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Fahme SA, Chehab S, Logie CH, Mumtaz G, Fitzgerald D, Downs JA, DeJong J, Sieverding M. Intersecting social-ecological vulnerabilities to and lived experiences of sexually transmitted infections among Syrian refugee women in Lebanon: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003507. [PMID: 39116144 PMCID: PMC11309427 DOI: 10.1371/journal.pgph.0003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024]
Abstract
Conflict-affected women and girls living in protracted forced displacement settings are vulnerable to sexually transmitted infections (STIs). Yet, little is known about the risk factors for and lived experiences of STIs in complex humanitarian settings, particularly in the Middle East and North Africa, where STIs have long been understudied. This qualitative study adapts the social ecological model to characterize the multi-level risks for and lived experiences of STIs among Syrian refugee women resettled in an urban refugee camp in Beirut, Lebanon. Adopting a community-based sampling strategy, community health workers, who were refugee women from the camp, recruited and conducted in-depth interviews (IDIs) with 30 adult Syrian refugee women. Data were analyzed using an interpretative phenomenological approach and thematically organized according to the levels of the social ecological model. We identified a confluence of individual, interpersonal, community-based, and societal vulnerabilities to STIs, including extreme poverty and insecurity, patriarchal gender norms, stigma, sexual exploitation and trafficking, poor healthcare accessibility, intimate partner violence, including marital rape, transactional sex, sexual harassment, social isolation, and internalized stigma. Participants described experiencing bothersome symptoms and sequelae of advanced and untreated STIs in the setting of limited access to health services and challenges with engaging their partners in STI treatment, largely due to STI stigma. These novel findings suggest dynamic, interrelated social and health disparities across all social ecological levels influencing refugee women's sexual health, including their risk of STIs. Comprehensive, multi-sectorial interventions, which transcend traditional public health methods and which adopt a sexual well-being approach, are urgently needed to address systemic and intrapersonal violence against refugee women, examine and mitigate the burden of STIs, and ensure sexual justice and health equity in this protracted forced displacement setting.
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Affiliation(s)
- Sasha Abdallah Fahme
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Faculty of Health Sciences, Epidemiology and Population Health Department, American University of Beirut, Beirut, Lebanon
| | - Sara Chehab
- Faculty of Health Sciences, Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Carmen Helen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ghina Mumtaz
- Faculty of Health Sciences, Epidemiology and Population Health Department, American University of Beirut, Beirut, Lebanon
- Faculty of Medicine, Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Daniel Fitzgerald
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Jennifer Alzos Downs
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Jocelyn DeJong
- Faculty of Health Sciences, Epidemiology and Population Health Department, American University of Beirut, Beirut, Lebanon
| | - Maia Sieverding
- Faculty of Health Sciences, Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
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Allen EM, Munala L, Ward-Rannow J. Do Gender-Based Violence Interventions Consider the Impacts of Climate Change? A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2421-2435. [PMID: 38102819 DOI: 10.1177/15248380231214793] [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: 12/17/2023]
Abstract
Climate change and extreme weather events have been shown to increase incidences of gender-based violence (GBV). Numerous organizations have devoted significant time, resources, and effort to the design and implementation of interventions aimed at reducing GBV in Africa. Some interventions effectively reduce violence, but GBV persists and remains pervasive. The United Nations has called for GBV interventions that consider the impact of climate change on violence. This review aims to determine whether public health interventions intended to reduce GBV in Africa take into account the effects of climate change on the region and the population. PubMed, PsychArticles, and CINAHL databases were searched systematically in February 2023 for interventions conducted in Africa published between 2010 and 2023. There were a total of 86 articles in the final review that described 40 distinct interventions. The intervention designs included empowerment and participatory approaches (microfinance, microfinance plus, community education, and community engagement), changing social and cultural norms (community education, community engagement, and media), and school-based programs. None of the 40 interventions mentioned climate, weather, or climate change as a component of the intervention. There are several opportunities to improve existing, successful GBV interventions in order to increase their efficacy. GBV interventions could incorporate economic independence programs that do not rely on agriculture and include climate change education. These findings could facilitate the integration of two previously distinct research disciplines-climate change and GBV prevention-to inform future research and develop more effective and cost-efficient interventions.
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Kalra N, Habumugisha L, Shankar A. Impacts of an abbreviated personal agency training with refugee women and their male partners on economic empowerment, gender-based violence, and mental health: a randomized controlled trial in Rwanda. BMC Public Health 2024; 24:1306. [PMID: 38745312 PMCID: PMC11092213 DOI: 10.1186/s12889-024-18780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). METHODS We conducted an individually randomized controlled trial with 1061 partnered women (aged 18-45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6-9 months post-intervention. RESULTS At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04-1.54), p < 0.05) and skill learning (aIRR 1.59 (1.39-1.82), p < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39-1.07), p < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58-1.09), p = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p = 0.05) and PTSD (aIRR 2.07 (1.10-3.91), p < 0.05) in the intervention arm compared to the control arm. CONCLUSION Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. TRIAL REGISTRATION NUMBER The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019.
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Affiliation(s)
- Naira Kalra
- Africa Region Gender Innovation Lab, Office of the Chief Economist, The World Bank Group, Washington D.C., USA
| | | | - Anita Shankar
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Keynejad RC, Bitew T, Sorsdahl K, Myers B, Honikman S, Mulushoa A, Demissie M, Deyessa N, Howard LM, Hanlon C. Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia. Psychother Res 2024; 34:538-554. [PMID: 37384929 DOI: 10.1080/10503307.2023.2222899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia. METHOD We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used "ADAPT" guidance to adapt the intervention to the context, before mapping potential harms in a "dark logic model". RESULTS Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately. CONCLUSION Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting.
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Affiliation(s)
- Roxanne C Keynejad
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, College of Education and Behavioural Sciences, Injibara University
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Division of Addiction Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia
- Mental health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Simone Honikman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Adiyam Mulushoa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekdes Demissie
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Raeber F, Haldemann MI, Ray S, Huber J, Firima E, Fernandez LG, Amstutz A, Gerber F, Labhardt ND, Belus JM. Community-based models of care for adolescent and adult depression, suicidal behavior, anxiety, trauma, and substance use in Africa: a scoping review. Front Psychol 2024; 15:1241403. [PMID: 38406302 PMCID: PMC10885163 DOI: 10.3389/fpsyg.2024.1241403] [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] [Received: 06/16/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background Community-based care (CBC), where care is delivered outside of the traditional health facility setting, has been proposed to narrow the mental health (MH) and substance use (SU) treatment gap in Africa. Objective This scoping review aims to comprehensively summarize CBC models addressing adolescent and adult MH (depression, anxiety, trauma, suicidal behavior) and (non-tobacco) SU problems in Africa. Methods We searched PsycINFO, Embase, Scopus, CINAHL, and Medline Ovid. Studies and protocols were included if they reported on CBC intervention's effects on MH or SU symptoms/ diagnoses, acceptability, feasibility, or patient engagement in care, regardless of whether the intervention itself was designed specifically for MH or SU. Results Among 11,477 screened publications, 217 were eligible. Of the unique intervention studies (n = 206), CBC models were classified into the following approaches (non-mutually exclusive): psychotherapeutic (n = 144), social (n = 81), lifestyle/physical health (n = 55), economic (n = 26), and psychopharmacological (n = 2). While quantitative results suggest possible efficacy of CBC models, description of CBC location was often poor. Fewer interventions addressed suicidal behavior (n = 12), the needs of adolescents (n = 49), or used traditional healers or religious figures as providers (n = 3). Conclusion Many CBC models have been tested on MH and SU in Africa and should be critically appraised and meta-analyzed in subsequent reviews, where possible.
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Affiliation(s)
- Fabian Raeber
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Maria-Inés Haldemann
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Somidha Ray
- Research Consultant, International Center for Research on Women, New Delhi, India
| | - Jacqueline Huber
- Swiss TPH Library, Swiss Tropical and Public Health Institute, Allschwil, Basel, Switzerland
| | - Emmanuel Firima
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Lucia Gonzalez Fernandez
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Felix Gerber
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Niklaus D. Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Jennifer M. Belus
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
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DiClemente-Bosco K, Binyungu A, Shabani C, Pellowski JA, Operario D, Nugent N, Harrison A. 'I am because you are': Community support as a bridge to mental wellbeing for resettled African refugee women living in Rhode Island. Glob Public Health 2024; 19:2314106. [PMID: 38334139 PMCID: PMC10966713 DOI: 10.1080/17441692.2024.2314106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.
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Affiliation(s)
- Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
| | | | | | - Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine at the Warren Alpert Medical School of Brown University, Providence, RI
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
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Prina E, Ceccarelli C, Abdulmalik JO, Amaddeo F, Cadorin C, Papola D, Tol WA, Lund C, Barbui C, Purgato M. Task-sharing psychosocial interventions for the prevention of common mental disorders in the perinatal period in low- and middle-income countries: A systematic review and meta-analysis. Int J Soc Psychiatry 2023; 69:1578-1591. [PMID: 37183793 DOI: 10.1177/00207640231174451] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM to assess the efficacy of psychosocial interventions delivered through task-sharing approaches for preventing perinatal common mental disorders among women in low- and middle-income countries. METHODS We conducted a systematic review of randomized controlled trials following a prespecified protocol registered in the Open Science Framework (osf.io/qt4y3). We searched MEDLINE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) through June 2022. Two reviewers independently extracted the data and evaluated the risk of bias of included studies using the Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS We included 23 studies with 24,442 participants. At post-intervention, task-shared psychosocial interventions, were effective in preventing the development of mental disorders in general (RR 0.57, 95% CI [0.35, 0.91]), and specifically depression (RR 0.51, 95% CI [0.35, 0.75]), but not anxiety disorders (RR 0.46, 95% CI [0.06, 3.33]). Similarly, psychosocial interventions reduced psychological distress (SMD -1.32, 95% CI [-2.28, -0.35]), and depressive symptoms (SMD -0.50, 95% CI [-0.80, -0.16]), and increased parenting self-efficacy (SMD -0.76, 95% CI [-1.13, -0.38]) and social support (SMD -0.72, 95% CI [-1.22, -0.22]). No effect was detected for anxiety symptoms at post-intervention. At follow-up the beneficial effects of interventions progressively decreased. CONCLUSIONS Psychosocial interventions delivered through the task-sharing modality are effective in preventing perinatal common mental disorders and fostering positive mental health among women in low- and middle-income countries. However, our findings are tentative, due to the low number of preventative intervention strategies considering outcomes as the incidence of mental disorders, especially in the long-term. This evidence supports calls to implement and scale up psychosocial prevention interventions for perinatal common mental disorders in low- and middle-income countries.
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Affiliation(s)
- Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Cochrane Global Mental Health, University of Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Cochrane Global Mental Health, University of Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Cochrane Global Mental Health, University of Verona, Italy
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Greene MC, Ventevogel P, Likindikoki SL, Bonz AG, Turner R, Rees S, Misinzo L, Njau T, Mbwambo JKK, Tol WA. Why local concepts matter: Using cultural expressions of distress to explore the construct validity of research instruments to measure mental health problems among Congolese women in Nyarugusu refugee camp. Transcult Psychiatry 2023; 60:496-507. [PMID: 36114647 PMCID: PMC10260259 DOI: 10.1177/13634615221122626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools-anxiety, depression, and post-traumatic stress disorder-adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local "cultural fit" of globally used tools for measuring mental health in cross-cultural research.
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Affiliation(s)
- M. Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, N Y, USA
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Samuel L. Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Rachael Turner
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Susan Rees
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Lusia Misinzo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tasiana Njau
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie K. K. Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wietse A. Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Greene MC, Scognamiglio T, Likindikoki SL, Misinzo L, Njau T, Bonz A, Ventevogel P, Mbwambo JKK, Tol WA. Examining implementation of an intervention to reduce psychological distress and intimate partner violence in a refugee camp setting. Glob Public Health 2022; 17:2868-2882. [PMID: 35108167 DOI: 10.1080/17441692.2022.2029926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An integrated approach to reduce intimate partner violence and improve mental health in humanitarian settings requires coordination across health and protection services. We developed and tested the Nguvu intervention, which combined evidence-based interventions for psychological distress and intimate partner violence among Congolese refugee women in Nyarugusu refugee camp (Tanzania). We conducted 29 semi-structured interviews with Nguvu participants and stakeholders to explore the relevance, acceptability, feasibility, and impact of this intervention. Participants reported that the intervention aligned with needs and filled a gap in programming, yet further adaptations may improve the fit of the intervention. The Nguvu intervention was acceptable to participants, including group discussion of sensitive topics. Confidentiality was highly regarded among staff and participants, which improved safety and acceptability. It was feasible to train non-specialist refugee workers to deliver the intervention with adequate supervision. Facilitators noted contextual challenges that made it difficult to implement the intervention: limited infrastructure, competing priorities, and population mobility. The intervention was perceived to improve awareness of the association between violence and mental health, reduce self-blame, and build skills to improve wellbeing. Recommended adaptations reveal promising, yet challenging future directions for addressing social determinants of mental health and implementing multi-sectoral programmes in complex humanitarian settings.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Samuel L Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusia Misinzo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tasiana Njau
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Jessie K K Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wietse A Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Zielinski MJ, Smith MKS, Kaysen D, Selig JP, Zaller ND, Curran G, Kirchner JE. A participant-randomized pilot hybrid II trial of group cognitive processing therapy for incarcerated persons with posttraumatic stress and substance use disorder symptoms: study protocol and rationale. HEALTH & JUSTICE 2022; 10:30. [PMID: 36181587 PMCID: PMC9525924 DOI: 10.1186/s40352-022-00192-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/09/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND Trauma exposure and drug addiction go hand-in-hand for the 2.17 million people who are incarcerated in US prisons; prevalence of both exceed 80% among this population. This manuscript describes the rationale and methods for a participant-randomized effectiveness-implementation hybrid type II pilot trial designed to: 1) examine the effectiveness of Cognitive Processing Therapy group (CPT), an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), for reducing post-release drug use and PTSD symptoms when adapted for and delivered in prisons; and 2) provide data on implementation outcomes associated with the use of implementation facilitation as a strategy for supporting uptake of CPT in prisons. METHOD Participants in the effectiveness portion of the trial (N = 120) will be incarcerated men and women who are randomly assigned to one of two group therapies: CPT or a control condition (PTSD coping skills group; PCS). Participants will complete assessment measures three times: pre-treatment, post-treatment, and 3 months following release from incarceration. CPT groups will be led by prison counselors who are receiving implementation facilitation to support their efforts. PCS groups will be led by trained clinicians on the research team. Implementation outcomes will include acceptability, appropriateness, adoption, feasibility, fidelity, and sustainability. After enrollment ends, the research team will monitor CPT sustainment and recidivism outcomes of study participants for one year. DISCUSSION This study will lay the groundwork for a larger study of interventions for co-occurring PTSD and SUD in prisons and, critically, inform the development of strategies (such as implementation facilitation) for supporting their uptake in routine practice. TRIAL REGISTRATION NCT04007666 , clinicaltrials.gov, 24 June 2019, 02 September 2021.
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Affiliation(s)
- Melissa J Zielinski
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- University of Arkansas, Fayetteville, USA.
| | | | | | - James P Selig
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - JoAnn E Kirchner
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, North Little Rock, USA
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Krishnan S, Zaman S, Ferdaus M, Kabir MH, Khatun H, Rahman SMS, Marzouk M, Durrance-Bagale A, Howard N. How can humanitarian services provision during mass displacement better support health systems? An exploratory qualitative study of humanitarian service provider perspectives in Cox's Bazar, Bangladesh. J Migr Health 2022; 6:100132. [PMID: 36158594 PMCID: PMC9489749 DOI: 10.1016/j.jmh.2022.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 12/30/2022] Open
Abstract
Health services provision in mass displacement settings is a humanitarian imperative and essential to promoting international and regional security. Internationally displaced populations experience a range of issues pre-, peri-, post-displacement and residing in host countries that affect their health and well-being. This study examined links between humanitarian and government health services provision for forcibly displaced Myanmar nationals (FDMN) in Cox's Bazar to consider how improved knowledge sharing and collaboration might better support health systems during mass displacement. We conducted a qualitative descriptive study, interviewing 25 humanitarian service providers in-person in Bangladesh in early 2021 and analysing data thematically. We found that government restricted what essential services humanitarian health actors could provide and FDMN had to undergo stringent screening and referral to receive tertiary healthcare. Concurrently, the government health system was challenged by accessibility, affordability and availability of medicines, equipment, and trained staff. Humanitarian health service providers augmented government responses by working with community groups, recruiting and training Rohingya volunteers, and involving religious leaders. Findings suggest that easing barriers to a fuller range of health services, allowing access to digital devices, and hiring FDMN to support their communities would improve health system responsiveness to the legitimate needs of FDMN displaced around Cox's Bazar. It is imperative to amplify and listen to the voices of FDMN and collaborate in addressing structural and social barriers constraining their access to effective health services, both to increase trust in and responsiveness of the health system.
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Affiliation(s)
- Sneha Krishnan
- Jindal School of Environment and Sustainability, Jindal Global University, Haryana and Environment, Technology and Community Health Consultancy Services, Mumbai, Maharashtra, India
| | - Samia Zaman
- BRAC University, UB04–66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Muhammad Ferdaus
- BRAC University, UB04–66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Md Humayun Kabir
- University of Dhaka, Department of Geography & Environment, Nilkhet Road, Dhaka 1000, Bangladesh
| | - Hafiza Khatun
- University of Dhaka, Department of Geography & Environment, Nilkhet Road, Dhaka 1000, Bangladesh
| | - SM Safiqur Rahman
- BRAC University, UB04–66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Manar Marzouk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore
| | - Anna Durrance-Bagale
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore,London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom,Corresponding author at: London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore,London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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12
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Olson RM, Nelson BD, Mike A, Ulibarri BJ, Naimer K, Johnson K, McHale T, Mishori R, Macias-Konstantopoulos WL. Assessing Knowledge and Acceptability of a Trauma-Informed Training Model to Strengthen Response to Conflict and Gender-Based Violence in the Democratic Republic of Congo. VIOLENCE AND VICTIMS 2022; 37:VV-2021-0032.R2. [PMID: 36038277 DOI: 10.1891/vv-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Conflict-related sexual and gender-based violence is common in the eastern Democratic Republic of Congo, but there are few evaluations of multisectoral training interventions in conflict settings. We conducted high-quality, trauma-informed medicolegal trainings amongst multisectoral professionals, and sought to describe changes in knowledge after training and perceived training acceptability. METHODS Participants were health, law enforcement, and legal professionals who completed training at one of four sites from January 2012 to December 2018. Twelve trainings were randomly selected for evaluation. We conducted pre- and post-training assessments and semi-structured interviews of participants within 12 months of index training. FINDINGS Forty-six trainings of 1,060 individuals were conducted during the study period. Of the randomly selected trainings, 368 questionnaires were included in the analysis (36% health, 31% legal, 12% law enforcement, 21% other). The mean knowledge scores (standard deviation) significantly improved after training: 77.9 (22.9) vs. 70.4 (20.8) (p <0.001). Four key benefits were identified: 1) improved cross-sector coordination; 2) enhanced survivor-centered care; 3) increased standardization of forensic practices; and 4) higher quality evidence collection. CONCLUSION Participants completing the training had improved knowledge scores and perceived several key benefits, suggesting the multisectoral training was acceptable in this under-resourced, conflict region.
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Affiliation(s)
- Rose McKeon Olson
- Brigham and Women's Hospital, 45 Francis StreetBostonMassachusetts02115-6195United States
| | - Brett D Nelson
- Massachusetts General Hospital Divisions of Global Health and Neonatology, Department of Pediatrics, BostonMassachusetts and Harvard Medical School Ringgold standard institution, BostonUnited States
| | - Anastario Mike
- Florida International UniversityRobert Stempel College of Public Health and Social Work, MiamiFloridaUnited States
| | - Billy J Ulibarri
- The University of Texas Rio Grande Valley SociologyBrownsvilleTexasUnited States
| | - Karen Naimer
- Physicians for Human Rights Boston Office, BostonMassachusettsUnited States
| | - Katy Johnson
- Physicians for Human Rights Boston Office, BostonMassachusettsUnited States
| | - Thomas McHale
- Physicians for Human Rights Boston Office, BostonMassachusettsUnited States
| | - Ranit Mishori
- Physicians for Human Rights Boston Office, Boston, Massachusetts and Georgetown University School of Medicine, WashingtonDistrict of ColumbiaUnited States
| | - Wendy L Macias-Konstantopoulos
- Massachusetts General Hospital Center for Social Justice and Health Equity, Department of Emergency Medicine, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts, United States
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13
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Leku MR, Ndlovu JN, Bourey C, Aldridge LR, Upadhaya N, Tol WA, Augustinavicius JL. SH+ 360: novel model for scaling up a mental health and psychosocial support programme in humanitarian settings. BJPsych Open 2022; 8:e147. [PMID: 35909348 PMCID: PMC9380001 DOI: 10.1192/bjo.2022.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 01/18/2023] Open
Abstract
We explore multi-sectoral integration as a model for scaling up evidence-based mental health and psychosocial support interventions in humanitarian settings. We introduce Self Help Plus 360, designed to support humanitarian partners across different sectors to integrate a psychosocial intervention into their programming and more holistically address population needs.
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Affiliation(s)
- Marx R. Leku
- HealthRight International, Arua, Uganda and New York, USA
| | | | - Christine Bourey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Luke R. Aldridge
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Wietse A. Tol
- HealthRight International, Arua, Uganda and New York, USA; Global Health Section, University of Copenhagen, Denmark; and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Jura L. Augustinavicius
- HealthRight International, Arua, Uganda and New York, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA; and School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Canada
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14
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. J Affect Disord 2022; 308:421-431. [PMID: 35452755 PMCID: PMC9520993 DOI: 10.1016/j.jad.2022.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes. METHODS We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models. RESULTS Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8). LIMITATIONS Given the design of our study, findings are subject to recall and social desirability bias. CONCLUSIONS Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.
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Affiliation(s)
- Lindsey M Filiatreau
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, United States of America; Washington University in St. Louis, Brown School, International Center for Child Health and Development, St. Louis, MO, United States of America; University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Columbia University, Department of Psychiatry, New York, NY, United States of America
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, New York, NY, United States of America
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America; Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M Parcesepe
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America; University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, United States of America
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15
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The cultural sensitivity continuum of mental health interventions in Sub-Saharan Africa: A systematic review. Soc Sci Med 2022; 306:115124. [PMID: 35751989 DOI: 10.1016/j.socscimed.2022.115124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
Although there is a small but growing literature examining mental health interventions in Sub-Saharan Africa (SSA), there are very few systematic reviews of mental health interventions in the region. Those that exist primarily examine interventions for specific ailments (e.g., substance use, trauma) or specific modes of treatment (e.g., traditional healers, interpersonal psychotherapy). No systematic review has sought to assess the extent to which interventions used in SSA reflect local cultural context. The current systematic review is unique in that it aims to: quantify the number of published studies examining distinct mental health interventions in SSA that reflect local culture; identify and characterize mental health interventions that can be considered indigenous; identify Western mental health interventions in SSA that have undergone cultural adaptation and characterize the nature and extent of those adaptations; and provide recommendations for researchers and practitioners seeking to develop mental health interventions for African populations. A total of 980 articles were identified across five databases from January 31st to February 1st, 2021, and 29 were included in the study. The Ecological Validity Model (EVM) was used to assess degree of cultural sensitivity of non-indigenous interventions within eight cultural dimensions. Findings indicate that few studies examine mental health interventions in SSA and much of this research is authored by Western rather than local researchers. The most common intervention approaches were cognitive-behavioral therapy and problem-solving therapy. Assessment with the EVM framework demonstrated that concepts and goals of treatment were the cultural dimensions that were most likely to lack culturally sensitive elements. Recommendations are provided regarding achieving cultural sensitivity and collaborations between indigenous practitioners and contemporary healthcare systems. This review is an important step in evaluating progress towards achieving global equity in access to suitable mental health care.
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16
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Haider S, Maheen A, Ansari M, Stolley M. Health Beliefs and Barriers to Healthcare of Rohingya Refugees. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01342-2. [PMID: 35689155 DOI: 10.1007/s40615-022-01342-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
In recent years, over 1,000 Rohingya families have been resettled to Milwaukee, Wisconsin from areas where they faced trauma and health disparities. To better understand their health beliefs and barriers to healthcare, we conducted a qualitative study with ten community health workers and stakeholders serving the Milwaukee Rohingya community. Interviews were transcribed, coded, and analyzed. Themes included: 1) health is defined as being able to meet basic needs of the family/community; 2) prior and existing mistrust and fear of systems of authority impact healthcare seeking behavior; 3) past-trauma negatively impacts physical and mental health; 4) religion and spirituality influence beliefs about illness, recovery, and wellbeing; 5) linguistic, cultural, and educational barriers impact access, quality of care, and understanding of disease. These results begin to address the significant gap in our knowledge of the health beliefs and needs of the local Rohingya community and underscore the need for tailored interventions.
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Affiliation(s)
- Shabi Haider
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Aniya Maheen
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Moiz Ansari
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US
| | - Melinda Stolley
- Department of Medicine and Cancer Center, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, US.
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Nemiro A, Jones T, Tulloch O, Snider L. Advancing and translating knowledge: a systematic inquiry into the 2010-2020 mental health and psychosocial support intervention research evidence base. Glob Ment Health (Camb) 2022; 9:133-145. [PMID: 36618729 PMCID: PMC9806978 DOI: 10.1017/gmh.2022.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background and study objectives MHPSS is increasingly seen as a critical component to effective and responsible humanitarian programming. This review examines the extent to which MHPSS research generated since 2010 has contributed to the public health evidence base and how this has influenced and impacted programming and policy in humanitarian settings. Methods This mixed-method study included a scoping literature review (n = 50) and a consultation process with qualitative key informant interviews (n = 19) and online survey responses (n = 52) to identify the facilitating and inhibiting factors for the two areas of inquiry and to understand the broader context in which knowledge is generated and taken up. The interviews were thematically analysed and the survey responses were descriptively analysed. Results The review identified a rapidly growing evidence base that has evaluated a range of MHPSS interventions. However, few studies examined long-term impacts of interventions, there was limited direct evidence on outcomes for children and adolescents and whole family approaches, and there were minimal replications of the same approach that could test efficacy across settings and population groups. A general shift was identified in the consultation process away from a focus on disorder towards the more positive aspects of wellbeing. However, there remained a mismatch in many studies included in the literature review, whereby the interventions were broad, community-based but the outcome measures used still focused on changes in symptoms of mental disorders. Conclusion The evidence base for MHPSS has grown significantly over the last 10 years. However, several knowledge gaps remain, as does the divide between research and practice. Moving forward, MHPSS intervention research needs to be more responsive to the needs on the ground.
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Affiliation(s)
- Ashley Nemiro
- The MHPSS Collaborative, Save the Children Denmark Rosenørns Allé 12, 1634 Copenhagen V, Denmark
| | - Theresa Jones
- Anthrologica, Woad Mill, Broughton, Oxfordshire, OX15 6AR, UK
| | - Olivia Tulloch
- Anthrologica, Woad Mill, Broughton, Oxfordshire, OX15 6AR, UK
| | - Leslie Snider
- The MHPSS Collaborative, Save the Children Denmark Rosenørns Allé 12, 1634 Copenhagen V, Denmark
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18
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St John L, Walmsley R. The Latest Treatment Interventions Improving Mental Health Outcomes for Women, Following Gender-Based Violence in Low-and-Middle-Income Countries: A Mini Review. Front Glob Womens Health 2022; 2:792399. [PMID: 34977864 PMCID: PMC8716596 DOI: 10.3389/fgwh.2021.792399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Gender-based violence (GBV), specifically violence against women, is a worldwide pandemic. Prevalence is further escalated in low-and-middle-income countries and in humanitarian crises. Survivors are left with a combination of post-traumatic stress disorder, depression and anxiety. These mental health disorders lead to further morbidity and mortality. Despite its high prevalence and co-morbidities, gender disparities and mental health stigma globally lead to few interventions developed for this population. The aim of this review is to highlight the mental health interventions developed in the past 5 years, for women following GBV in low-and-middle-income countries. It aims to discuss their efficacy and controversies when implemented into healthcare systems, understand the gaps that remain in the field and suggest future research developments. A thorough literature search revealed 16 new interventions available for improving mental health outcomes for women following GBV in low-and-middle-income countries. Following an in-depth evaluation of the papers, one intervention was successful in effectively implementing treatment into healthcare systems-"PM+." However, it proved only to be effective in the short term. Further research must be done for improving long-term mental health outcomes. Results demonstrated poor follow-up for women engaging in group therapy. The review also highlights community workers were used in service delivery to reduce barriers accessing care. No interventions proved effective in humanitarian crises, despite GBV escalated in these settings. There are very few interventions available in comparison to the prevalence of this global health issue. Therefore, this review encourages further research and improvements in mental healthcare interventions following GBV.
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Affiliation(s)
- Lily St John
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Rebecca Walmsley
- School of Medicine, University of St Andrews, Fife, United Kingdom
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Greene MC, Bencomo C, Rees S, Ventevogel P, Likindikoki S, Nemiro A, Bonz A, Mbwambo JKK, Tol WA, McGovern TM. Multilevel Determinants of Integrated Service Delivery for Intimate Partner Violence and Mental Health in Humanitarian Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12484. [PMID: 34886211 PMCID: PMC8656517 DOI: 10.3390/ijerph182312484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
Inter-agency guidelines recommend that survivors of intimate partner violence in humanitarian settings receive multisectoral services consistent with a survivor-centered approach. Providing integrated services across sectors is challenging, and aspirations often fall short in practice. In this study, we explore factors that influence the implementation of a multisectoral, integrated intervention intended to reduce psychological distress and intimate partner violence in Nyarugusu Refugee Camp, Tanzania. We analyzed data from a desk review of donor, legal, and policy documents; a gender-based violence services mapping conducted through 15 interviews and 6 focus group discussions; and a qualitative process evaluation with 29 stakeholders involved in the implementation of the integrated psychosocial program. We identified the challenges of implementing a multisectoral, integrated intervention for refugee survivors of intimate partner violence at the structural, inter-institutional, intra-institutional, and in social and interpersonal levels. Key determinants of successful implementation included the legal context, financing, inter-agency coordination, engagement and ownership, and the ability to manage competing priorities. Implementing a multisectoral, integrated response for survivors of intimate partner violence is complex and influenced by interrelated factors from policy and financing to institutional and stakeholder engagement. Further investment in identifying strategies to overcome the existing challenges of implementing multisectoral approaches that align with global guidelines is needed to effectively address the burden of intimate partner violence in humanitarian settings.
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Affiliation(s)
- M. Claire Greene
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (M.C.G.); (C.B.)
| | - Clarisa Bencomo
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (M.C.G.); (C.B.)
| | - Susan Rees
- School of Psychiatry, University of New South Wales, Sydney, NSW 2033, Australia;
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees (UNHCR), Rue de Montbrillant 94, 1201 Geneva, Switzerland;
| | - Samuel Likindikoki
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam P.O. Box 65001, Tanzania; (S.L.); (J.K.K.M.)
| | - Ashley Nemiro
- The MHPSS Collaborative, Rosenørns Allé 12, 1634 Copenhagen, Denmark;
| | | | - Jessie K. K. Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam P.O. Box 65001, Tanzania; (S.L.); (J.K.K.M.)
| | - Wietse A. Tol
- Department of Public Health, Global Health Section, University of Copenhagen, Nørregade 10, 1165 Copenhagen, Denmark;
| | - Terry M. McGovern
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (M.C.G.); (C.B.)
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Jannesari S, Lotito C, Turrini G, Oram S, Barbui C. How does context influence the delivery of mental health interventions for asylum seekers and refugees in low- and middle-income countries? A qualitative systematic review. Int J Ment Health Syst 2021; 15:80. [PMID: 34702334 PMCID: PMC8546788 DOI: 10.1186/s13033-021-00501-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) host the majority of the world's refugees. Evidence suggests that refugees and asylum seekers have high mental health needs compared to the host country population. However, they face many social, economic and culture barriers to receiving mental health care and benefitting from mental health interventions. This paper examines how these contextual factors affect the implementation of mental health interventions for refugees and asylum seekers in LMICs. METHODS We conducted a qualitative systematic review searching 11 databases and 24 relevant government and non-governmental organisation (NGO) websites. We spoke with academic experts and NGO professionals for recommendations, and conducted forwards and backwards citation tracking. RESULTS From 2055 records in abstract and title screening, and then 99 in full-text screening, 18 eligible studies were identified. Qualitative thematic synthesis was conducted on eligible papers. Three main thematic clusters were identified around: (1) support during a time of pressure and insecurity, and the need for intervention flexibility through facilitator and participant autonomy; (2) different cultural conceptions of mental health, and how interventions negotiated these differences; and (3) the importance of facilitator skills, knowledge, characteristics and relationships to intervention implementation. CONCLUSION Evidence suggests that intervention coordinators and developers should continue to: (1) think broadly about the range of social influences on mental health, addressing structural issues where possible; (2) offer flexibility with intervention style, content and timings; and (3) encourage building research capacity in LMICs while acknowledging pre-existing mental health knowledge and practice.
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Affiliation(s)
- Sohail Jannesari
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King’s College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Claudia Lotito
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Siân Oram
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King’s College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial. PLoS One 2021; 16:e0252982. [PMID: 34143803 PMCID: PMC8213126 DOI: 10.1371/journal.pone.0252982] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). Methods We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women’s groups that were randomized to the Nguvu intervention or usual care. Participants from women’s groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. Results We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. Conclusions We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. Trial registration ISRCTN65771265, June 27, 2016.
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23
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Ryan GK, Bauer A, Endale T, Qureshi O, Doukani A, Cerga-Pashoja A, Brar SK, Eaton J, Bass JK. Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries. Confl Health 2021; 15:30. [PMID: 33892755 PMCID: PMC8062937 DOI: 10.1186/s13031-021-00363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Published by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations. METHODS Seven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov . We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed. RESULTS We identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies. CONCLUSION Although results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis. TRIAL REGISTRATION PROSPERO registration number: CRD42017058287 .
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Affiliation(s)
- Grace K Ryan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.
| | - Andreas Bauer
- Department of Psychology, University of Bath, Bath, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College of Columbia University, New York City, New York, USA
| | - Onaiza Qureshi
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Asmae Doukani
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Arlinda Cerga-Pashoja
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Global Health Training, Public Health England, London, UK
| | - Savvy K Brar
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, New York, USA
| | - Julian Eaton
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Mental Health, CBM Global, Laudenbach, Germany
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
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Tol WA, Ager A, Bizouerne C, Bryant R, El Chammay R, Colebunders R, García-Moreno C, Hamdani SU, James LE, Jansen SCJ, Leku MR, Likindikoki S, Panter-Brick C, Pluess M, Robinson C, Ruttenberg L, Savage K, Welton-Mitchell C, Hall BJ, Harper Shehadeh M, Harmer A, van Ommeren M. Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC. Confl Health 2020; 14:71. [PMID: 33292413 PMCID: PMC7602334 DOI: 10.1186/s13031-020-00317-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC's research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).
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Affiliation(s)
- Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, bg 9, DK-1014, Copenhagen, Denmark.
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Cecile Bizouerne
- Mental Health, Child Care Practices, Gender and Protection, Action Contre La Faim, Paris, France
| | - Richard Bryant
- School of Psychology & Traumatic Stress Clinic, University of New South Wales, Sydney, Australia
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon
- Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
| | | | - Claudia García-Moreno
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Leah E James
- Institute of Behavioral Science, University of Colorado, Boulder, CA, USA
| | - Stefan C J Jansen
- Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Catherine Panter-Brick
- Jackson Institute of Global Affairs, Yale University, New Haven, CT, USA
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Courtland Robinson
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, London, UK
| | - Leontien Ruttenberg
- International Medical Relief Services (IMRES), Prior association: Arq International, Europe, Netherlands
| | - Kevin Savage
- Evidence Building, World Vision International, Geneva, Switzerland
| | - Courtney Welton-Mitchell
- Institute of Behavioral Science and Colorado School of Public Health, University of Colorado, Boulder, Denver, USA
| | - Brian J Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China
| | | | | | - Mark van Ommeren
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Tol W. Interpersonal violence and mental health: a social justice framework to advance research and practice. Glob Ment Health (Camb) 2020; 7:e10. [PMID: 32742668 PMCID: PMC7379322 DOI: 10.1017/gmh.2020.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/29/2020] [Indexed: 01/02/2023] Open
Abstract
This editorial paper accompanies a special series in the journal Global Mental Health focused on the topic of interpersonal violence and mental health. This series included 24 papers reporting on data from 31 countries, published between 2017 and 2019. This accompanying paper provides a short summary of findings in the special series and reflects on next steps in research and practice. Collectively, the series' 24 papers suggest intricate bi-directional relationships between interpersonal violence and mental health, situated in particular contexts and varying across the life course. In order to study this complexity, an overarching theoretical framework is critical. This paper takes the social justice theory developed by Powers and Faden (2006, 2019) as a starting point. It is argued that application of this social justice framework will be helpful to: strengthen conceptual clarity; provide a sense of direction for research and practice in the area of interpersonal violence and mental health; assist in conducting more fine grained analyses of contextually determined processes of disadvantage; and help situate disciplinary specific research and practice questions in their broader context, thereby strengthening multi-disciplinary research and multi-sectoral policy and programming efforts.
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Affiliation(s)
- W.A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA
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Miah MA, Mahmuda M, Elshazly M, Khan S, Tay A, Ventevogel P. Contextual adaptation and piloting of Group Integrative Adapt Therapy (IAT-G) amongst Rohingya refugees living in Bangladesh. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2019. [DOI: 10.4103/intv.intv_48_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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