The mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya

Post-traumatic stress disorder symptoms among internally displaced persons: unveiling the impact of the war of Tigray

INTRODUCTION

Due to the war in Tigray, 2.1 million people (31% of the total population) were internally displaced. Epidemiological evidence shows that the burden of mental health is higher in war/conflict and post-conflict areas of the world compared to non-conflict places, especially for those who have experienced targeted ethnic violence as a result of civil and political unrest. Post-traumatic stress disorder is one of the common psychiatric disorders experienced during war. Thus, this study aimed to assess the level and aggravating factors of PTSD during the war in Tigray.

METHODS

A community-based cross-sectional study was conducted among 2132 IDP family heads in Tigray from August 6-30, 2021. Study participants were recruited using a multi-stage sampling technique. Data were collected using a pretested structured questionnaire through face-to-face interviews. The PCL-C checklist, derived from DSM-IV criteria, was used to assess the magnitude of post-traumatic stress disorder. The entered data were exported to the SPSS version 26 statistical package for analysis. Summary statistics were computed, and logistic regression analysis was used to investigate factors associated with developing PTSD.

RESULTS

A total of 2071 IDPs were surveyed with a response rate of 99.7%. The survey revealed that the level of PTSD among community-hosted IDPs was 57.7%; 95% CI 55.5%-59.8%. Older age (> 50) (AOR 3.1, 95% CI 1.497-6.421), primary and secondary school attendance (AOR 2.1, 95% CI 1.344-3.279; and 1.697, 95% CI 1.067-2.7) respectively, internally displaced persons with a family size of > 6 members (AOR 1.821, 95% CI 1.124-2.95), disability due to the war (AOR 1.702, 95% CI 1.077-2.69), and loss of contact with family members (AOR 1.472, 95% CI 1.032-2.099) were significantly associated with PTSD.

CONCLUSION

The overall level of PTSD among cIDPs was found to be high (57.7%). Almost every other IDP developed this serious mental health syndrome. Immediate psycho-social health intervention is needed by local and international organizations in collaboration with governmental and non-governmental institutions based on the study's findings.

Dimensionality of the Swahili version of the General Health Questionnaire (GHQ-12) in a Kenyan population: A confirmatory factor analysis

The current study evaluated the Kiswahili version of General Health Questionnaire (GHQ-12) in a Kenyan context comprising of women exposed to gender-based violence. Participants were randomly drawn from community sampling using household screening methods in peri-urban areas in Nairobi. A total of 1,394 participants with varying levels of literacy (years of education: mean [M] = 9.42; standard deviation [SD] = 3.73) and aged between 18 and 89 years were recruited for the study. The observed factor structure of the GHQ-12 was evaluated using six most tested models querying the dimensionality of the instrument insofar as the impacts of positive and negative wording effects in driving multidimensionality. Results from the confirmatory factor analysis supported a bifactor model, consisting of a general distress factor and two separate factors representing common variance due to the positive and negative wording of items. Overall, the findings support the use of the Kiswahili version of the GHQ-12 as a unidimensional construct with method-specific variance owing to wording effects. Importantly, GHQ-12 responses from a sample of Kenyan women with relatively low levels of literacy are congruent with the factor structure observed in other cross-cultural settings in low- and-middle-income countries.

Effects of blast exposure on anxiety and symptoms of post-traumatic stress disorder (PTSD) among displaced Ukrainian populations

Generalized anxiety and symptoms of post-traumatic stress disorder (PTSD) are common among individuals forcibly displaced during war and conflict. Blast exposure may be one important contributor of such symptoms. The aims of this study were to provide data on blast-related experiences of internally displaced persons (IDPs) and refugees following Russia's invasion of Ukraine, and to assess the influence of blast exposure on generalized anxiety, and PTSD flashbacks and nightmares. An online health needs survey was distributed to Ukrainian IDPs and refugees between April and July 2022 using Facebook Ads Manager. Participants reported whether they experienced blast exposure since the beginning of the invasion, and whether they took medication for a mental health condition before the war started. Finally, they completed measures of generalized anxiety (GAD-2), and PTSD flashbacks and nightmares. Analyses included 3253 IDPs and 5073 refugees (N = 8326). Results revealed that 67.6% of total participants- 79.9% of IDPs and 61.7% of refugees-reported blast exposure since Russia's invasion. Further, 69.1% (95% CI: 68.05, 70.15) of total participants met the cut-off for generalized anxiety in which further diagnostic evaluation was warranted. Compared to refugees, IDPs reported higher generalized anxiety and greater frequency of PTSD symptoms, specifically flashbacks and nightmares. Further analyses revealed that the impact of blast exposure on flashback frequency was stronger among IDPs compared to refugees (β = 0.51; t(8322) = 11.88, p < .0001, 95% CI: 0.43, 0.60) and among participants with pre-existing mental health conditions compared to those without (β = 0.18; t(8157) = 2.50, p = .013, 95% CI: 0.04, 0.33). Mental health and psychosocial support must be prioritised within humanitarian relief for both IDPs and refugees and especially among people with underlying mental health conditions.

Social integration, solidarity, and psychological health of internally displaced persons in Cameroon: Exploring the role of community satisfaction

Background/Introduction

Conflict-induced displacement continue to be a pressing public policy concern due to the adverse effects on the well-being of internally displaced persons (IDPs). Understanding the integration process of these individuals, particularly the role of solidarity and social integration in fostering a sense of belonging and improving their community experiences and psychological well-being, remains unclear. This study investigates the role of community satisfaction in the relationship among social integration, solidarity, and psychological health of IDPs in Cameroon.

Methods

Cross-sectional data from 428 displaced individuals in the Ntui subdivision, Cameroon, were analyzed using structural equation modeling (SEM). This technique tested four latent variables: social integration, solidarity, community satisfaction, and psychological health.

Results

The results show a direct association between solidarity and both community satisfaction (β = 0.282; p < 0.001) and psychological health (β = 0.137; p < 0.01). Community satisfaction also has a direct relationship with the psychological health of the IDPs (β = 0.292; p < 0.001). An indirect effect of solidarity on psychological health through community satisfaction was observed (β = 0.084 (SE = 0.025, CI = [0.047, 0.129], p < 0.001)). However, no mediational effect of community satisfaction was found on the association between social integration and psychological health. The model accounted for 7% of the variance in community satisfaction (R2 = 0.07) and 20% of the variance in psychological health (R2 = 0.20). Conclusion: The findings indicate a strong sense of solidarity among the displaced persons in the studied communities in Cameroon, which promotes their psychological health via community satisfaction. As such, interventions should aim to foster solidarity among displaced persons to enhance their community experiences and psychological health.

COVID-19 and its prevention in internally displaced person (IDP) camps in Somalia: impact on livelihood, food security and mental health

BACKGROUND

Somalia has over 2.6 million internally displaced people (IDP) that depend on daily wages and humanitarian assistance for their livelihoods. This study investigated the impact of COVID-19 on livelihoods, food security and mental health of Somalia's IDPs.

METHODS

A questionnaire was conducted with "breadwinners" (n = 585) residing in 15 randomly selected IDP camps. Mental health was assessed using the 5-item World Health Organization Wellbeing Index (WHO-5) and the Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to explore the effect of depressive symptoms on soap use and ability to pay for food/medicine/rent.

RESULTS

Knowledge of COVID-19 symptoms, transmission and prevention was relatively high, however only 55% reported using soap for hand washing. Around one third perceived that prohibition of public gatherings had negatively impacted weekly earnings. Participants reported difficulty buying food (85%), medicine (82%) and paying rent (51%) because of COVID-19. The majority were assessed as having low wellbeing and high depressive symptoms (mean WHO-5 = 44.2/100; mean PHQ-9 = 18.6/27), with most (74%) indicating that they felt worse than before the pandemic. Compared to people with low depressive symptoms, people with high depressive symptoms were less likely to use soap (aOR = 0.3, 95% CI = 0.2, 0.7; P < 0.001) and more likely to report difficulty buying food (aOR = 2.2; 95% CI = 1.1, 4.3; P = 0.02).

CONCLUSION

COVID-19 and associated restrictions have negatively impacted Somalia's internally displaced population. Livelihood and mental health support is urgently needed in the recovery phase of the pandemic and should be factored into future pandemic planning.

Feasibility evaluation of psychosocial intervention for internally displaced youth in Kenya

BACKGROUND

There is limited evidence on the cultural appropriateness of first-stage psychosocial interventions for youth with mental health problems who experience conflict and disadvantage in low- and middle-income countries (LMIC).

AIMS

To evaluate the feasibility of such an intervention (Writing for Recovery - WfR) among youth with emerging emotional problems following internal displacement in Kenya.

METHOD

Fifty-four youth aged 14-17 years were randomly allocated to a six-session intervention or a waiting list control group. They completed measures of stressful life events; post-traumatic stress, depressive and anxiety symptoms; quality of life; and free text on their experience of the intervention.

RESULTS

Young participants reported high levels of trauma exposure and emotional problems. The intervention was perceived as flexible and culturally acceptable, with reported short-term impact. This was found to have promising post-intervention effect in reducing post-traumatic stress, but not depressive or anxiety symptoms; and in enhancing quality of life scores.

CONCLUSIONS

Similar psychosocial interventions that can be delivered by paraprofessionals are important for resource-constrained LMIC settings, but need to be integrated within a comprehensive scaled service model.

Anxiety, depression and stress among internally displaced persons and host community in an armed conflict region: A comparative study

This study compares the psychological profile of Internally Displaced Persons (IDPs) and individuals living in host communities in the war-affected setting. We conducted a cross-sectional survey from October-November 2019. Subjects were recruited from six IDPs camps and the surrounding host communities within the metropolis of Maiduguri, Nigeria by convenience sampling. Data were collected using the Hausa version of Depression Anxiety Stress Scale-21, and analysed by logistic regression using adjusted odds ratio (AOR) at 95% Confidence Interval (CI). A total of 562 subjects were recruited. Living in IDP camp was the most significantly predictor of depression, anxiety, and stress. The common predictors were living in an IDP camp, and marital status (separated). Aged 18-29years was a protective factor compared to those ≥50years. Living in IDP camps, separated from partners, lack of education and pre-conflict employment were significant predictors of depression, anxiety and stress.

Disruptions, adjustments and hopes: The impact of the COVID-19 pandemic on child well-being in five Majority World Countries

Drawing on integrated data from focus groups and diary entries, we explored the impact of the COVID-19 pandemic on child well-being for children from five Majority World Countries. We focus on the disruptions the pandemic caused, the adjustments made in response to these, and children's vision of a post-pandemic world. Underlying children's experiences of loss, boredom and concerns about educational progress, was an awareness of systemic inequalities that disadvantaged them or others in their community. Findings have implications on capturing children's voices through introspective and dialogical approaches that transcend cultures and for the development of preventive and responsive interventions during crises.

Assessing Inequalities in Wellbeing at a Neighbourhood Scale in Low-Middle-Income-Country Secondary Cities and Their Implications for Long-Term Livability

To ensure future sustainability, cities need to consider concepts of livability and resident wellbeing alongside environmental, economic and infrastructure development equity. The current rapid urbanization experienced in many regions is leading to sustainability challenges, but also offers the opportunity to deliver infrastructure supporting the social aspects of cities and the services that underpin them alongside economic growth. Unfortunately, evidence of what is needed to deliver urban wellbeing is largely absent from the global south. This paper contributes to filling this knowledge gap through a novel interdisciplinary mixed methods study undertaken in two rapidly changing cities (one Thai and one Kenyan) using qualitative surveys, subjective wellbeing and stress measurements, and spatial analysis of urban infrastructure distribution. We find the absence of basic infrastructure (including waste removal, water availability and quality) unsurprisingly causes significant stress for city residents. However, once these services are in place, smaller variations (inequalities) in social (crime, tenure) and environmental (noise, air quality) conditions begin to play a greater role in determining differences in subjective wellbeing across a city. Our results indicate that spending time in urban greenspaces can mitigate the stressful impacts of city living even for residents of informal neighborhoods. Our data also highlights the importance of places that enable social interactions supporting wellbeing-whether green or built. These results demonstrate the need for diversity and equity in the provision of public realm spaces to ensure social and spatial justice. These findings strengthen the need to promote long term livability in LMIC urban planning alongside economic growth, environmental sustainability, and resilience.

Complementing standard western measures of depression with locally co-developed instruments: A cross-cultural study on the experience of depression among the Luo in Kenya

Our present understanding of depression relies on a Western nosology that might not be generalizable across diverse cultures around the world. As a consequence, current clinical research and practice may not capture culturally salient features of depression. Expanded cross-cultural research that uses ethnographic methods and local instruments may yield information of clinical utility to enhance culturally sensitive research and practice. In this mixed methods study, we used ethno-semantic interview procedures based on the DSM-5's cultural formulation process to elicit a broad range of depression features reported by the Luo people of western Kenya. We identified how the Luo conceptualize depression, including idioms of depressive distress, moods associated with persistent negative affect, and other features including context, stressors and support systems. This information informed the co-development of a Luo Depression Questionnaire (LDQ-17). We used the LDQ-17 in a cross-sectional community survey (N = 116) to investigate its association with a standard Western instrument (Patient Health Questionnaire-9; PHQ-9). Factor analysis revealed a one-factor model for the PHQ-9 but not the LDQ-17 for which exploratory factor analysis suggested a three-factor model including cognitive, affective, and physical symptoms. Psychological, environmental/social, and even supernatural causes (i.e., ancestors, God and devil) of these symptoms were identified, as were support systems. Finally, visualizations through multidimensional scaling approaches showed some overlap between the LDQ-17 and the PHQ-9, but the local LDQ-17 identified salient features the Luo associated with depression that the PHQ-9 missed. Our findings illustrate how simple ethnographic procedures may guide the development of local instruments to complement current standardized instruments, potentially enhancing cultural relevance.

The mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya: a critique

The study titled ‘[t] he mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya’ by Getanda, Papadopoulos and Evans identifies a critical area and contributed significantly to literature. Despite the contribution, there are some issues in that study that deserve attention. For example, the use of the satisfaction with life scale instead of the temporal satisfaction with life scale, for a pre-and post-displacement study, is questionable. It is important to note that the scores from the satisfaction with life scale can only measure life satisfaction at a particular point while the temporal satisfaction with life can be used to determine life satisfaction between pre-and post-displacement periods. Again, conflicting statements in the abstract and methods sections have been noted, where the abstract refers to refugee camps while methods refer to internally displaced persons’ camps. Finally, some reported statistics have been found to have errors. It is important to highlight these critical issues to readers for a better understanding. This study, therefore, endeavours to critique that study and clarify some of these issues so that readers get better understandings. Recommendations for future studies are made.

The Shamiri group intervention for adolescent anxiety and depression: study protocol for a randomized controlled trial of a lay-provider-delivered, school-based intervention in Kenya

BACKGROUND

Developing low-cost, socio-culturally appropriate, and scalable interventions for youth depression and anxiety symptoms in low-income regions such as countries in sub-Saharan Africa is a global mental health priority. We developed and intend to evaluate one such intervention for adolescent depression and anxiety in Kenya. The intervention, named Shamiri (a Swahili word for "thrive"), draws upon evidence-based components of brief interventions that involve nonclinical principles rather than treatment of psychopathology (e.g., growth mindset, gratitude, and virtues).

METHODS

Four hundred twenty Kenyan adolescents (ages 13-18) with clinically elevated depression and/or anxiety symptoms will be randomized to either the 4-week Shamiri group intervention or a group study-skills control intervention of equal duration and dosage. Participating adolescents will meet in groups of 8-15, led by a high-school graduate trained to deliver Shamiri as a lay-provider. Adolescents will self-report primary outcome measures (depression-measured by the PHQ-8, and anxiety symptoms-measured by the GAD-7) and secondary outcome measures (perceived social support, perceived academic control, self-reported optimism and happiness, loneliness, and academic grades) at the 2-week intervention midpoint, 4-week post-intervention endpoint, and 2-week post-intervention follow-up. We predict that adolescents in the Shamiri group, when compared to the study-skills control group, will show greater improvements in primary outcomes and secondary outcomes.

DISCUSSION

Results may suggest that a brief, lay-provider delivered, school-based intervention may reduce depression and anxiety symptoms, improving academic outcomes and other psychosocial outcomes in adolescents with clinically-elevated symptoms in sub-Saharan Africa.

TRIAL REGISTRATION

Pan African Clinical Trials Registry PACTR201906525818462 . Registered on 12 June 2019.

Health Status and Health Care Needs of Drought-Related Migrants in the Horn of Africa-A Qualitative Investigation

Somalia, Kenya and Ethiopia, situated in the Horn of Africa, are highly vulnerable to climate change, which manifests itself through increasing temperatures, erratic rains and prolonged droughts. Millions of people have to flee from droughts or floods either as cross-border refugees or as internally displaced persons (IDPs). The aim of this study was to identify knowledge status and gaps regarding public health consequences of large-scale displacement in these countries. After a scoping review, we conducted qualitative in-depth interviews during 2018 with 39 stakeholders from different disciplines and agencies in these three countries. A validation workshop was held with a selection of 13 interviewees and four project partners. Malnutrition and a lack of vaccination of displaced people are well-known challenges, while mental health problems and gender-based violence (GBV) are less visible to stakeholders. In particular, the needs of IDPs are not well understood. The treatment of mental health and GBV is insufficient, and IDPs have inadequate access to essential health services in refugee camps. Needs assessment and program evaluations with a patients’ perspective are either lacking or inadequate in most situations. The Horn of Africa is facing chronic food insecurity, poor population health and mass displacement. IDPs are an underserved group, and mental health services are lacking. A development approach is necessary that moves beyond emergency responses to the building of long-term resilience, the provision of livelihood support and protection to reduce displacement by droughts.

Predictors of social support, physical health and mental health among food insecure internally displaced persons in Turkana, Kenya

Background

Food insecurity and the mental and physical health of internally displaced persons (IDPs) is a public health concern. The aim of this study was to determine the predictors of social support, physical and mental health among food insecure IDPs in Nakwamekwei IDP camp in Turkana, Kenya.

Methods

A cross sectional study was conducted among 159 household heads living in the camp. Analysis was conducted using statistical summaries, logistic regression and linear regression.

Results

Ninety four percent (94%) of the households were severely food insecure and the rest of the households had moderate food insecurity. Majority of the household heads (77%) had symptoms of depression and those with five or more children were 3 times (95%CI, 1.31–9.24; p = 0.015) more likely to be have symptoms of depression, while those who were married were less likely to have the same (95%CI, 0.14–0.92; p = 0.038). Seventy six percent (76%) of the household heads had anxiety symptoms; none of the predictor variables were significantly associated with anxiety symptoms in the adjusted analysis. Those who had spent many years in the camp, were older, and had more children had significantly poorer physical health (p = 0.042, p = 0.001, and p = 0.047, respectively). Those who were married and those who had experienced violence in the current camp had significantly higher social support (p = 0.001 and p = 0.006, respectively).

Conclusions

Participants have been living in camp for the last 10 years hence the need to improve their living conditions, address their physical and mental health as well as food insecurity. This can be done by providing the participants with safe drinking water, constructing pit latrines to prevent communicable disease and adhere to the Sphere recommendations for sanitation and hygiene as well as training them in income generating activities to mitigate the high unemployment and food insecurity rates. The IDPs should be integrated into the local community to bring an end to their protracted displacement.

Meals under tents: experiences of food insecurity among the displaced people of southern Philippines

The article examines food conditions among Internally Displaced Persons (IDPs) in the southern Philippines. This aims to highlight the experience of food availability, accessibility and utilization as significant components of the household food security concept among people who lost their communities and sources of income due to war. The study also explores the consequences of food insecurity or hardship to the lives of the family members. Key informant interviews (KII) were conducted among 10 household heads to gather the qualitative data and quantitative data was provided by 306 respondents to the survey questionnaire. Both results reflect poor food security status, requiring coping strategies and affecting familial dynamics among other things. The study reechoes earlier findings that internal displacement predicts not only household food insecurity but also decreased mental well-being and reduced personal motivation. Mindful of these facts, a considerable range of services and assistance must be extended to the IDPs including food, livelihood, and psychological interventions. The study ultimately hopes to put pressure on the state legislature of the Philippines for the immediate enactment of specific law that protects Filipino IDPs.

Perceived Trajectories of Past, Present, and Future Life Satisfaction of North Korean Defectors

This study compared perceived trajectories of life satisfaction (LS) between North Korean defectors' (NKDs') and the general South Korean population and examined psychosocial factors associated with future LS. Data were obtained from 300 NKDs residing in South Korea and 5089 South Koreans using self-questionnaires and face-to-face interviews. LS values from 5 years ago (3.46 vs. 6.18) and at present (5.30 vs. 5.91) were lower in NKDs than the control group, but the inverse was true for expected LS score in 5 years (7.82 vs. 6.87). NKDs' LS trajectory showed a more statistically positive trend than that of the control group. Among NKDs, subjective sense of loneliness and satisfaction with one's sense of autonomy were associated with expected future LS. NKDs experience higher life satisfaction and expect an optimistic future relative to the control group. Social policies and therapeutic approaches to loneliness and improving a sense of autonomy may be beneficial.

Agency via Life Satisfaction as a Protective Factor From Cumulative Trauma and Emotional Distress Among Bedouin Children in Palestine

Adopting an ecological perspective on children's functioning and psychological well-being, we investigated the association between agency and life satisfaction, and its bearing on trauma symptoms and negative emotions in a group of Bedouin children living in the occupied Palestinian territories. Specifically, we hypothesized that the more children were agentic, the more they would be satisfied with their lives; and that greater life satisfaction would be associated with better affect balance, and reduced trauma symptoms. A sample of 286 Bedouin children attending primary schools in four different villages in the Jordan Valley completed the multidimensional students' life satisfaction scale (MSLSS), positive affect and negative affect scale for children (PANAS-C), Children's Impact of Event Scale (CRIES-13), and the children's hope scale (CHS). Structural equation modeling was performed to evaluate the cumulative network of direct and indirect effects between children's agency, life satisfaction, and trauma symptoms. The findings confirmed the key role of life satisfaction in mitigating traumatic reactions. Higher levels of life satisfaction were associated with reduced negative emotions and trauma symptoms, suggesting that agency may be viewed as a pre-determining factor with the potential to protect children from trauma symptoms. We discuss the implications for research and clinical practice.

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.

[Territory, places, and health: resizing spatiality in public health]

The aim of this study is to extend the reading of the health-disease process from the territorial perspective. Theoretical production on the link between health and the environment should go beyond medical typologies and their emphasis on the distribution of environmental risks (physical, biological, and chemical) to acknowledge the social and subjective production of territories. In order to make progress with this theoretical production, public health should draw on the integration of concepts from the social sciences such as the appropriation of space, territory-territorialities, and places. In terms of scale, it should also focus on micro-territories, since the scenario of local territories and places of daily living are where lifestyles, illness, and the construction of health materialize.

Exploring the challenges of meeting child mental health needs through community engagement in Kenya

BACKGROUND

Despite growing evidence on the extent of child mental health problems in low-middle-income countries, the gap between need and provision remains high. Previous research in high income countries has demonstrated that evidence-based interventions can be scaled-up through community consultation, particularly by engaging key stakeholders.

AIMS

This study aimed to explore community stakeholders' views on children's mental health needs and culturally acceptable interventions in Kenya, to ascertain how to integrate global service standards with culturally-specific expectations.

METHODS

Focus groups were conducted with community stakeholders (seven young people 14-17 years, seven parents, nine teachers and 11 other professionals). These participants were recruited from an urban community of internally displaced and disadvantaged families in Nakuru.

RESULTS

Results indicated that Kenya faced similar challenges in meeting mental health needs as in other countries, including economic constraints, limited knowledge, stigma and systemic issues, but that these were manifested in culturally specific ways that were linked to societal and professional's attitudes and local context.

CONCLUSIONS

Stakeholders' views are important in informing the planning, delivery and evaluation of interventions. However, for such interventions to be sustained, a clear therapeutic framework, evidence-base and sociocultural adaptation are likely to be important factors.

Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial

BACKGROUND

Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries (LMICs). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in LMICs. The aim of this study was to test the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver.

METHODS AND FINDINGS

In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Secondary outcomes were impaired functioning (measured by the WHO Disability Adjustment Schedule [WHODAS]), symptoms of posttraumatic stress (measured by the Posttraumatic Stress Disorder Checklist [PCL]), personally identified problems (measured by Psychological Outcome Profiles [PSYCHLOPS]), stressful life events (measured by the Life Events Checklist [LEC]), and health service utilisation. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 518 women (37%) screened positive, of whom 421 (81%) were women who had experienced GBV. Of these 421 women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were completed on 16 January 2016. The primary analysis was intention to treat and included 53 women in PM+ (25%) and 49 women in EUC (23%) lost to follow-up. The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was 3.33 (95% CI 1.86-4.79, P = 0.001) in favour of PM+. In terms of secondary outcomes, for WHODAS the difference between PM+ and EUC in the change from baseline to 3-month follow-up was 1.96 (95% CI 0.21-3.71, P = 0.03), for PCL it was 3.95 (95% CI 0.06-7.83, P = 0.05), and for PSYCHLOPS it was 2.15 (95% CI 0.98-3.32, P = 0.001), all in favour of PM+. These estimated differences correspond to moderate effect sizes in favour of PM+ for GHQ-12 score (0.57, 95% CI 0.32-0.83) and PSYCHLOPS (0.67, 95% CI 0.31-1.03), and small effect sizes for WHODAS (0.26, 95% CI 0.02-0.50) and PCL (0.21, 95% CI 0.00-0.41). Twelve adverse events were reported, all of which were suicidal risks detected during screening. No adverse events were attributable to the interventions or the trial. Limitations of the study include no long-term follow-up, reliance on self-report rather than structured interview data, and lack of an attention control condition.

CONCLUSIONS

Among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614001291673.

Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya

Background

In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population.

Method

This was a cross-sectional epidemiological survey (n = 443) conducted over a period of 3 months among adult patients seeking care from traditional and faith healers in rural Kenya. Data were collected using the Beck Depression Inventory II (BDI-II), Beck Scale for Suicide Ideation (BSS) and WHO Quality of Life Survey- BREF (WHOQOL-BREF), and analyzed using correlation analyses, parametric tests, and regression analyses.

Results

Increasing levels of depression were associated with lower QoL among patients seeking care from traditional and faith healers. BSS scores were significantly negatively correlated with overall, physical, psychological, and environmental QoL, p < .05. There was a statistically significant difference between mean scores for overall QoL between depressed (M = 2.35, SD = 0.76) and non-depressed participants (M = 3.03, SD = 0.67), t(441) = 8.899, p < .001. Overall life satisfaction for depressed participants (M = 2.23, SD = 0.69) was significantly lower than non-depressed participants. Regression analyses indicated that depression, suicidal ideation, and being married predicted lower overall QoL controlling for other variables. Post hoc tests and subgroup analysis by gender revealed significant differences for females only. Depression, and older age predicted lower life satisfaction whereas being self-employed predicted higher life satisfaction, when controlling for other variables.

Conclusion

This study sheds light on correlates of QoL in depressed and non-depressed patients in rural Kenya. Evidence suggests that traditional and faith healers treat patients with a variety of QoL issues. Further research should focus on understanding how these issues tie into QoL, and how these healers can target these to improve care.

Feasibility trial of a scalable psychological intervention for women affected by urban adversity and gender-based violence in Nairobi

BACKGROUND

Living in conditions of chronic adversity renders many women more vulnerable to experiencing gender-based violence (GBV). In addition to GBV's physical and social consequences, the psychological effects can be pervasive. Access to evidence-based psychological interventions that seek to support the mental health of women affected by such adversity is rare in low- and middle-income countries.

METHODS

The current study evaluates a brief evidence-informed psychological intervention developed by the World Health Organization for adults impacted by adversity (Problem Management Plus; PM+). A feasibility randomised control trial (RCT) was conducted to inform a fully powered trial. Community health workers delivered the intervention to 70 women residing in three peri-urban settings in Nairobi, Kenya. Women, among whom 80% were survivors of GBV (N = 56), were randomised to receive five sessions of either PM+ (n = 35) by community health workers or enhanced treatment as usual (ETAU; n = 35).

RESULTS

PM+ was not associated with any adverse events. Although the study was not powered to identify effects and accordingly did not identify effects on the primary outcome measure of general psychological distress, women survivors of adversity, including GBV, who received PM+ displayed greater reductions in posttraumatic stress disorder symptoms following treatment than those receiving ETAU.

CONCLUSIONS

This feasibility study suggests that PM+ delivered by lay health workers is an acceptable and safe intervention to reach women experiencing common mental disorders and be inclusive for those affected by GBV and can be studied in a RCT in this setting. The study sets the stage for a fully powered, definitive controlled trial to assess this potentially effective intervention.

TRIAL REGISTRATION

ACTRN12614001291673 , 10/12/2014, retrospectively registered during the recruitment phase.