"Finding a way out": Case histories of mental health care-seeking and recovery among long-term internally displaced persons in Georgia

Lived Experiences of a Sustained Mental Health Recovery Process Without Ongoing Medication Use

Serious mental health conditions have historically been considered lifelong conditions, with substantial literature supporting pharmaceutical approaches to remission. More recently, the recovery movement has emphasized lasting recovery, which can occur through a variety of pathways. With the traditional focus on medication, less is known about the recovery process of persons who achieve sustained recovery without ongoing medication use. This qualitative study used a grounded theory approach to explore the recovery process of 19 participants with diagnoses of schizophrenia, bipolar disorder, or major depression who were in recovery and not taking medications for at least twelve months. Participants identified internal recovery processes (cognitive changes, emotional processes, and spirituality/faith) leading to a perspective change about self and symptoms. Participants also identified external recovery processes including both support received and productive ways of giving back. The study findings highlight the importance of self-efficacy, emotion management, and social giving in mental health recovery.

Psychometric properties of the Meaning in Life Questionnaire - Hausa version among internally displaced persons in Nigeria

Valid measurement of meaning in life (MIL) is crucial for cross-cultural understanding of the construct. The Meaning in Life Questionnaire (MLQ), a widely used measure of MIL, has yet to be translated into any indigenous African language. The current study presents a preliminary report of a Hausa language translation of the MLQ, the MLQ-Hausa version (MLQ-H), and its reliability and validity in a Nigerian sample. Participants were 809 internally displaced persons (IDPs) (50.7% males) in Kabusa IDP Centre in Abuja Municipal Area Council of the Federal Capital Territory of Nigeria. They completed Hausa versions of the MLQ, the Brief Personal Meaning Profile (PMP-B), and scales of the Symptoms Distress Checklist (SCL-90). Results of a confirmatory factor analysis supported the original two-factor model of the MLQ comprising presence of meaning (5 items) and search for meaning (5 items). The two factors had adequate reliability. Responses to the MLQ-H did not differ by sociodemographic factors. Concurrent validity of MLQ-H was suggested by significant correlations between MLQ-H and psychopathology symptom scales. Importantly, we found convergent validity through positive correlations of MLQ-H with the PMP-B. Results indicate that the MLQ-H is a psychometrically sound measure of MIL among Hausa IDPs and may be applied in research on meaning in life among other Hausa-speaking populations.

Ethical and methodological issues in qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions: a critical review

Undertaking research studies in the field of mental health is essential in mental health nursing. Qualitative research methodologies enable human experiences to become visible and recognize the importance of lived experiences. This paper argues that involving people with schizophrenia in research is critical to promote their health and well-being. The quality of qualitative research needs scrutinizing according to methodological issues such as trustworthiness and ethical standards that are a fundamental part of qualitative research and nursing curricula. The aim of this study was to critically review recent qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions, regarding descriptions of ethical and methodological issues in data collection and analysis. A search for relevant papers was conducted in three electronic databases, in December 2016. Fifteen qualitative interview studies were included and reviewed regarding methodological issues related to ethics, and data collection and analysis. The results revealed insufficient descriptions of methodology regarding ethical considerations and issues related to recruitment and sampling in qualitative interview studies with individuals with severe mental illness, putting trustworthiness at risk despite detailed descriptions of data analysis. Knowledge from the perspective of individuals with their own experience of mental illness is essential. Issues regarding sampling and trustworthiness in qualitative studies involving people with severe mental illness are vital to counteract the stigmatization of mental illness.

Identifying mental health problems and Idioms of distress among older adult internally displaced persons in Georgia

The global population of older adults (60 years and older) has been growing steadily; however, inadequate attention is given to the health needs of older persons, particularly within contexts of conflict and migration. This paper reports findings from the qualitative phase of an investigation assessing the mental health status of older adult internally displaced persons (IDPs) in Georgia, a country in the South Caucasus. The study aimed to assess community-wide social and health problems among older adult IDPs, with a focus on mental health problems and healthy functioning, as well as terminology used to describe these problems. Free-list interviews with older adult IDPs (n = 75) and key informant interviews with community members and service providers (n = 45) were conducted in 2010-2011 in three regions of Georgia: Tbilisi, Shida Kartli, and Samegrelo. Findings demonstrated that older IDPs experienced symptoms of distress that could be clustered into depression-like and anxiety-like syndromes. Participants described other psychosocial problems among older IDPs, including feelings of abandonment, isolation, and passivity, as well as conflicts in the family. All problems were linked with displacement-related experiences, such as difficulties with integration, grief, and war trauma. The expression of displacement-related problems was identified as an idiom of distress for this population. Older IDPs coped with these problems through social support mechanisms, including socializing, helping each other, working, and participating in the community. Key modalities for redressing older IDPs' psychosocial problems, improving quality of life, and achieving healthy 'aging-in-displacement' include: promoting social connectedness and community engagement, drawing on IDPs' skills, identifying new social roles, and strengthening social support networks.