatment, domestic and community violence, and war-related events. INTERPRETATION Young Afghans experience violence that is persistent and not confined to acts of war. Our study emphasises the value of school-based initiatives to address child mental health, and the importance of understanding trauma in the context of everyday forms of suffering, violence, and adversity. FUNDING Wellcome Trust.
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Attanayake V, McKay R, Joffres M, Singh S, Burkle F, Mills E. Prevalence of mental disorders among children exposed to war: a systematic review of 7,920 children. Med Confl Surviv 2009; 25:4-19. [PMID: 19413154 DOI: 10.1080/13623690802568913] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Worldwide, millions of children are affected by armed conflict. However, data on the prevalence of mental disorders among these children is sparse. We aimed to determine the prevalence of mental disorders among children affected by war using a systematic review and meta-regression analysis. We systematically reviewed existing literature to identify studies on prevalence of post-traumatic stress disorder (PTSD), anxiety, depression and psychosis among children exposed to armed conflict. We searched electronic databases and references listed in studies to obtain eligible studies. We pooled studies using the random-effects method and explored heterogeneity using meta-regression analysis. Seventeen studies met our inclusion criteria. Studies included 7,920 children. Sample sizes ranged from 22 to 2,976. Four studies were conducted during a conflict and others during post-conflict. All the studies reported PTSD as the primary outcome ranging from 4.5 to 89.3%, with an overall pooled estimate of 47% (9% CI: 35-60%, I2 = 98%). Meta-analysis heterogeneity was attributable to study location (OR 1.33, 95% CI: 1.27-1.41), method of measurement (OR 1.36, 95% CI: 1.29-1.44) and duration since exposure to war (coefficient 0.17, 95% CI: 0.94-0.25). In addition, four studies reported elevated depression that allowed pooling (43%, 95% CI: 31-55%) and three studies reported elevated anxiety disorders allowing pooling (27%, 95% CI: 21-33%). Our systematic review suggests a higher prevalence rate of mental disorders among children exposed to conflict than among the general population. Given the number of current conflicts, there is a paucity of information regarding mental disorders among children affected by war.
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Affiliation(s)
- Vindya Attanayake
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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Jordans MJD, Komproe IH, Tol WA, De Jong JTVM. Screening for psychosocial distress amongst war-affected children: cross-cultural construct validity of the CPDS. J Child Psychol Psychiatry 2009; 50:514-23. [PMID: 19236527 DOI: 10.1111/j.1469-7610.2008.02028.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large-scale psychosocial interventions in complex emergencies call for a screening procedure to identify individuals at risk. To date there are no screening instruments that are developed within low- and middle-income countries and validated for that purpose. The present study assesses the cross-cultural validity of the brief, multi-informant and multi-indicator Child Psychosocial Distress Screener (CPDS). METHODS The CPDS data of total samples in targeted catchment areas of a psychosocial care program in four conflict-affected countries (Burundi n = 4193; Sri Lanka n = 2573; Indonesia n = 1624; Sudan n = 1629) were studied to examine the cross-cultural construct validity of the CPDS across settings. First, confirmatory factor analyses were done to determine the likelihood of pre-determined theory-based factor structures in each country sample. Second, multi-sample confirmatory factor analyses were done within each country sample to test measurement equivalence of the factor structure as a measure of construct validity. RESULTS A 3-factor structure reflecting the theoretical premises of the instrument (e.g., child distress, child resilience and contextual factors) was found in the samples from Burundi, Sri Lanka and Indonesia, albeit with context specific deviations. The robustness of the 3-factor structure as an indicator of construct validity was confirmed within these three samples by means of multi-sample confirmatory factor-analyses. A 3-factor structure was not found in the Sudan sample. CONCLUSIONS This study demonstrates the comparability of the assessment by the CPDS of the construct 'non-specific psychosocial distress' across three out of four countries. Robustness of the factor structure of the CPDS within different samples refers to the construct validity of the instrument. However, owing to context-specific deviations of inter-item relationships, the CPDS scores cannot be compared cross-culturally, a finding that confirms the need for attention to contextual factors when screening for non-specific psychosocial distress.
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Affiliation(s)
- M J D Jordans
- HealthNet TPO, Public Health & Research Department, Amsterdam, The Netherlands.
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van Ommeren M, Morris J, Saxena S. Social and clinical interventions after conflict or other large disaster. Am J Prev Med 2008; 35:284-6. [PMID: 18692744 DOI: 10.1016/j.amepre.2008.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
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Betancourt TS, Williams T. Building an evidence base on mental health interventions for children affected by armed conflict. INTERVENTION (AMSTELVEEN, NETHERLANDS) 2008; 6:39-56. [PMID: 19997531 PMCID: PMC2789493 DOI: 10.1097/wtf.0b013e3282f761ff] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper reviews what is currently known from research about the effectiveness of interventions to address mental health problems in children and adolescents affected by armed conflict. The focus will be on interventions delivered in conflict affected countries either during active humanitarian emergencies or during the post conflict period. The paper will discuss two main paradigms of intervention dominating the field: psychosocial approaches and clinical/psychiatric approaches. The paper reviews some of the basic literature, theories and issues involved in assessment, programme planning, monitoring and evaluation of both approaches. In order to explore these issues in depth, the paper will draw from the author's field experiences with research in the Russian Federation and in northern Uganda. The paper also presents a brief review of a handful of other published evaluations of mental health interventions for war affected children. We will close with a discussion of what future research is needed to build an evidence base regarding mental health interventions for children affected by armed conflict as well as the ethical and feasibility issues associated with carrying out this work.
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Affiliation(s)
- Theresa S. Betancourt
- Department of Population and International Health. François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, 651 Huntington Avenue, 7th floor, Boston, MA 02115 USA, Phone: 617 432-5003.
| | - Timothy Williams
- Department of Society, Human Development, and Health, Harvard School of Public Health.
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