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Nakkash R, Ghandour L, Brown G, Panter-Brick C, Bomar H, Tleis M, Al Masri H, Fares M, Al Halabi F, Najjar Y, Louis B, Hodroj M, Chamoun Y, Zarzour M, Afifi RA. Syrian refugee young adults as community mental health workers implementing problem management plus: Protocol for a pilot randomized controlled trial to measure the mechanisms of effect on their own wellbeing, stress and coping. Contemp Clin Trials Commun 2024; 40:101325. [PMID: 39045391 PMCID: PMC11263753 DOI: 10.1016/j.conctc.2024.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
This pilot randomized controlled trial protocol aims to (1) assess the impact on the wellbeing of Syrian refugee young adults (18-24 years) of being a community mental health worker (CMHW) implementing WHO's evidence-based psychosocial intervention - Problem Management Plus (PM+) - with adults in their community, and (2) identify the mechanisms associated with the outcomes of enhanced wellbeing and coping, and reduced stress among these CMHWs. Over 108 million people have been forcibly displaced as of the end of 2022. Mental health consequences of these displacements are significant, yet human resources for health are not sufficient to meet the needs. A large proportion of refugee populations are youth and young adults (YA). Evidence indicates their engagement in supporting their communities leads to their own enhanced wellbeing and that of their community. This trial trains Syrian refugees to serve their communities as CMHW (n=19) or tutors (n=19) and compare wellbeing, stress and coping outcomes between these two groups and a control group (n = 40). We will also assess 7 mechanisms as potential pathways for the interventions to influence outcomes. Surveys will assess outcomes and mechanisms, hair samples will measure stress cortisol. The primary analysis will use a Bayesian Hierarchical Model approach to model the trajectories of the mechanisms and primary study endpoints over time for individuals in each of the arms. Our results will elucidate critical mechanisms in which engagement of young adults to support their community enhances their own wellbeing. Trial registration National Institutes of Mental Health, NCT05265611, Registered prospectively in 2021. Lebanon clinical trials registry # LBCTR2023015206, Registered in 2023.
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Affiliation(s)
- Rima Nakkash
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Lilian Ghandour
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Grant Brown
- Biostatistics Department, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Catherine Panter-Brick
- Anthropology Department, Yale University, New Haven, CT, USA
- Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Hailey Bomar
- Community and Behavioral Health Department, College of Public Health, Iowa City, IA, USA
| | - Malak Tleis
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hanan Al Masri
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | - Maha Hodroj
- Lebanese National Mental Health Program, Lebanon Ministry of Public Health, Beirut, Lebanon
| | - Yara Chamoun
- Saint Joseph University of Beirut, Beirut, Lebanon
| | | | - Rima A. Afifi
- Community and Behavioral Health Department, College of Public Health, Iowa City, IA, USA
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2
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Zemp C, Vallières F, Jama MA, Ali AH, Young K, Jagoe C. The unmet need for mental health support among persons with disabilities in Somalia: Principal correlates and barriers to access. Glob Ment Health (Camb) 2024; 11:e73. [PMID: 39257679 PMCID: PMC11383976 DOI: 10.1017/gmh.2024.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/23/2024] [Accepted: 04/29/2024] [Indexed: 09/12/2024] Open
Abstract
Disability and mental ill-health may be especially prevalent in Somalia, largely due to a protracted armed conflict and its consequent humanitarian crises. Little, if any, research to date, however, has simultaneously explored disability- and mental health-related factors in the Somali context. Using both descriptive and regression analytical techniques, we aimed to determine how increasing levels of functional impairment reported across different disability domains (i.e., visual, hearing and cognition), number of concomitant disabilities, and other empirically supported variables (such as employment and sex) are associated with the likelihood of self-identifying the need for mental health support among a sample (N = 1,355) of Somalis with disabilities, as well as identify the common barriers to such support. Despite most participants self-identifying a need for mental health support, only 15% were able to access it, with the most common barriers being the cost of services and the unavailability of local services. Being female, married, and having increasing levels of functional difficulty in the cognitive, mobility and self-care domains of disability were each significantly associated with an increased likelihood of the self-identified need for mental health support. This study's findings highlight potential points of prioritisation for mental health policy and programming in Somalia. A Somali version of this abstract can be found in the Supplementary Material.
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Affiliation(s)
- Charles Zemp
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | | | | | - Kirsten Young
- United Nations Human Rights and Protection Group, Mogadishu, Somalia
| | - Caroline Jagoe
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin 2, Ireland
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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3
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Leresche E, Hossain M, De Rubeis ML, Hermans V, Burtscher D, Rossi R, Lonsdale C, Singh NS. How is the implementation of empirical research results documented in conflict-affected settings? Findings from a scoping review of peer-reviewed literature. Confl Health 2023; 17:39. [PMID: 37605198 PMCID: PMC10464477 DOI: 10.1186/s13031-023-00534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Implementation science scholars argue that knowing 'what works' in public health is insufficient to change practices, without understanding 'how', 'where' and 'why' something works. In the peer reviewed literature on conflict-affected settings, challenges to produce research, make decisions informed by evidence, or deliver services are documented, but what about the understanding of 'how', 'where' and 'why' changes occur? We explored these questions through a scoping review of peer-reviewed literature based on core dimensions of the Extended Normalization Process Theory. We selected papers that provided data on how something might work (who is involved and how?), where (in what organizational arrangements or contexts?) and why (what was done?). We searched the Global Health, Medline, Embase databases. We screened 2054 abstracts and 128 full texts. We included 22 papers (of which 15 related to mental health interventions) and analysed them thematically. We had the results revised critically by co-authors experienced in operational research in conflict-affected settings. Using an implementation science lens, we found that: (a) implementing actors are often engaged after research is produced to discuss feasibility; (b) new interventions or delivery modalities need to be flexible; (c) disruptions affect how research findings can lead to sustained practices; (d) strong leadership and stable resources are crucial for frontline actors; (e) creating a safe learning space to discuss challenges is difficult; (f) feasibility in such settings needs to be balanced. Lastly, communities and frontline actors need to be engaged as early as possible in the research process. We used our findings to adapt the Extended Normalization Process Theory for operational research in settings affected by conflicts. Other theories used by researchers to document the implementation processes need to be studied further.
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Affiliation(s)
- Enrica Leresche
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mazeda Hossain
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Global Health, Nottingham Trent University, Nottingham, UK
| | | | - Veerle Hermans
- LuxOR, Médecins Sans Frontières Operational Centre Brussels, Luxembourg, Luxembourg
| | - Doris Burtscher
- Médecins Sans Frontières Vienna Evaluation Unit, Vienna, Austria
| | - Rodolfo Rossi
- Centre for Operational Research and Experience (CORE), International Committee of the Red Cross, Geneva, Switzerland
| | - Cordelia Lonsdale
- Elrha's Research for Health in Humanitarian Crises Programme, Cardiff, UK
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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4
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Weissbecker I, Bhaird CNA, Alves V, Ventevogel P, Willhoite A, Hijazi Z, Hanna F, Atukunda Friberg P, Dakkak H, van Ommeren M. A Minimum Service Package (MSP) to improve response to mental health and psychosocial needs in emergency situations. World Psychiatry 2023; 22:161-162. [PMID: 36640410 PMCID: PMC9840487 DOI: 10.1002/wps.21048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Inka Weissbecker
- Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
| | | | - Vania Alves
- Child Protection ProgrammeUNICEFNew YorkNYUSA
| | | | | | - Zeinab Hijazi
- Office of Director of Programmes, Programme DivisionUNICEFNew YorkNYUSA
| | - Fahmy Hanna
- Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
| | | | | | - Mark van Ommeren
- Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
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5
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Limone P, Toto GA. Protocols and strategies to use emergency psychology in the face of an emergency: A systematic review. Acta Psychol (Amst) 2022; 229:103697. [PMID: 35963114 DOI: 10.1016/j.actpsy.2022.103697] [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: 04/20/2022] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trauma survivors are at a high risk of developing mental health problems. Hence, mental help in the form of emergency psychology has to be availed in the aftermath of a traumatizing event. When studied in-depth, emergency psychology comprises protocols, strategies, and techniques that establish it as an interventional activity. OBJECTIVE The main of this review is to analyze how emergency psychology services are provided to people, to verify to what extent these interventions are homogeneous in the delivery methods and consequently, facilitate the creation of relevant measures. Consequently, the general view of emergency psychology is reviewed and analyzed to identify the protocols, guidelines, and strategies used. METHODS A search was done on the ScienceDirect, APA PsycINFO, Emerald, and Scopus databases for articles published from 1st January 2017 to 1st April 2022. The reference lists of the identified studies were also screened. RESULTS After the non-duplicate articles were removed and after filtering the articles according to inclusion criteria, 20 articles were included for the thematic analysis: nine research articles, 10 case study reports, and one randomized controlled trial (RCT). During the analysis, different aspects of emergency psychology were categorized: Responders, Crisis Management and Structure, and types of psychological interventions. This categorization led to the identification of protocols, guidelines, and strategies that can be placed in a sequence to give a general direction of how an emergency psychology intervention is supposed to be carried out. CONCLUSIONS The adopted protocols, guidelines and strategies may vary from one disaster management to another but the main goal will always remain the same.
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Affiliation(s)
- Pierpaolo Limone
- Learning Science Hub, Department of Humanities, University of Foggia, Italy.
| | - Giusi Antonia Toto
- Learning Science Hub, Department of Humanities, University of Foggia, Italy.
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6
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Miyagawa A, Tanigawa K. Health and Medical Issues in the Area Affected by Fukushima Daiichi Nuclear Power Plant Accident. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:144. [PMID: 35010401 PMCID: PMC8750495 DOI: 10.3390/ijerph19010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Futaba County was the area most affected by the 2011 Fukushima Daiichi nuclear power plant accident. To understand issues around the re-development of the medical system, we investigated the post-accident changes in medical needs and the system's transition. We analyzed reports from Fukushima Prefecture and local municipalities, ambulance transport data from the Futaba Fire Department, and patient data from Futaba Medical Center (FMC). After the accident, all medical institutions were closed, and the number of ambulance use dropped sharply. With the lifting of evacuation orders beginning in 2014, the amount of ambulance use increased at an annual rate of about 10%. Early on, the proportion of trauma caused by occupational and traffic accidents increased rapidly to more than 30%. As residents returned, the proportion related to endogenous diseases (most commonly respiratory) increased. Soon after the FMC opened in 2018, the majority of the patients were in their 60s, and by 2019 the proportion of patients in their 80s markedly increased. The return of the residents as well as ongoing decontamination and reconstruction projects were related to changes in the demographics of patients and the types of injuries and illnesses observed.
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7
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Frawley T, van Gelderen F, Somanadhan S, Coveney K, Phelan A, Lynam-Loane P, De Brún A. The impact of COVID-19 on health systems, mental health and the potential for nursing. Ir J Psychol Med 2021; 38:220-226. [PMID: 32933594 PMCID: PMC7596574 DOI: 10.1017/ipm.2020.105] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/08/2020] [Accepted: 09/04/2020] [Indexed: 02/01/2023]
Abstract
This paper offers a perspective on nursing and lived experience responses to the COVID-19 pandemic. It charts health systems and mental health impacts with a particular focus on children and adolescents, older people and people availing of mental health services. Issues of moral distress and the nursing reaction are considered alongside psychological and social concerns which continue to rapidly evolve. The perspective of a person attending adult community mental health services and the experience of engaging with a mental health service remotely is provided. Matters of note for acute inpatient mental health nursing are highlighted and informed by the lived experience of a mental health nurse. The need for integrated health systems responses across nursing disciplines and the wider interdisciplinary team is elucidated.
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Affiliation(s)
- T. Frawley
- UCD School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland
| | - F. van Gelderen
- UCD School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland
| | - S. Somanadhan
- UCD School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland
| | - K. Coveney
- UCD School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland
| | - A. Phelan
- TCD School of Nursing and Midwifery, 24 D’Olier Street, Dublin, Ireland
| | - P. Lynam-Loane
- Dublin North City Mental Health Services, Phoenix Care Centre, Grangegorman, Dublin
| | - A. De Brún
- UCD School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland
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8
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Murphy J, Qureshi O, Endale T, Esponda GM, Pathare S, Eaton J, De Silva M, Ryan G. Barriers and drivers to stakeholder engagement in global mental health projects. Int J Ment Health Syst 2021; 15:30. [PMID: 33812375 PMCID: PMC8019163 DOI: 10.1186/s13033-021-00458-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Engagement with diverse stakeholders, including policy makers, care providers and service users and communities, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature. Methods We conducted semi-structured qualitative interviews with 29 recipients of Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of projects. We used framework analysis to identify key themes related to implementation barriers and drivers. This paper reports on barriers and drivers to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this journal. Results Barriers and drivers to stakeholder engagement were identified across four themes: (1) Contextual Considerations, (2) Resources, (3) Participation, Uptake and Empowerment, and (4) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as drivers. Stigma at the institutional, community and individual level was also identified as a substantial barrier to engagement. Conclusion The findings of this study are relevant to implementers in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement by investing in high-quality formative research, supporting capacity building for policy engagement, investing in longer-term funding schemes to support sustainable partnerships and scale-up, thus fostering successful engagement and supporting effective implementation of global mental health innovations.
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Affiliation(s)
- Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Onaiza Qureshi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Georgina Miguel Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004, India
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Mary De Silva
- Wellcome Trust, 215 Euston Road, London, NW1 2BE, UK
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
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9
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Endale T, Qureshi O, Ryan GK, Esponda GM, Verhey R, Eaton J, De Silva M, Murphy J. Barriers and drivers to capacity-building in global mental health projects. Int J Ment Health Syst 2020; 14:89. [PMID: 33292389 PMCID: PMC7712613 DOI: 10.1186/s13033-020-00420-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The global shortage of mental health workers is a significant barrier to the implementation and scale-up of mental health services. Partially as a result of this shortage, approximately 85% of people with mental, neurological and substance-use disorders in low- and middle-income countries do not receive care. Consequently, developing and implementing scalable solutions for mental health capacity-building has been identified as a priority in global mental health. There remains limited evidence to inform best practices for capacity building in global mental health. As one in a series of four papers on factors affecting the implementation of mental health projects in low- and middle-income countries, this paper reflects on the experiences of global mental health grantees funded by Grand Challenges Canada, focusing on the barriers to and drivers of capacity-building. METHODS Between June 2014 and May 2017, current or former Grand Challenges Canada Global Mental Health grantees were recruited using purposive sampling. N = 29 grantees participated in semi-structured qualitative interviews, representing projects in Central America and the Caribbean (n = 4), South America (n = 1), West Africa (n = 4), East Africa (n = 6), South Asia (n = 11) and Southeast Asia (n = 3). Based on the results of a quantitative analysis of project outcomes using a portfolio-level Theory of Change framework, six key themes were identified as important to implementation success. As part of a larger multi-method study, this paper utilized a framework analysis to explore the themes related to capacity-building. RESULTS Study participants described barriers and facilitators to capacity building within three broad themes: (1) training, (2) supervision, and (3) quality assurance. Running throughout these thematic areas were the crosscutting themes of contextual understanding, human resources, and sustainability. Additionally, participants described approaches and mechanisms for successful capacity building. CONCLUSIONS This study demonstrates the importance of capacity building to global mental health research and implementation, its relationship to stakeholder engagement and service delivery, and the implications for funders, implementers, and researchers alike. Investment in formative research, contextual understanding, stakeholder engagement, policy influence, and integration into existing systems of education and service delivery is crucial for the success of capacity building efforts.
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Affiliation(s)
- Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 201th Street, New York, NY, 10027, USA.
| | - Onaiza Qureshi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace Kathryn Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Georgina Miguel Esponda
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ruth Verhey
- Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Julian Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- CBM Global, Bensheim, Germany
| | - Mary De Silva
- Department of Population Health, Wellcome Trust, London, UK
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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10
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Smith SL, Raviola GJ. 'Jack be nimble, Jack be quick…': mental health and psychosocial response in the time of coronavirus. Glob Ment Health (Camb) 2020; 7:e21. [PMID: 32908676 PMCID: PMC7417996 DOI: 10.1017/gmh.2020.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Stephanie L. Smith
- Partners In Health, 800 Boylston Street, Suite 300, Boston, MA02199, USA
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA02115, USA
| | - Giuseppe J. Raviola
- Partners In Health, 800 Boylston Street, Suite 300, Boston, MA02199, USA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
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11
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Howells ME, Dancause K, Pond R, Rivera L, Simmons D, Alston BD. Maternal marital status predicts self-reported stress among pregnant women following hurricane Florence. Am J Hum Biol 2020; 32:e23427. [PMID: 32342589 DOI: 10.1002/ajhb.23427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/06/2020] [Accepted: 04/03/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The effects of stress caused by natural disasters may be more pronounced in individuals with preexisting disadvantages. The degree of hardship and psychological distress associated with Hurricane Florence was assessed in 83 pregnant women. This research helps identify unmarried pregnant women as a group particularly at risk of distress following a natural disaster. METHODS We assessed hardship associated with the hurricane using a questionnaire modeled on previous studies of stress due to natural disasters. We assessed distress using the Impact of Event Scale-Revised. We assessed social support and household food security using validated questionnaires. We used hierarchical linear regression to test predictors of distress marital status. Finally, we analyzed interactions between marital status and hardship, social support, and food security to examine whether these variables explained differences in distress among married and unmarried women. RESULTS Results indicated that unmarried women may be at higher risk of distress following natural disasters. Unmarried women were younger, had lower food security and education levels. We found no differences between experiences of hurricane-related hardship based on marital status. However, unmarried women were likely to have higher levels of distress following the hurricane. Hardship was a significant predictor of distress, but food security and social support were not significant predictors. CONCLUSIONS This study identifies unmarried pregnant women as a high risk/vulnerable group that may need additional support during emergencies. Taken together, this study further assesses how socially disadvantaged members of society may be unequally impacted by natural disasters.
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Affiliation(s)
- Michaela E Howells
- Department of Anthropology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Kelsey Dancause
- Department of Physical Activity Sciences, University of Quebec, Montreal, Canada
| | - Richard Pond
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Latisha Rivera
- Department of Anthropology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | | | - Brionna D Alston
- School of Social Work, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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12
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Silove D, Mohsin M, Klein L, Tam NDJ, Dadds M, Eapen V, Tol WA, da Costa Z, Savio E, Soares R, Steel Z, Rees SJ. Longitudinal path analysis of depressive symptoms and functioning among women of child-rearing age in postconflict Timor-Leste. BMJ Glob Health 2020; 5:e002039. [PMID: 32337078 PMCID: PMC7170425 DOI: 10.1136/bmjgh-2019-002039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 11/11/2022] Open
Abstract
This longitudinal study indicates that exposure to the traumas of mass conflict and subsequent depressive symptoms play an important role in pathways leading to functional impairment in the postconflict period among women of child-rearing age. Our study, conducted in Timor-Leste, involved an analytic sample of 1292 women recruited at antenatal clinics in the capital and its surrounding districts. Women were re-interviewed at home 2 years later (77.3% retention). We applied the Edinburgh Postnatal Depression Scale, the Harvard Trauma Questionnaire for conflict-related traumatic events, the WHO Violence Against Women Instrument covering the past year for intimate partner violence and the WHO Disability Assessment Schedule (WHODAS V.2.0) to assess functional impairment. A longitudinal path analysis tested direct and indirect relationships involving past conflict-related trauma exposure, depressive symptoms measured over the two time points and functional impairment at follow-up. The prevalence of predefined clinically significant depressive symptoms diminished from 19.3% to 12.8%. Nevertheless, there was a tendency for depressive symptoms to persist over time (β=0.20; p<0.001). Follow-up depressive symptoms were associated with functional impairment (β=0.35; p<0.001). Reported conflict-related trauma occurring a minimum of 6 years earlier (β=0.23; p<0.001) and past-year physical intimate partner violence (β=0.26; p<0.001) were each associated with depressive symptoms at baseline and at follow-up. A measure of poverty specific to the context and reported health problems in the mother and infant also contributed to depressive symptoms. The findings highlight the association between ongoing trauma-related depressive symptoms and the capacity of women in the childbearing age to function in multiple areas of their lives in a postconflict country. Recognition of these relationships is important in the formulation and implementation of contemporary international recovery and development policies applied to postconflict countries.
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Affiliation(s)
- Derrick Silove
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohammed Mohsin
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Louis Klein
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Natalino De Jesus Tam
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Mark Dadds
- Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Sch Publ Hlth, Baltimore, Maryland, USA
| | - Zelia da Costa
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Elisa Savio
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Rina Soares
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Zachary Steel
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Richmond Hospital, St John of God Health Care, North Richmond, New South Wales, Australia
| | - Susan J Rees
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
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Hamza MK, Clancy K. Building mental health and resilience: regional and global perspectives from the inaugural Syrian American Medical Society Mental Health Mission Trip (July 2 to July 7, 2019). Avicenna J Med 2020; 10:54-59. [PMID: 32110550 PMCID: PMC7014995 DOI: 10.4103/ajm.ajm_157_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Syrian conflict has resulted in the most significant refugee crisis since World War II. Current estimates suggest there are over 13.5 million Syrians in need of comprehensive humanitarian assistance as a direct result of the conflict. These humanitarian needs include mental health services to address the elevated rates of psychiatric disorders in this population. Towards this end, the Syrian American Medical Society conducted its inaugural mental health mission trip to Lebanon and Jordan from June to July 2019 to advance the state of mental health care for displaced Syrians. Following two weeks of trainings by international experts in trauma psychology, the mission concluded with a two-day scientific symposium, identifying two key elements for the advancement of humanitarian mental health care: 1) the need for community-based mental health services, and 2) the importance of transitioning from a crisis-response model in humanitarian mental health towards a model of resilience and post-traumatic growth.
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Affiliation(s)
- Mohammad K Hamza
- Counseling Department, Lamar University, Texas State System, Clinical Mental Health; Syrian American Medical Society, Mental Health, United States
| | - Kevin Clancy
- Department of Psychology, Florida State University, United States
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Development of a comprehensive, sustained community mental health system in post-earthquake Haiti, 2010-2019. Glob Ment Health (Camb) 2020; 7:e6. [PMID: 32180989 PMCID: PMC7056862 DOI: 10.1017/gmh.2019.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022] Open
Abstract
Between 2010 and 2019 the international health care organization Partners In Health (PIH) and its sister organization Zanmi Lasante (ZL) mounted a long-term response to the 2010 Haiti earthquake, focused on mental health. Over that time, implementing a Theory of Change developed in 2012, the organization successfully developed a comprehensive, sustained community mental health system in Haiti's Central Plateau and Artibonite departments, directly serving a catchment area of 1.5 million people through multiple diagnosis-specific care pathways. The resulting ZL mental health system delivered 28 184 patient visits and served 6305 discrete patients at ZL facilities between January 2016 and September 2019. The experience of developing a system of mental health services in Haiti that currently provides ongoing care to thousands of people serves as a case study in major challenges involved in global mental health delivery. The essential components of the effort to develop and sustain this community mental health system are summarized.
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Psychosocial distress among women following a natural disaster in a low- to middle-income country: "healthy mothers, healthy communities" study in Vanuatu. Arch Womens Ment Health 2019; 22:825-829. [PMID: 31165924 DOI: 10.1007/s00737-019-00980-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/17/2019] [Indexed: 01/03/2023]
Abstract
Natural disasters have major consequences for mental health in low- and middle-income countries. Symptoms are often more pronounced among women. We analyzed patterns and predictors of distress among pregnant and non-pregnant women 3-4 and 15-16 months after a cyclone in Vanuatu, a low- to middle-income country. Distress levels were high among both pregnant and non-pregnant women, although pregnant women showed lower longer-term symptoms. Low dietary diversity predicted greater distress, which could affect women even in villages with little cyclone damage.
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Kienzler H. Mental Health System Reform in Contexts of Humanitarian Emergencies: Toward a Theory of "Practice-Based Evidence". Cult Med Psychiatry 2019; 43:636-662. [PMID: 31729689 DOI: 10.1007/s11013-019-09641-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Humanitarian emergencies such as armed conflicts are increasingly perceived as opportunities to improve mental health systems in fragile states. Research has been conducted into what building blocks are required to reform mental health systems in states emerging from wars and into the barriers to reform. What is less well known is what work and activities are actually performed when mental health systems in war-affected resource-poor countries are reformed. Questions that remain unanswered are: What is it that international humanitarian aid workers and local experts do on the ground? What are the actual activities they perform in order to enable and sustain system reform? This article begins to answer these questions through ethnographic case studies of mental health system reform in Kosovo and Palestine. Based on the findings, a theory of "practice-based evidence" is developed. Practice-based evidence assumes that knowledge is derived from practice, rather than the other way around where practice is believed to be informed by systematic evidence. It is argued that a focus on practice rather than evidence can improving system reform processes as well as the provision of mental health care in a way that is sensitive to local contexts, structural realities, culture, and history.
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Affiliation(s)
- Hanna Kienzler
- Department of Global Health & Social Medicine, School of Global Affairs, Faculty of Social Science and Public Policy, King's College London, Room 2, 10 East Wing, Strand, London, WC2R 2LS, UK.
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Faregh N, Lencucha R, Ventevogel P, Dubale BW, Kirmayer LJ. Considering culture, context and community in mhGAP implementation and training: challenges and recommendations from the field. Int J Ment Health Syst 2019; 13:58. [PMID: 31462908 PMCID: PMC6708207 DOI: 10.1186/s13033-019-0312-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Major efforts are underway to improve access to mental health care in low- and middle-income countries (LMIC) including systematic training of non-specialized health professionals and other care providers to identify and help individuals with mental disorders. In many LMIC, this effort is guided by the mental health Gap Action Programme (mhGAP) established by the World Health Organization, and commonly centres around one tool in this program: the mhGAP-Intervention Guide. OBJECTIVE To identify cultural and contextual challenges in mhGAP training and implementation and potential strategies for mitigation. METHOD An informal consultative approach was used to analyze the authors' combined field experience in the practice of mhGAP implementation and training. We employed iterative thematic analysis to consolidate and refine lessons, challenges and recommendations through multiple drafts. Findings were organized into categories according to specific challenges, lessons learned and recommendations for future practice. We aimed to identify cross-cutting and recurrent issues. RESULTS Based on intensive fieldwork experience with a focus on capacity building, we identify six major sets of challenges: (i) cultural differences in explanations of and attitudes toward mental disorder; (ii) the structure of the local health-care system; (iii) the level of supervision and support available post-training; (iv) the level of previous education, knowledge and skills of trainees; (v) the process of recruitment of trainees; and (vi) the larger socio-political context. Approaches to addressing these problems include: (1) cultural and contextual adaptation of training activities, (2) meaningful stakeholder and community engagement, and (3) processes that provide support to trainees, such as ongoing supervision and Communities of Practice. CONCLUSION Contextual and cultural factors present major barriers to mhGAP implementation and sustainability of improved services. To enable trainees to effectively apply their local cultural knowledge, mhGAP training needs to: (1) address assumptions, biases and stigma associated with mental health symptoms and problems; (2) provide an explicit framework to guide the integration of cultural knowledge into assessment, treatment negotiation, and delivery; and (3) address the specific kinds of problems, modes of clinical presentations and social predicaments seen in the local population. Continued research is needed to assess the effectiveness these strategies.
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Affiliation(s)
- Neda Faregh
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
| | - Raphael Lencucha
- School of Physical & Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC H3G 1Y5 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
| | - Peter Ventevogel
- Public Health Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, 94 Rue de Montbrillant, 1202 Geneva, Switzerland
| | - Benyam Worku Dubale
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laurence J. Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Ave, Montreal, QC H3A 1A1 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
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Zahlawi T, Roome AB, Chan CW, Campbell JJ, Tosiro B, Malanga M, Tagaro M, Obed J, Iaruel J, Taleo G, Tarivonda L, Olszowy KM, Dancause KN. Psychosocial support during displacement due to a natural disaster: relationships with distress in a lower-middle income country. Int Health 2019; 11:472-479. [DOI: 10.1093/inthealth/ihy099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Past studies show relationships between disaster-related displacement and adverse psychosocial health outcomes. The development of psychosocial interventions following displacement is thus increasingly prioritized. However, data from low- and middle-income countries (LMICs) are lacking. In October 2017, the population of Ambae Island in Vanuatu, a lower-middle income country, was temporarily displaced due to volcanic activity. We analyzed distress among adults displaced due to the event and differences based on the psychosocial support they received.
Methods
Data on experiences during displacement, distress and psychosocial support were collected from 443 adults 2–3 wk after repatriation to Ambae Island. Four support categories were identified: Healthcare professional, Traditional/community, Not available and Not wanted. We analyzed differences in distress by sex and group using one-way ANOVA and generalized linear models.
Results
Mean distress scores were higher among women (1.90, SD=0.97) than men (1.64, SD=0.98) (p<0.004). In multivariate models, psychosocial support group was associated with distress among women (p=0.033), with higher scores among women who reported no available support compared with every other group. Both healthcare professional and traditional support networks were widely used.
Conclusions
Women might be particularly vulnerable to distress during disaster-related displacement in LMICs, and those who report a lack of support might be at greater risk. Both healthcare professional and traditional networks provide important sources of support that are widely used and might help to ameliorate symptoms.
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Affiliation(s)
- Tatiana Zahlawi
- Département des sciences de l’activité physique, Université du Québec à Montréal, Montréal, QC, Canada
| | - Amanda B Roome
- Binghamton University, Department of Anthropology, Binghamton, NY, USA
| | - Chim W Chan
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden
| | | | - Bev Tosiro
- Lolowai Hospital, PMB 9009, Ambae, Republic of Vanuatu
| | - Max Malanga
- Lolowai Hospital, PMB 9009, Ambae, Republic of Vanuatu
| | | | - Jimmy Obed
- Vanuatu Ministry of Health, PMB 9042, Port Vila, Republic of Vanuatu
| | - Jerry Iaruel
- Vanuatu Ministry of Health, PMB 9042, Port Vila, Republic of Vanuatu
| | - George Taleo
- Vanuatu Ministry of Health, PMB 9042, Port Vila, Republic of Vanuatu
| | - Len Tarivonda
- Vanuatu Ministry of Health, PMB 9042, Port Vila, Republic of Vanuatu
| | - Kathryn M Olszowy
- Cleveland State University, Department of Criminology, Anthropology & Sociology, Cleveland, OH, USA
| | - Kelsey N Dancause
- Département des sciences de l’activité physique, Université du Québec à Montréal, Montréal, QC, Canada
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Muga T, Mbuthia G, Gatimu SM, Rossiter R. A Pilot Study Exploring Nursing Knowledge of Depression and Suicidal Ideation in Kenya. Issues Ment Health Nurs 2019; 40:15-20. [PMID: 30111201 DOI: 10.1080/01612840.2018.1489922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Nurses play key roles in recognizing, diagnosing, managing, and referring persons with mental disorders. This cross-sectional study assessed mental health literacy (depression and suicidal ideation) among nurses in a private urban referral hospital in Kenya. Nurses read a vignette and answered questions regarding diagnosis, treatment/interventions, and related attitudes and beliefs. Thirty-seven nurses (12 males) completed the questionnaire. Three correctly identified the diagnosis and 23 identified depression only. Although 75% noted the symptoms were extremely distressing, fear, and stigma were common reactions. This highlights challenges in mental health promotion/prevention in Kenya, and suggests continuous nursing education and curriculum enhancement is needed.
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Affiliation(s)
| | - Gladys Mbuthia
- b School of Nursing and Midwifery , Aga Khan University , Nairobi , Kenya
| | | | - Rachel Rossiter
- c School of Nursing, Midwifery and Indigenous Health, Faculty of Science , Charles Sturt University , Australia
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Ventevogel P, Tarannum S, Elshazly M, Harlass S. Integrating mental health into primary health care in Rohingya refugee settings in Bangladesh: experiences of UNHCR. INTERVENTION 2019. [DOI: 10.4103/intv.intv_34_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chase LE, Marahatta K, Sidgel K, Shrestha S, Gautam K, Luitel NP, Dotel BR, Samuel R. Building back better? Taking stock of the post-earthquake mental health and psychosocial response in Nepal. Int J Ment Health Syst 2018; 12:44. [PMID: 30083225 PMCID: PMC6071401 DOI: 10.1186/s13033-018-0221-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The World Health Organization's 'building back better' approach advocates capitalizing on the resources and political will elicited by disasters to strengthen national mental health systems. This study explores the contributions of the response to the 2015 earthquake in Nepal to sustainable mental health system reform. METHODS We systematically reviewed grey literature on the mental health and psychosocial response to the earthquake obtained through online information-sharing platforms and response coordinators (168 documents) to extract data on response stakeholders and activities. More detailed data on activity outcomes were solicited from organizations identified as most active in the response. To triangulate and extend findings, we held a focus group discussion with key governmental and non-governmental stakeholders in mental health system development in Nepal (n = 10). Discussion content was recorded, transcribed, and subjected to thematic analysis. RESULTS While detailed documentation of response activities was limited, available data combined with stakeholders' accounts suggest that the post-earthquake response accelerated progress towards national mental health system building in the areas of governance, financing, human resources, information and research, service delivery, and medications. Key achievements in the post-earthquake context include training of primary health care service providers in affected districts using mhGAP and training of new psychosocial workers; appointment of mental health focal points in the government and World Health Organization Country Office; the addition of new psychotropic drugs to the government's free drugs list; development of a community mental health care package and training curricula for different cadres of health workers; and the revision of mental health plans, policy, and financing mechanisms. Concerns remain that government ownership and financing will be insufficient to sustain services in affected districts and scale them up to non-affected districts. CONCLUSIONS Building back better has been achieved to varying extents in different districts and at different levels of the mental health system. Non-governmental organizations and the World Health Organization Country Office must continue to support the government to ensure that recent advances maximally contribute to realising the vision of a national mental health care system in Nepal.
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Affiliation(s)
- Liana E. Chase
- Department of Anthropology, SOAS University of London, 10 Thornhaugh Street, Russell Square, London, WC1H 0XG UK
| | - Kedar Marahatta
- WHO Health Emergencies Programme, WHO Country Office for Nepal, UN House, Lalitpur, Nepal
| | - Kripa Sidgel
- Psychbigyaan Network Nepal, Chakrapath-3, Kathmandu, Nepal
| | - Sujan Shrestha
- Psychbigyaan Network Nepal, Chakrapath-3, Kathmandu, Nepal
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Bhogendra Raj Dotel
- Primary Health Care Revitalization Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Reuben Samuel
- WHO Health Emergencies Programme, WHO Country Office for Nepal, UN House, Lalitpur, Nepal
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22
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Leveraging Post-Disaster Windows of Opportunities for Change towards Sustainability: A Framework. SUSTAINABILITY 2018. [DOI: 10.3390/su10051390] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Murphy A, Chikovani I, Uchaneishvili M, Makhashvili N, Roberts B. Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study. BMC Health Serv Res 2018; 18:306. [PMID: 29712551 PMCID: PMC5928589 DOI: 10.1186/s12913-018-3113-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/11/2018] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There is a paucity of evidence on access to services for mental health and psychosocial support for conflict-affected populations in low- and middle-income countries. In the Republic of Georgia, rates of utilization of mental health services among internally displaced people with mental disorders are low. We set out to identify the health system barriers leading to this treatment gap. METHODS We used rapid appraisal methods (collection and triangulation of multiple data sources) to investigate barriers to accessing mental health care services among adult IDPs in Georgia. Data collection included review of existing policy documents and other published data, as well as semi-structured interviews with 29 key informants including policy makers, NGO staff, health professionals and patients. RESULTS The following factors emerged as important barriers affecting access to mental health care services among IDPs in Georgia: inadequate insurance coverage of mental disorders and poor identification and referral systems, underfunding, shortage of human resources, poor information systems, patient out-of-pocket payments and stigmatization. CONCLUSION While rapid appraisal methods cannot control for potential biases or achieve representativeness, triangulation supports internal validity and reliability of the data collected, allowing data to be used to inform health care interventions. The appropriateness and potential effectiveness of policy interventions such as insurance coverage of a wider range of mental disorders, integration of services for these at the primary health care level, and community-based approaches in this context should be explored.
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Affiliation(s)
- Adrianna Murphy
- London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Ivdity Chikovani
- Curatio International Foundation, 3 Kavsadze str., Office 5, 0179 Tbilisi, Georgia
| | - Maia Uchaneishvili
- Curatio International Foundation, 3 Kavsadze str., Office 5, 0179 Tbilisi, Georgia
| | - Nino Makhashvili
- Ilia State University, 3/5, Kakuca Cholokashvili Ave, Tbilisi, Georgia
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH UK
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Wong KP, Bonn G, Tam CL, Wong CP. Preferences for Online and/or Face-to-Face Counseling among University Students in Malaysia. Front Psychol 2018; 9:64. [PMID: 29445352 PMCID: PMC5798405 DOI: 10.3389/fpsyg.2018.00064] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Increasingly, online counseling is considered to be a cost-effective and highly accessible method of providing basic counseling and mental health services. To examine the potential of online delivery as a way of increasing overall usage of services, this study looked at students' attitudes toward and likelihood of using both online and/or face-to-face counseling. A survey was conducted with 409 students from six universities in Malaysia participating. Approximately 35% of participants reported that they would be likely to utilize online counseling services but would be unlikely to participate in face-to-face counseling. Based on these results, it is suggested that offering online counseling, in addition to face-to-face services, could be an effective way for many university counseling centers to increase the utilization of their services and thus better serve their communities.
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Affiliation(s)
- Kah P. Wong
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Gregory Bonn
- King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
| | - Cai L. Tam
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Chee P. Wong
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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What are the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies? A qualitative evidence synthesis. Glob Ment Health (Camb) 2018; 5:e21. [PMID: 29997893 PMCID: PMC6036649 DOI: 10.1017/gmh.2018.12] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Humanitarian emergencies can impact people's psychosocial well-being and mental health. Providing mental health and psychosocial support (MHPSS) is an essential component of humanitarian aid responses. However, factors influencing the delivery MHPSS programmes have yet to be synthesised. We undertook a systematic review on the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies in low- and middle-income countries. METHODS A comprehensive search of 12 bibliographic databases, 25 websites and citation checking was undertaken. Studies published in English from 1980 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in or programmes providers involved in delivering, MHPSS programmes in humanitarian settings. Thirteen studies were critically appraised and analysed thematically. RESULTS Community engagement was a key mechanism to support the successful implementation and uptake of MHPSS programmes. Establishing good relationships with parents may also be important when there is a need to communicate the value of children and young people's participation in programmes. Sufficient numbers of trained providers were essential in ensuring a range of MHPSS programmes were delivered as planned but could be challenging in resource-limited settings. Programmes need to be socially and culturally meaningful to ensure they remain appealing. Recipients also valued engagement with peers in group-based programmes and trusting and supportive relationships with providers. CONCLUSION The synthesis identified important factors that could improve MHPSS programme reach and appeal. Taking these factors into consideration could support future MHPSS programmes achieve their intended aims.
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Kazlauskas E, Zelviene P. Association between posttraumatic stress and acceptance of social changes: Findings from a general population study and proposal of a new concept. Int J Soc Psychiatry 2017; 63:126-131. [PMID: 28074666 DOI: 10.1177/0020764016687788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a growing understanding of the importance of the social factors of posttraumatic stress disorder. AIMS This study expands research on association between posttraumatic stress and social factors by introducing the measure of the acceptance of social changes and evaluating possible links between posttraumatic stress disorder symptoms and acceptance of social changes. METHODS A general population sample ( n = 778) aged from 18 to 89 years ( M = 40.2) from Lithuania participated in our study, of whom 68% reported exposure to traumatic events. Posttraumatic stress reactions were measured with the Impact of Event Scale - Revised (IES-R), and acceptance of social changes was measured with the Acceptance of Social Changes Instrument (SOCHI) developed by the authors of this study. RESULTS About 8% of the participants had a potential posttraumatic stress disorder (PTSD) diagnosis. Acceptance of social changes was negatively associated with posttraumatic stress. PTSD was related to lower acceptance of social changes ( d = .61). Structural equation model (SEM) revealed the mediating role of PTSD for acceptance of social changes following trauma exposure. CONCLUSION Findings of our study indicate that the acceptance of social changes might be an important psychosocial factor of PTSD.
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Affiliation(s)
- Evaldas Kazlauskas
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
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Implementing mhGAP training to strengthen existing services for an internally displaced population in Pakistan. Glob Ment Health (Camb) 2017; 4:e6. [PMID: 28596907 PMCID: PMC5454790 DOI: 10.1017/gmh.2017.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/06/2016] [Accepted: 01/11/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In 2014, over a million people were internally displaced after the launch of a military operation in North Waziristan, a tribal region on Pakistan's side of the Durand Line. Despite security concerns and restrictions, a collaborative mental health and psychosocial support initiative was undertaken in the district of Bannu. Monthly mental health camps were conducted for a period of 6 months by a multidisciplinary mental health team. The initiative also helped to assess mental health needs and plan training for primary care staff to strengthen existing resources. METHODS As part of this initiative, Mental Health Gap Action Programme (mhGAP) training was conducted for physicians and psychosocial staff in the affected district. This marked the first instance of implementing these guidelines in Pakistan following a humanitarian crisis. This paper describes the training process including the adaptation of the mhGAP curriculum, training of trainers, training workshops for primary care staff and an analysis of results of pre- and post-testing of their knowledge about common mental disorders using a 25-item questionnaire. RESULTS The gaps in knowledge of primary care physicians in recognizing and managing common mental disorders were clearly identified. The mean pre- and post-test scores of the participants were 15.43, 62% (p value 0.000, s.d. 4.05) and 19.48, 78% (p value 0.000, s.d. 3.13) respectively, which showed significant improvement. CONCLUSIONS Despite the challenges of a humanitarian crisis, mhGAP guidelines can be successfully implemented to train primary care physicians in in low- and middle-income countries such as Pakistan. However, the dearth of primary care resources can hinder the complete integration of mental health services into primary healthcare.
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Trani JF, Ballard E, Bakhshi P, Hovmand P. Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan. Confl Health 2016; 10:25. [PMID: 27822297 PMCID: PMC5090881 DOI: 10.1186/s13031-016-0089-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 07/18/2016] [Indexed: 11/22/2022] Open
Abstract
Background Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context. Methods We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness. Group model building sessions, designed based on a series of scripts and led by three facilitators, took place with NGO staff members in Mazar-I-Sharif in July 2014 and in Kabul in February 2015. Results We identified major feedback loops that constitute a hypothesis of how system components interact to generate a persistently low rate of service utilization by people with mental illness. In particular, we found that the interaction of the combined burdens of poverty and cost of treatment interact with cultural and social stigmatizing beliefs, in the context of limited clinical or other treatment support, to perpetuate low access to care for people with mental disorders. These findings indicate that the introduction of mental healthcare services alone will not be sufficient to meaningfully improve the condition of individuals with mental illness if community stigma and poverty are not addressed concurrently. Conclusions Our model highlights important factors that prevent persons with mental illness from accessing services. Our study demonstrates that group model building methods using community based system dynamics can provide an effective tool to elicit a common vision on a complex problem and identify shared potential strategies for intervention in a development and global health context. Its strength and originality is the leadership role played by the actors embedded within the system in describing the complex problem and suggesting interventions.
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Affiliation(s)
- Jean-Francois Trani
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO 63130 USA
| | - Ellis Ballard
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO 63130 USA
| | - Parul Bakhshi
- Program in Occupational Therapy, School of Medicine, Washington University in St Louis, St Louis, USA
| | - Peter Hovmand
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO 63130 USA
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Humanitarian emergencies and mental health. Curr Opin Psychiatry 2016; 29:277-9. [PMID: 27434496 DOI: 10.1097/yco.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Marthoenis M, Yessi S, Aichberger MC, Schouler-Ocak M. Mental health in Aceh--Indonesia: A decade after the devastating tsunami 2004. Asian J Psychiatr 2016; 19:59-65. [PMID: 26957340 DOI: 10.1016/j.ajp.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/16/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
Abstract
The province of Aceh has suffered enormously from the perennial armed conflict and the devastating Tsunami in 2004. Despite the waves of external aid and national concern geared toward improving healthcare services as part of the reconstruction and rehabilitation efforts after the Tsunami, mental health services still require much attention. This paper aims to understand the mental healthcare system in Aceh Province, Indonesia; its main focus is on the burden, on the healthcare system, its development, service delivery and cultural issues from the devastating Tsunami in 2004 until the present. We reviewed those published and unpublished reports from the local and national government, from international instances (UN bodies, NGOs) and from the academic literature pertaining to mental health related programs conducted in Aceh. To some extent, mental health services in Aceh have been improved compared to their condition before the Tsunami. The development programs have focused on procurement of policy, improvement of human resources, and enhancing service delivery. Culture and religious beliefs shape the pathways by which people seek mental health treatment. The political system also determines the development of the mental health service in the province. The case of Aceh is a unique example where conflict and disaster serve as the catalysts toward the development of a mental healthcare system. Several factors contribute to the improvement of the mental health system, but security is a must. Whilst the Acehnese enjoy the improvements, some issues such as stigma, access to care and political fluctuations remain challenging.
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Affiliation(s)
| | - Sarifah Yessi
- Aceh Provincial Health Office, Banda Aceh, Indonesia
| | - Marion C Aichberger
- Departments of Psychiatry and Psychotherapy, Charité University Clinic, Berlin, Germany
| | - Meryam Schouler-Ocak
- University Psychiatric Clinic of Charité at St. Hedwig's Hospital Berlin, Germany
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Maercker A, Hecker T. Broadening perspectives on trauma and recovery: a socio-interpersonal view of PTSD. Eur J Psychotraumatol 2016; 7:29303. [PMID: 26996533 PMCID: PMC4800282 DOI: 10.3402/ejpt.v7.29303] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/29/2015] [Accepted: 11/13/2015] [Indexed: 11/14/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is one of the very few mental disorders that requires by definition an environmental context-a traumatic event or events-as a precondition for diagnosis. Both trauma sequelae and recovery always occur in the context of social-interpersonal contexts, for example, in interaction with a partner, family, the community, and the society. The present paper elaborates and extends the social-interpersonal framework model of PTSD. This was developed to complement other intrapersonally focused models of PTSD, which emphasize alterations in an individual's memory, cognitions, or neurobiology. Four primary reasons for broadening the perspective from the individual to the interpersonal-societal contexts are discussed. The three layers of the model (social affects, close relationships, and culture and society) are outlined. We further discuss additional insights and benefits of the social-interpersonal perspective for the growing field of research regarding resilience after traumatic experiences. The paper closes with an outlook on therapy approaches and interventions considering this broader social-interpersonal perspective on PTSD.
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Affiliation(s)
- Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland;
| | - Tobias Hecker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
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Ventevogel P, van Ommeren M, Schilperoord M, Saxena S. Improving mental health care in humanitarian emergencies. Bull World Health Organ 2015; 93:666-666A. [PMID: 26600604 PMCID: PMC4645443 DOI: 10.2471/blt.15.156919] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Peter Ventevogel
- Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees, 94 Rue de Montbrillant, 1202 Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Marian Schilperoord
- Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees, 94 Rue de Montbrillant, 1202 Geneva, Switzerland
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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