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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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Keynejad RC, Bentley A, Bhatia U, Nalwadda O, Mekonnen FD, Ali PA, McGarry J. Research, education and capacity building priorities for violence, abuse and mental health in low- and middle-income countries: an international qualitative survey. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1761-1771. [PMID: 33765211 PMCID: PMC10627995 DOI: 10.1007/s00127-021-02061-5] [Citation(s) in RCA: 1] [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: 10/31/2020] [Accepted: 03/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Despite the World Health Organization and United Nations recognising violence, abuse and mental health as public health priorities, their intersection is under-studied in low- and middle-income countries (LMICs). International violence, abuse and mental health network (iVAMHN) members recognised the need to identify barriers and priorities to develop this field. METHODS Informed by collaborative discussion between iVAMHN members, we conducted a pilot study using an online survey to identify research, education and capacity building priorities for violence, abuse and mental health in LMICs. We analysed free-text responses using thematic analysis. RESULTS 35 senior (29%) and junior researchers (29%), non-government or voluntary sector staff (18%), health workers (11%), students (11%) and administrators (3%) completed the survey. Respondents worked in 24 LMICs, with 20% working in more than one country. Seventy-four percent of respondents worked in sub-Saharan Africa, 37% in Asia and smaller proportions in Latin America, Eastern Europe and the Middle East. Respondents described training, human resource, funding and sensitivity-related barriers to researching violence, abuse and mental health in LMICs and recommended a range of actions to build capacity, streamline research pathways, increase efficiency and foster collaborations and co-production. CONCLUSION The intersection between violence, abuse and mental health in LMICs is a priority for individuals with a range of expertise across health, social care and the voluntary sector. There is interest in and support for building a strong network of parties engaged in research, service evaluation, training and education in this field. Networks like iVAMHN can act as hubs, bringing together diverse stakeholders for collaboration, co-production and mutually beneficial exchange of knowledge and skills.
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Affiliation(s)
- Roxanne C Keynejad
- Department of Health Service and Population Research, King's College London, London, UK.
| | | | - Urvita Bhatia
- Sangath Addictions Research Group, Porvorim, Goa, India
| | | | | | - Parveen A Ali
- University of Sheffield Health Sciences School, Sheffield, UK
| | - Julie McGarry
- University of Nottingham School of Health Sciences, Nottingham, UK
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Rizzi D, Ciuffo G, Landoni M, Mangiagalli M, Ionio C. Psychological and environmental factors influencing resilience among Ukrainian refugees and internally displaced persons: a systematic review of coping strategies and risk and protective factors. Front Psychol 2023; 14:1266125. [PMID: 37876848 PMCID: PMC10590896 DOI: 10.3389/fpsyg.2023.1266125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
Background There is much discussion in the literature about the link between traumatic events related to war and mental illness. However, in comparison, mental health has been more researched than protective factors such as coping methods, which are the primary factors to build resilience in these circumstances. This review examines the psychological and environmental elements that influence the resilience of Ukrainian refugees and IDPs by analyzing coping strategies and risk and protective factors. Methods A literature search was conducted on PsycINFO, Pubmed, Scopus, and Science Direct, with 259 articles screened and 13 determined as eligible for inclusion. Inclusion criteria were: (1) studies on adult Ukrainian refugees and/or IDPs; (2) original, peer-reviewed studies; and (3) studies written in English or Italian language. Single-case reports and qualitative studies were excluded, as well as those studies written in any other language, and any studies for which the full-text version could not be obtained (i.e., conference abstracts). Two reviewers independently reviewed titles and abstracts, reviewed relevant articles' full text, and extracted the data. Results A diverse range of individual and socio-environmental risk and protective factors were identified, influencing the resilience of Ukrainian refugees and IDPs, as well as five main categories of coping strategies: emotion-focused strategies, problem-focused strategies, avoidance, faith-based strategies, and the ones based on sense of belonging. Discussion War trauma and associated stressors can lead to distressing physical and psychological reactions, which persist even after leaving the war zone. Many individual and socio-environmental risk factors, such as mental disorders, financial security, having relatives wounded or displaced, and an unfamiliar environment could influence the risk and severity of psychological difficulties, emphasizing the importance of coping strategies, social connections, faith, and cultural resilience. Conclusion This systematic review underscores the complex range of coping strategies and factors influencing the resilience of Ukrainian refugees and IDPs. Social connections and inclusive community interventions play vital roles in improving their psychological well-being, while longitudinal studies and culturally sensitive support are needed to address their unique challenges and strengths. Implementing collaborative care models can provide comprehensive support by integrating mental health services with primary healthcare and community-based organizations.
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Affiliation(s)
- Damiano Rizzi
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy
- Unità di Medicina d’Urgenza, Dipartimento di Medicina Interna, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - Giulia Ciuffo
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
- CRIdee, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - Marta Landoni
- CRIdee, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - Matteo Mangiagalli
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia, Pavia, Italy
| | - Chiara Ionio
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
- CRIdee, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
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Thomas FC, Divirgilio R, Jayawickreme N, Sivayokan S, McShane K, Jayawickreme E. Coping with the long-term impact of civil strife: A grief-centered analysis of Tamil Sri Lankan communities affected by ethnopolitical conflict. Appl Psychol Health Well Being 2023. [PMID: 37712290 DOI: 10.1111/aphw.12491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
Limited research has examined coping mechanisms in response to chronic war-related stressors, as opposed to war-exposure trauma. The current study sought to investigate the types of losses experienced by communities affected by the Sri Lankan conflict, how participants responded to their losses, and what coping mechanisms they employed. Data consisted of interviews from two independent investigations conducted following the end of the conflict in Northern Sri Lanka (total N = 103). Interview transcripts were analyzed using a directed content analysis approach. Participants most frequently described experiencing material loss and loss of loved ones. Relatedly, participants commonly reported experiencing ambiguous loss, that is, living with the uncertainty of their loved one's death. These losses were particularly pronounced by gender, with women experiencing higher rates of loss. Common coping strategies included support-seeking, including informal support from social networks and religion, and formal mental health services. Additionally, participants described a range of longer term coping strategies from establishing a future-oriented cognitive style to a sense of helplessness and resignation. The findings shed light on how conflict-affected groups cope with profound loss. We provide recommendations for how such findings can inform grief-related clinical interventions.
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Affiliation(s)
- Fiona C Thomas
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Richard Divirgilio
- Department of Psychology, School of Liberal Arts, Manhattan College, Bronx, New York, USA
| | - Nuwan Jayawickreme
- Department of Psychology, School of Liberal Arts, Manhattan College, Bronx, New York, USA
| | | | - Kelly McShane
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Ontario, Canada
- Human Resource Management and Organizational Behaviour, Ted Rogers School of Management, Toronto, Ontario, Canada
| | - Eranda Jayawickreme
- Department of Psychology and Program for Leadership and Character, Wake Forest University, Winston-Salem, North Carolina, USA
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Augustinavicius J, Purgato M, Tedeschi F, Musci R, Leku MR, Carswell K, Lakin D, van Ommeren M, Cuijpers P, Sijbrandij M, Karyotaki E, Tol WA, Barbui C. Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda. BMJ Open 2023; 13:e048043. [PMID: 37699637 PMCID: PMC10503328 DOI: 10.1136/bmjopen-2020-048043] [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: 12/18/2020] [Accepted: 10/26/2022] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda. METHODS This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores. RESULTS A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment. CONCLUSIONS These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings. TRIAL REGISTRATION NUMBER ISRCTN50148022.
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Affiliation(s)
- Jura Augustinavicius
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Rashelle Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Wietse A Tol
- Global Health Section, University of Copenhagen, Kobenhavn, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- HealthRight International, New York city, New York, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
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Hyseni Duraku Z, Jahiu G, Geci D. Intergenerational trauma and war-induced PTSD in Kosovo: insights from the Albanian ethnic group. Front Psychol 2023; 14:1195649. [PMID: 37637887 PMCID: PMC10449605 DOI: 10.3389/fpsyg.2023.1195649] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction War has profound and deep-rooted ramifications for individuals and societies. War-induced post-traumatic stress disorder (PTSD) is highly prevalent in Kosovo. This study aimed to obtain insights into the prevalence of perceived PTSD symptoms and their relation to the traumatic experiences of two generations: parents (survivors of the Kosovo War) and youth (children born after the Kosovo War), with an emphasis on the Albanian ethnic group. These experiences were then compared to understand intergenerational trauma. The study also aimed to identify the factors affecting PTSD prevalence, the role of social support, and the participants' experience with mental health services. Method A total of 237 Kosovar Albanians (121 parents, 116 youth) from all seven districts of Kosovo were included in this study. Study variables were measured using the PTSD Checklist, the Life Events Checklist, Criterion A, and the Multidimensional Scale of Perceived Social Support. Results The results revealed that the youth had significantly higher levels of perceived PTSD symptoms and lower levels of perceived support than their parents. Youth whose parents had PTSD were more prone to experiencing PTSD symptoms than those whose parents did not have PTSD. These youth also experienced significantly more traumatic situations, such as exposure to sudden violent death or accidental death, assault with a weapon, sexual assault, and captivity. Participants with perceived PTSD and lower perceived social support needed mental health interventions significantly more than those without PTSD symptoms. Discussion The findings emphasize the importance of addressing the intergenerational nature of PTSD and identifying factors affecting its prevalence, including social support and access to mental health services. The study underscores the need for a comprehensive approach to examine the complex and diverse nature of PTSD and its impact on individuals, families, and communities, especially in conflict-prone or conflict-affected societies.
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Affiliation(s)
| | - Genta Jahiu
- Department of Psychology, University of Prishtina “Hasan Prishtina”, Prishtina, Kosovo
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Tol WA, Le PD, Harrison SL, Galappatti A, Annan J, Baingana FK, Betancourt TS, Bizouerne C, Eaton J, Engels M, Hijazi Z, Horn RR, Jordans MJD, Kohrt BA, Koyiet P, Panter-Brick C, Pluess M, Rahman A, Silove D, Tomlinson M, Uribe-Restrepo JM, Ventevogel P, Weissbecker I, Ager A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: research priorities for 2021-30. Lancet Glob Health 2023; 11:e969-e975. [PMID: 37116530 PMCID: PMC10188364 DOI: 10.1016/s2214-109x(23)00128-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 04/30/2023]
Abstract
We describe an effort to develop a consensus-based research agenda for mental health and psychosocial support (MHPSS) interventions in humanitarian settings for 2021-30. By engaging a broad group of stakeholders, we generated research questions through a qualitative study (in Indonesia, Lebanon, and Uganda; n=101), consultations led by humanitarian agencies (n=259), and an expert panel (n=227; 51% female participants and 49% male participants; 84% of participants based in low-income and middle-income countries). The expert panel selected and rated a final list of 20 research questions. After rating, the MHPSS research agenda favoured applied research questions (eg, regarding workforce strengthening and monitoring and evaluation practices). Compared with research priorities for the previous decade, there is a shift towards systems-oriented implementation research (eg, multisectoral integration and ensuring sustainability) rather than efficacy research. Answering these research questions selected and rated by the expert panel will require improved partnerships between researchers, practitioners, policy makers, and communities affected by humanitarian crises, and improved equity in funding for MHPSS research in low-income and middle-income countries.
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Affiliation(s)
- Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - PhuongThao D Le
- Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; School of Global Public Health, New York University, New York, NY, USA
| | - Sarah L Harrison
- International Federation of Red Cross Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Ananda Galappatti
- Mental Health and Psychosocial Support Network (MHPSS.net), Colombo, Sri Lanka
| | - Jeannie Annan
- Airbel Impact Lab, The International Rescue Committee, New York, NY, USA
| | | | - Theresa S Betancourt
- Boston College, School of Social Work, Research Program on Children and Adversity, Chestnut Hill, MA, USA
| | - Cecile Bizouerne
- Mental Health, PsychoSocial Support and Protection Sector, Action Contre la Faim, Paris, France
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; CBM Global, Amstelveen, Netherlands
| | | | - Zeinab Hijazi
- Mental Health Unit, Programme Division, UNICEF, New York, NY, USA
| | - Rebecca R Horn
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
| | - Mark J D Jordans
- Centre for Global Mental Health, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Catherine Panter-Brick
- Department of Anthropology and Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Inka Weissbecker
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Carter S, Sadiq S, Calear AL, Housen T, Joshy G, Fredj N, Lokuge K. The feasibility and acceptability of implementing and evaluating a caregiver group intervention to address child mental health: A pilot study in Iraq. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Nguyen AJ, Lasater ME, Lee C, Mallawaarachchi IV, Joshua K, Bassett L, Gelsdorf K. Psychosocial support interventions in the context of forced displacement: A systematic review and meta-analysis. J Migr Health 2023; 7:100168. [PMID: 36816445 PMCID: PMC9932448 DOI: 10.1016/j.jmh.2023.100168] [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: 03/24/2021] [Revised: 04/22/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Background Forced displacement is associated with elevated risk for poor psychosocial wellbeing, yet there remains a lack of clarity around the effectiveness of commonly implemented psychosocial support interventions focused on preventing disorder and promoting wellbeing. This study aimed to synthesize the literature on evaluations of psychosocial support interventions for populations affected by forced displacement. Methods We searched for peer reviewed and gray literature in seven databases (PubMed, Embase, Global Health, CINAHL, SocIndex, PsychInfo, PILOTS), fifteen organizational websites, and via solicitation through multiple networks. Various study designs were included, with the criteria that they report an evaluation of a psychosocial intervention delivered to populations affected by forced displacement, and included quantitative or qualitative data on psychosocial outcomes. Records were screened independently by two reviewers at both title/abstract and full-text review; data was double-extracted and study quality assessed, with discrepancies resolved by consensus. Meta-analyses for seven outcomes were conducted on a subset of 33 studies. Results We identified 162 reports. Over half (55%) used a single-group study design, with fewer using non-random (19%) or randomized (21%) comparisons. Study designs incorporating comparison conditions were less likely to report positive findings than single-group studies. In the meta-analyses, a moderately strong overall effect was found for psychosocial wellbeing (ES: -0.534, 95% CI: [-0.870, -0.197], p=.005); small effects on both internalizing (ES: -0.152, 95% CI: [-0.310, 0.005], p= .057) and externalizing (ES: -0.249, 95% CI: [-0.515, 0.016], p=.064) problems were promising but not conclusive. Subgroup analysis suggested differential impacts on internalizing problems for adults (improvement; ES: -0.289, 95% CI: [-0.435, -0.143], p=.001) and children (worsening; ES: 0.129, 95% CI: [.054, 0.204], p=.002). Other subgroup analyses showed little meaningful variation by context, population, or intervention characteristics. Conclusion Pragmatic, field-driven program evaluations are dominated by single-group designs with significant risk of bias. Findings from controlled studies are promising but highlight a need for more rigorous research to support causal inference, align outcomes with theories of change, improve measurement of more positive or wellbeing-focused outcomes, examine subgroup differences, and report potentially negative impacts.
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Affiliation(s)
- Amanda J. Nguyen
- School of Education and Human Development, University of Virginia, PO Box 400281, 417 Emmet St S., Charlottesville, VA 22904, United States,Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States,Corresponding author at: School of Education and Human Development, University of Virginia, PO Box 400281, 417 Emmet St S., Charlottesville, VA 22904, United States.
| | - Molly E. Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, United States
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, United States
| | - Indika V. Mallawaarachchi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22904, United States
| | - Kate Joshua
- Claude Moore Health Sciences Library, University of Virginia, 1350 Jefferson Park Avenue, PO Box 800722, Charlottesville, VA 22908, United States
| | - Lucy Bassett
- Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States
| | - Kirsten Gelsdorf
- Humanitarian Collaborative, University of Virginia, 235 McCormick Rd, PO Box 400893, Charlottesville, VA 22904, United States
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Yildiz Mİ, Başterzi AD, Yildirim EA, Yüksel Ş, Aker AT, Semerci B, Çakiroğlu S, Yazgan Y, Sercan M, Erim BR, Küçükparlak İ, Yildirim MH. Preventive and Therapeutic Mental Health Care after the Earthquake- Expert Opinion from the Psychiatric Association of Turkey. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2023; 34:39-49. [PMID: 36970961 PMCID: PMC10552168 DOI: 10.5080/u27305] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Two major earthquakes hit Turkey at the Kahramanmaraş region on February 6th 2023. The earthquakes affected almost 15 million individuals, resulting in more than forty thousand deaths, thousands of wounded and the destruction of ancient cities of humankind. Immediately after the earthquakes, the Psychiatric Association of Turkey organized an educational event to address the needs for a guidance on how to approach a trauma of such a big scale. The experts in this educational event summarized their presentations and prepared this review to guide the mental health professionals serving victims of this disaster. The review summarizes the early symptoms of trauma, and puts a framework on the principles of psychological first aid, the approach at the initial stages of the disaster, principles of planning, triage, and psychosocial support systems and the proper use of medications. The text covers the evaluation of the impact of trauma, aligning psychiatric practice with psychosocial interventions, the improvement of counseling skills and methods to better understand the mind during the acute post trauma phase. A set of presentations highlight the challenges in child psychiatry, brings a systematic overview to the earthquake and discuss the symptomatology, first aid and intervention principles in children and adolescents. Last, the forensic psychiatric perspective is presented, followed by a piece on the essentials of delivering bad news and the review is concluded with the emphasis on burnout, a syndrome to avoid particularly for field professionals, and possible preventive measures. Keywords: Disaster, trauma, psychosocial support, psychological first aid, acute stress disorder, post traumatic stress disorder.
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Panter‐Brick C. Energizing partnerships in research‐to‐policy projects. AMERICAN ANTHROPOLOGIST 2022. [DOI: 10.1111/aman.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine Panter‐Brick
- Department of Anthropology and Jackson School of Global Affairs, Yale University New Haven CT USA
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Seruwagi G, Nakidde C, Lugada E, Ssematiko M, Ddamulira DP, Masaba A, Luswata B, Ochen EA, Okot B, Muhangi D, Lawoko S. Psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda: burden and associations. Confl Health 2022; 16:25. [PMID: 35551630 PMCID: PMC9096741 DOI: 10.1186/s13031-022-00451-3] [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: 06/10/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We studied the association between psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.
Methods Cross-sectional survey data on psychological distress, social support, demographics, socio-economic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed in SPSS-version 22, and statistical significance was assumed at p < 0.05. Results Refugees resident in rural/semi-rural settlements exhibited higher levels of psychological distress [F(2, 1011) = 47.91; p < 0.001], higher availability of social interaction [F(2, 1011) = 82.24; p < 0.001], lower adequacy of social interaction [F(2, 1011) = 54.11; p < 0.001], higher availability of social attachment [F(2, 1011) = 47.95; p < 0.001], and lower adequacy of social attachment [F(2, 1011) = 50.54; p < 0.001] than peers in urban settlements. Adequacy of social interaction significantly explained variations in psychological distress levels overall and consistently across settlements, after controlling for plausible confounders. Additionally, adequacy of social attachment significantly explained variations in psychological distress levels among refugees in rural settlements, after controlling for plausible confounders. Conclusion There is a settlement-inequality (i.e. rural vs. urban) in psychological distress and social support among conflict refugees in Uganda. To address psychological distress, Mental Health and Psychosocial Support Services (MHPSS) should focus on strategies which strengthen the existing social networks among refugees. Variations in social support are a key predictor of distress which should guide tailored need-adapted interventions instead of duplicating similar and generic interventions across diverse refugee settlements.
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Affiliation(s)
- Gloria Seruwagi
- Makerere University School of Public Health, Kampala, Uganda. .,Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda.
| | - Catherine Nakidde
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Eric Lugada
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Maria Ssematiko
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | | | | | - Brian Luswata
- Directorate of Governance and Regulation, Ministry of Health, Kampala, Uganda
| | - Eric A Ochen
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Betty Okot
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Denis Muhangi
- Department of Social Work and Social Administration, Centre for Health and Social Economic Improvement (CHASE-i), Makerere University, Kampala, Uganda
| | - Stephen Lawoko
- Department of Public Health Faculty of Medicine, Gulu University, Gulu, Uganda
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van Herpen MM, Dückers MLA, Schaap R, Olff M, te Brake H. Online One-Stop Shop for Disaster Response Services After the MH17 Airplane Crash: An Evaluation Study. Front Public Health 2022; 10:832840. [PMID: 35586001 PMCID: PMC9108207 DOI: 10.3389/fpubh.2022.832840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background A one-stop shop for disaster response services provides a central location for information and advice in an accessible way. Yet little is known about its organization and outcomes. After the MH17 airplane crash, the one-stop shop concept was realized through a digital environment called the Information and Referral Center (IRC). The aim of this study was to evaluate the experiences of users and providers in regard to the IRC and to identify improvement points for future IRCs. Method Data was collected among affected ones as well as involved organizations, using interviews, focus groups, surveys and online user information. Existing evaluation and quality models were combined to design the study and analyze the data. Results First, affected ones and a variety of organizations involved were positive about the merits of the IRC. Affected ones indicated they perceived the IRC as a reliable source of information and appreciated the referral possibilities. Second, the feature of the IRC to serve as a community where affected ones could meet, share experiences and support each other was hardly used according to participants. Lastly, tracking evolving psychosocial needs and problems through the IRC was hampered due to difficulty in accessing relevant data. Conclusions The IRC helped organizations to structure and align their services. Affected ones were positive about its reliability and accessibility. An IRC has to be embedded within the established care structures. Future research could indicate whether an IRC is useful in other event types and population contexts as well.
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Affiliation(s)
- Merel M. van Herpen
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, Netherlands
| | - Michel L. A. Dückers
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Rick Schaap
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Hans te Brake
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
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Thomas FC, Puente-Duran S, Mutschler C, Monson CM. Trauma-focused cognitive behavioral therapy for children and youth in low and middle-income countries: A systematic review. Child Adolesc Ment Health 2022; 27:146-160. [PMID: 33216426 DOI: 10.1111/camh.12435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Trauma-focused cognitive behavioral therapy (TF-CBT) has been identified as a gold standard treatment for childhood posttraumatic stress disorder (PTSD) in Western countries. More recently, TF-CBT has emerged in the literature as an area of interest for children and youth affected by conflict and war in low- and middle-income countries (LMIC). METHODS The present systematic review assesses the current evidence base of TF-CBT for children and youth in LMIC, with a focus on conflict-affected countries. A total of 143 articles were identified, of which 11 articles, representing 1,354 participants, met the proposed inclusion criteria. RESULTS Results showed that the majority of the studies identified were conducted in low-resource community settings in East or Central Africa (n = 8). It was also found that cultural considerations were taken into account in TF-CBT delivery to meet the needs of local populations. Additionally, measures were translated and validated for local use. CONCLUSIONS Findings of outcome data indicated that TF-CBT was effective in treating trauma-related symptoms and improving psychosocial functioning in children and adolescents in LMICs. Given the limited number of published literature available in this area, further studies are needed to conclude when and for whom trauma-focused interventions are most relevant.
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Affiliation(s)
- Fiona C Thomas
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Sofia Puente-Duran
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, ON, Canada
| | | | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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Tay AK, Mohsin M, Hau KM, Badrudduza M, Balasundaram S, Morgan K, Parthiban N, Silove D. Variations in prevalence and risk profiles for Common Mental Disorders amongst Rohingya, Chin and Kachin refugees from Myanmar. Psychol Med 2022; 52:1306-1320. [PMID: 32914737 DOI: 10.1017/s0033291720003104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Large variations in prevalence rates of common mental disorder (CMD) amongst refugees and forcibly displaced populations have raised questions about the accuracy and value of epidemiological surveys in these cross-cultural settings. We examined the associations of sociodemographic indices, premigration traumatic events (TEs), postmigration living difficulties (PMLDs), and psychosocial disruptions based on the Adaptive Stress Index (ASI) in relation to CMD prevalence amongst the Rohingya, Chin and Kachin refugees originating from Myanmar and relocated to Malaysia. METHODS Parallel epidemiological studies were conducted in areas where the three groups were concentrated in and around Malaysia (response rates: 80-83%). RESULTS TE exposure, PMLDs and ASI were significantly associated with CMD prevalence in each group but the Rohingya recorded the highest exposure to all three of these former indices relative to Chin and Kachin (TE: mean = 11.1 v. 8.2 v. 11; PMLD: mean = 13.5 v. 7.4 v. 8.7; ASI: mean = 128.9 v. 32.1 v. 35.5). Multiple logistic regression analyses based on the pooled sample (n = 2058) controlling for gender and age, found that ethnic group membership, premigration TEs (16 or more TEs: OR, 2.00; 95% CI, 1.39-2.88; p < 0.001), PMLDs (10-15 PMLDs: OR, 4.19; 95% CI, 3.17-5.54; 16 or more PMLDs: OR, 7.23; 95% CI, 5.24-9.98; p < 0.001) and ASI score (ASI score 100 or greater: OR, 2.19; 95% CI, 1.46-3.30; p < 0.001) contributed to CMD. CONCLUSIONS Factors specific to each ethnic group and differences in the quantum of exposure to TEs, PMLDs and psychosocial disruptions appeared to account in large part for differences in prevalence rates of CMDs observed across these three groups.
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Affiliation(s)
- Alvin Kuowei Tay
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia
| | - Mohammed Mohsin
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Khat Mung Hau
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
| | - Mohammad Badrudduza
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
| | | | - Karen Morgan
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Nirmalatiban Parthiban
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Derrick Silove
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
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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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Christy S, Siriwardhana C, Lohmann J, Roberts B, Smith S. Quality of mental health questionnaires in conflict-affected adult populations in low and middle income countries: A systematic review. J Migr Health 2021; 4:100068. [PMID: 34901899 PMCID: PMC8640451 DOI: 10.1016/j.jmh.2021.100068] [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: 03/29/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Accurate measurement of mental health disorders in conflict-affected populations is crucial for improving mental health care for these populations. Most studies to develop mental health questionnaires for conflict-affected populations are conducted in high income countries despite the vast majority of conflict-affected populations residing in Low and Middle Income Countries (LAMICs). The aim of this systematic review is to assess the quality of questionnaires for mental disorders that have been either developed or validated in conflict- affected settings in LAMICs. METHODS A systematic review of 5 databases (CINAHL Plus, EMBASE, Global Health, MEDLINE and PsycINFO) was conducted to identify validation studies for questionnaires measuring mental health disorders in adult conflict-affected population in LAMICs. Well-established psychometric criteria evaluating reliability, validity and responsiveness of questionnaires were applied for quality appraisal. RESULTS Thirty validation studies were included in this review, which reported on data for 33 questionnaires. Twenty-four were questionnaires that had been originally developed in different settings and adapted for use with a new conflict-affected population and 9 had been newly developed for the conflict-affected population being studied. Overall, there was high variability in the quality of evidence for the questionnaires with moderate evidence for the validity and reliability of included questionnaires but no responsiveness data reported. CONCLUSION There has been increasing recognition of the particular importance of psychometrics in this field to facilitate the development of good quality mental health questionnaires suitable for use in LAMICs. However, this review highlighted the current limited quantity and quality of such questionnaires.
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Affiliation(s)
- Sharon Christy
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | | | - Julia Lohmann
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Sarah Smith
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
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Priorities for addressing substance use disorder in humanitarian settings. Confl Health 2021; 15:71. [PMID: 34556142 PMCID: PMC8460183 DOI: 10.1186/s13031-021-00407-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Populations affected by humanitarian emergencies are vulnerable to substance (alcohol and other drug) use disorders, yet treatment and prevention services are scarce. Delivering substance use disorder treatment services in humanitarian settings is hampered by limited guidance around the preparation, implementation, and evaluation of substance use disorder treatment programs. This study aims to identify and prioritize key gaps and opportunities for addressing substance use disorder in humanitarian settings.
Methods UNODC convened a consultation meeting (n = 110) in coordination with UNHCR and WHO and administered an online survey (n = 34) to, thirteen program administrators and policymakers, eleven service providers, nine researchers, and one person with lived experience to explore best practices and challenges to addressing substance use disorder in diverse populations and contexts. Participants presented best practices for addressing substance use disorder, identified and ranked challenges and opportunities for improving the delivery of substance use disorder treatment interventions, and provided recommendations for guidelines that would facilitate the delivery of substance use disorder treatment services in humanitarian emergencies. Results Participants agreed on key principles for delivering substance use disorder treatment in humanitarian settings that centered on community engagement and building trust, integrated service delivery models, reducing stigma, considering culture and context in service delivery, and an ethical ‘do no harm’ approach. Specific gaps in knowledge that precluded the delivery of appropriate substance use disorder treatment include limited knowledge of the burden and patterns of substance use in humanitarian settings, the effectiveness of substance use disorder treatment services in humanitarian settings, and strategies for adapting and implementing interventions for a given population and humanitarian context. Participants emphasized the need to strengthen awareness and commitment related to the burden of substance use disorder treatment interventions among communities, practitioners, and policymakers in humanitarian settings. Conclusions Results from this consultation process highlight existing gaps in knowledge related to the epidemiology and treatment of substance use disorders in humanitarian emergencies. Epidemiological, intervention, and implementation research as well as operational guidance are needed to fill these gaps and improve access to substance use treatment services in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00407-z.
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Yoshihama M. Visualizing drivers of gender health disparities: Ongoing participatory action research following the 2011 disaster in Japan. Soc Sci Med 2021; 283:114133. [PMID: 34218116 DOI: 10.1016/j.socscimed.2021.114133] [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: 10/08/2020] [Revised: 02/24/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
As part of an ongoing participatory action research project initiated following the 2011 Great East Japan Disaster to improve disaster policies and responses, this study examines social factors and processes that affect women's well-being in and after disasters. Using PhotoVoice methodology, the project has engaged women affected by the Great East Japan Disaster in participatory assessment and analysis over the last ten years. Begun in three sites in June 2011, the project is currently operating in seven locations: four in the coastal areas affected by the tsunami in the Iwate and Miyagi prefectures; two in Fukushima Prefecture; and one in the Tokyo Metropolitan Area, where the largest number of out-of-prefecture evacuees reside. Participating members, recruited in collaboration with local NGOs, are women affected by the disaster aged from in their 20s to over 70 years. They take photographs of their lives and attend facilitated group discussions on an ongoing basis. Participatory analysis of their photographs and narratives by members and group facilitators (including the author) uses the analytical approach of grounded theory's open and focused coding with constant comparison. The analysis identifies various ways the disaster affected women, compromising their livelihood, safety, and well-being. It reveals an interconnection between the evacuation of children and women of reproductive age, loss of employment in the female-dominated occupational sectors, and increased dependent care responsibilities, which in turn compromises women's financial and emotional well-being. The analysis also elucidates the gendered division of labor in private and public spheres, shortages of maternal and infant health care, and gender-based violence in the post-disaster context. Notably, many of these issues and connections correspond to known social determinants of health disparities. The study findings add a valuable but often neglected local perspective and call for increased policy attention to eliminating gender disparities in disasters.
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Affiliation(s)
- Mieko Yoshihama
- University of Michigan School of Social Work1080 S. University, Ann Arbor, MI, 48109-1106, USA.
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Yuval K, Aizik-Reebs A, Lurie I, Demoz D, Bernstein A. A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention. Transcult Psychiatry 2021; 58:268-282. [PMID: 33292082 DOI: 10.1177/1363461520965436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.
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Affiliation(s)
| | | | - Ido Lurie
- Shalvata Mental Health Center, Hod HaSharon, Israel and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University
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Bleile ACE, Koppenol-Gonzalez GV, Verreault K, Abeling K, Hofman E, Vriend W, Hasan A, Jordans MJD. Process evaluation of TeamUp: a movement-based psychosocial intervention for refugee children in the Netherlands. Int J Ment Health Syst 2021; 15:25. [PMID: 33741025 PMCID: PMC7977563 DOI: 10.1186/s13033-021-00450-6] [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: 10/12/2020] [Accepted: 03/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly 60,000 people applied for asylum in the Netherland in 2015, confronting the governmental structures and services with great administrative, logistical and service provision challenges. Refugee children's psychosocial needs and wellbeing are often overlooked, and post-migration support is of pivotal importance. METHODS An easy accessible movement-based psychosocial intervention, called TeamUp, was developed for children aged 6-17 living in refugee reception centres. A mixed-method process evaluation was conducted of (1) implementation process, assessing attendance (n = 2183 children, and n = 209 children); (2) implementation quality, using structured observations at two time points to evaluate facilitator's (2a) individual-level fidelity (n = 81 facilitators); (2b) team-level fidelity (n = 22 teams); (2c) facilitators' competencies (n = 81); (2d) trainee perceived self-efficacy pre-post training (n = 73); and (3) perceptions on implementation and outcomes, employing a survey (n = 99), focus group discussions and key informant interviews with children (n = 94), facilitators (n = 24) and reception centre staff (n = 10). RESULTS Attendance lists showed a mean of 8.5 children per session, and children attending 31.3% of sessions. Structured observations demonstrated 49.2% and 58.2% individual-level fidelity, 72.5% and 73.0% team-level fidelity, and 82.9% and 88.4% adequacy in competencies, each at T1 and T2 respectively. The main reported challenges included managing children's energy regulation (e.g. offering settling moments) and challenging behaviour. Training participation significantly improved perceived self-efficacy for trainees. The facilitator survey demonstrated on average, high satisfaction and self-efficacy, low experienced burden, and high perceived capacity-building support. Qualitatively, TeamUp was positively perceived by all stakeholders and was regarded as contributing to children's psychosocial outcomes. CONCLUSION (1) Attendance and group size were lower than expected. (2) The intervention's facilitator fidelity ranged from moderate to adequate-exhibiting a need for specific fidelity and capacity strengthening-while facilitator competencies were high. Trainee's perceived self-efficacy improved significantly following a 2-day training. (3) Facilitators expressed high levels of satisfaction, self-efficacy and support, and low burden. The intervention was positively perceived by all stakeholders and to have a positive impact on children's psychosocial learning and wellbeing.
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Affiliation(s)
| | | | | | | | - Elin Hofman
- War Child Holland, Amsterdam, The Netherlands
| | | | - Adnan Hasan
- War Child Holland, Amsterdam, The Netherlands
| | - Mark J D Jordans
- War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
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Esponda GM, Ryan GK, Estrin GL, Usmani S, Lee L, Murphy J, Qureshi O, Endale T, Regan M, Eaton J, De Silva M. Lessons from a theory of change-driven evaluation of a global mental health funding portfolio. Int J Ment Health Syst 2021; 15:18. [PMID: 33640004 PMCID: PMC7913430 DOI: 10.1186/s13033-021-00442-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the underinvestment in global mental health to-date, it is important to consider how best to maximize the impact of existing investments. Theory of Change (ToC) is increasingly attracting the interest of funders seeking to evaluate their own impact. This is one of four papers investigating Grand Challenges Canada's (GCC's) first global mental health research funding portfolio (2012-2016) using a ToC-driven approach. METHODS A portfolio-level ToC map was developed through a collaborative process involving GCC grantees and other key stakeholders. Proposed ToC indicators were harmonised with GCC's pre-existing Results-based Management and Accountability Framework to produce a "Core Metrics Framework" of 23 indicators linked to 17 outcomes of the ToC map. For each indicator relevant to their project, the grantee was asked to set a target prior to the start of implementation, then report results at six-month intervals. We used the latest available dataset from all 56 projects in GCC's global mental health funding portfolio to produce a descriptive analysis of projects' characteristics and outcomes related to delivery. RESULTS 12,999 people were trained to provide services, the majority of whom were lay or other non-specialist health workers. Most projects exceeded their training targets for capacity-building, except for those training lay health workers. Of the 321,933 people screened by GCC-funded projects, 162,915 received treatment. Most projects focused on more than one disorder and exceeded all their targets for screening, diagnosis and treatment. Fewer people than intended were screened for common mental disorders and epilepsy (60% and 54%, respectively), but many more were diagnosed and treated than originally proposed (148% and 174%, respectively). In contrast, the three projects that focused on perinatal depression exceeded screening and diagnosis targets, but only treated 43% of their intended target. CONCLUSIONS Under- or over-achievement of targets may reflect operational challenges such as high staff turnover, or challenges in setting appropriate targets, for example due to insufficient epidemiological evidence. Differences in delivery outcomes when disaggregated by disorder suggest that these challenges are not universal. We caution implementers, funders and evaluators from taking a one-size-fits all approach and make several recommendations for how to facilitate more in-depth, multi-method evaluation of impact using portfolio-level ToC.
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Affiliation(s)
- G Miguel Esponda
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK.
- ESRC Centre for Society and Mental Health, King's College London, London, UK.
| | - G K Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - G Lockwood Estrin
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, London, UK
| | - S Usmani
- Independent Researcher, Minneapolis, MN, USA
| | - L Lee
- Independent Researcher, London, UK
| | - J Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - O Qureshi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - T Endale
- Department of Counselling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - M Regan
- Health Improvement Directorate, Public Health England, London, UK
| | - J Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- CBM Global, Cambridge, UK
| | - M De Silva
- Department of Population Health, Wellcome Trust, London, UK
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Jordans MJD, Kohrt BA. Scaling up mental health care and psychosocial support in low-resource settings: a roadmap to impact. Epidemiol Psychiatr Sci 2020; 29:e189. [PMID: 33239113 PMCID: PMC7737188 DOI: 10.1017/s2045796020001018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Despite recent global attention to mental health and psychosocial support services and a growing body of evidence-support interventions, few mental health services have been established at a regional or national scale in low- and middle-income countries (LMIC). There are myriad challenges and barriers ranging from testing interventions that do not target priority needs of populations or policymakers to interventions that cannot achieve adequate coverage to decrease the treatment gap in LMIC. METHOD We propose a 'roadmap to impact' process that guides planning for interventions to move from the research space to the implementation space. RESULTS We establish four criteria and nine associated indicators that can be evaluated in low-resource settings to foster the greatest likelihood of successfully scaling mental health and psychosocial interventions. The criteria are relevance (indicators: population need, cultural and contextual fit), effectiveness (change in mental health outcome, change in hypothesised mechanism of action), quality (adherence, competence, attendance) and feasibility (coverage, cost). In the research space, relevance and effectiveness need to be established before moving into the implementation space. In the implementation space, ongoing monitoring of quality and feasibility is required to achieve and maintain a positive public health impact. Ultimately, a database or repository needs to be developed with these criteria and indicators to help researchers establish and monitor minimum benchmarks for the indicators, and for policymakers and practitioners to be able to select what interventions will be most likely to succeed in their settings. CONCLUSION A practicable roadmap with a sequence of measurable indicators is an important step to delivering interventions at scale and reducing the mental health treatment gap around the world.
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Affiliation(s)
- Mark J. D. Jordans
- Research & Development, War Child Holland, Amsterdam, the Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry & Behavioral Sciences, The George Washington University
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24
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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: 19] [Impact Index Per Article: 4.8] [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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Purgato M, Tedeschi F, Bonetto C, de Jong J, Jordans MJD, Tol WA, Barbui C. Trajectories of psychological symptoms and resilience in conflict-affected children in low- and middle-income countries. Clin Psychol Rev 2020; 82:101935. [PMID: 33126036 DOI: 10.1016/j.cpr.2020.101935] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/17/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
Longitudinal studies on children's and adolescents' psychological reactions to conflict-related traumatic events in low- and middle-income countries are scarce. The present study aimed to analyze children's and adolescents' responses to conflict-related potentially traumatic events (PTEs) and the impact of the number of different types of PTEs on psychological symptoms and resilience over time. We investigated the presence of psychological symptoms and resilience, defined as low levels of symptoms and high levels of hope, in a sample of 597 conflict-affected children and adolescents allocated to a waiting list condition in four randomized trials conducted in Burundi, Indonesia, Nepal and Sri Lanka. A decrease in functional impairment (p < 0.001), symptoms of PTSD (p < 0.001), anxiety (p < 0.001), depression (p = 0.052), and an increase in social support (p < 0.001), was observed over a six-month follow-up. More than one third of children and adolescents (34.6%) exposed to conflict-related traumatic events improved at follow-up. Levels of hope did not significantly change. Improvement in psychological symptoms and resilience were significantly associated with the number of different types of PTEs experienced before study entry. This study showed that children and adolescents have the capacity to react to multiple traumatic events, and that the number of different types of traumatic events has an impact on resilience mechanisms. This will help differentiate the choice and focus of psychosocial interventions according to the amount of traumatic events experienced by children and adolescents, and will inform the development and testing of new psychosocial interventions.
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Affiliation(s)
- Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy.
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Bonetto
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Joop de Jong
- Amsterdam University Medical Center, The Netherlands; Boston University School of Medicine, Boston, MA, USA
| | - Mark J D Jordans
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands; Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy
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26
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Riello M, Purgato M, Bove C, MacTaggart D, Rusconi E. Prevalence of post-traumatic symptomatology and anxiety among residential nursing and care home workers following the first COVID-19 outbreak in Northern Italy. ROYAL SOCIETY OPEN SCIENCE 2020; 7:200880. [PMID: 33047047 PMCID: PMC7540798 DOI: 10.1098/rsos.200880] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/16/2020] [Indexed: 05/07/2023]
Abstract
The current COVID-19 pandemic has been officially linked to the deaths of hundreds of thousands of people across the globe in just a few months. It is particularly lethal for the elderly in general, as well as for populations residing in long-term stay facilities. By this time, those working and caring for high-risk populations have been exposed to very intense and sudden levels of physical and psychological strain. The situation has taken a particularly tragic turn in residential nursing and care homes (NCH), which were hit hard by the pandemic. In residential NCH, neither residents nor workers tend to have immediate access to the same expertise, medication and equipment as in hospitals, which exacerbates an already tense situation. Among the mental health conditions related to exposure to potentially traumatic events, post-traumatic stress disorder and anxiety are the most prevalent and scientifically recognized. In this survey-based epidemiological study, we test the prevalence of anxiety and post-traumatic symptomatology in residential nursing and care home workers-a group of individuals that has been largely neglected but who nonetheless plays a very important and sensitive role in our society. We do this by focusing on the North of Italy, the most affected region during the first COVID-19 outbreak in Italy. Using a single-stage cluster design, our study returns an estimate for the prevalence of moderate-to-severe anxiety and/or post-traumatic symptomatology of 43% (s.e. = 3.09; 95% CI [37-49]), with an 18% (s.e. = 1.83; 95% CI [14-22]) prevalence of comorbidity among workers of Northern Italian NCH between 15 June and 25 July 2020 (i.e. 12-52 days after the end of national lockdown). Women and workers who had recently been in contact with COVID-19-positive patients/colleagues are more likely to report moderate-to-severe symptoms, with odds ratios of 2.2 and 1.7, respectively.
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Affiliation(s)
- Marianna Riello
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, 38068 Rovereto (TN), Italy
- Gruppo SPES, Trento, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Bove
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, 38068 Rovereto (TN), Italy
| | - David MacTaggart
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Elena Rusconi
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, 38068 Rovereto (TN), Italy
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Panter-Brick C, Eggerman M, Ager A, Hadfield K, Dajani R. Measuring the psychosocial, biological, and cognitive signatures of profound stress in humanitarian settings: impacts, challenges, and strategies in the field. Confl Health 2020; 14:40. [PMID: 32582366 PMCID: PMC7310257 DOI: 10.1186/s13031-020-00286-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/05/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Evidence of 'what works' in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial intervention, implemented by Mercy Corps with Syrian refugees and Jordanian host-community youth. In this paper, we present a case analysis of this evaluation study and reflect on the scientific contributions of the work, the challenges experienced in its delivery, and the strategies deployed to address them. DISCUSSION We identified challenges with respect to study design, methods, and dissemination: these included the logistics and acceptability of implementing a randomized controlled trial in a humanitarian context, the selection and refinement of culturally-relevant research tools and community-based practices, and the dissemination of results to multiple stakeholders. We demonstrated beneficial and sustained impacts on self-reports of insecurity, stress, and mental health; developed a reliable and culturally-relevant measure of resilience; experimentally tested cognitive skills; and showed that levels of cortisol, a biomarker of chronic stress, reduced by one third in response to intervention. Using stress biomarkers offered proof-of-concept evidence, beyond self-reported data: interventions targeting mental health and psychosocial wellbeing can regulate physiological stress in the body as well as improve self-reported mental health and wellbeing. We built constructive dialogue between local communities, scholars, humanitarian practitioners, and policy-makers. CONCLUSIONS Our work shows the value of rigorous research in humanitarian settings, emphasizing relevance for local communities and meaningful ways to build research ownership. Findings encourage the adoption of cognitive measures and stress biomarkers alongside self-report surveys in evaluating programme impacts. High-quality scientific research with youth can be feasible, useful, and ethical in humanitarian settings.
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Affiliation(s)
- Catherine Panter-Brick
- Department of Anthropology & Jackson Institute of Global Affairs, Yale University, New Haven, USA
| | - Mark Eggerman
- MacMillan Center for International and Area Studies, Yale University, New Haven, USA
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Kristin Hadfield
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Rana Dajani
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan
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Kohrt BA, Mistry AS, Anand N, Beecroft B, Nuwayhid I. Health research in humanitarian crises: an urgent global imperative. BMJ Glob Health 2019; 4:e001870. [PMID: 31798999 PMCID: PMC6861060 DOI: 10.1136/bmjgh-2019-001870] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/30/2023] Open
Abstract
Globally, humanitarian crises-such as armed conflict, forced displacement, natural disasters and major disease outbreaks-affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in humanitarian settings. While working in these settings is uniquely challenging, there are effective strategies that can be employed, such as using flexible and adaptive research methodologies, partnering with non-governmental organisations and other humanitarian actors, and devoting greater attention to issues of research ethics, community engagement, local LMIC-based partners, building humanitarian research capacity and collaborating across disciplines.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences and Department of Global Health, George Washington University, Washington, DC, USA
| | - Amit S Mistry
- Fogarty International Center, NIH, Bethesda, Maryland, USA
| | - Nalini Anand
- Fogarty International Center, NIH, Bethesda, Maryland, USA
| | | | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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29
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Tomlinson M, Darmstadt GL, Yousafzai AK, Daelmans B, Britto P, Gordon SL, Tablante E, Dua T. Global research priorities to accelerate programming to improve early childhood development in the sustainable development era: a CHNRI exercise. J Glob Health 2019; 9:020703. [PMID: 31673352 PMCID: PMC6815874 DOI: 10.7189/jogh.09.020703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Approximately 250 million children under the age of five in low and middle-income countries (LMICs) will not achieve their developmental potential due to poverty and stunting alone. Investments in programming to improve early childhood development (ECD) have the potential to disrupt the cycle of poverty and therefore should be prioritised. Support for ECD has increased in recent years. Nevertheless, donors and policies continue to neglect ECD, in part from lack of evidence to guide policy makers and donors about where they should focus policies and programmes. Identification and investment in research is needed to overcome these constraints and in order to achieve high quality implementation of programmes to improve ECD. Methods The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities for improving ECD. A group of 348 global and local experts in ECD-related research were identified and invited to generate research questions. This resulted in 406 research questions which were categorised and refined by study investigators into 54 research questions across six thematic goals which were evaluated using five criteria: answerability, effectiveness, feasibility, impact, and effect on equity. Research options were ranked by their final research priority score multiplied by 100. Results The top three research priority options from the LMIC experts came from the third thematic goal of improving the impact of interventions, whereas the top three research priority options from high-income country experts came from different goals: improving the integration of interventions, increasing the understanding of health economics and social protection strategies, and improving the impact of interventions. Conclusion The results of this process highlight that priorities for future research should focus on the need for services and support to parents to provide nurturing care, and the training of health workers and non-specialists in implementation of interventions to improve ECD. Three of the six thematic goals of the present priority setting centred on interventions (ie, improving impact, implementation of interventions and improving the integration of interventions). In order to achieve higher coverage through sustainable interventions to improve ECD with equitable reach, interventions should be integrated and not be sector driven.
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Affiliation(s)
- Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Pia Britto
- Early Childhood Development Unit, UNICEF, New York, New York, USA
| | - Sarah L Gordon
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Tarun Dua
- World Health Organization, Geneva, Switzerland
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Metzler J, Diaconu K, Hermosilla S, Kaijuka R, Ebulu G, Savage K, Ager A. Short- and longer-term impacts of Child Friendly Space Interventions in Rwamwanja Refugee Settlement, Uganda. J Child Psychol Psychiatry 2019; 60:1152-1163. [PMID: 31106415 PMCID: PMC6852245 DOI: 10.1111/jcpp.13069] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The establishment of Child Friendly Spaces (CFSs) has become a widespread intervention targeting protection and support for displaced children in humanitarian contexts. There is a lack of evidence of impact of these interventions with respect to both short-term outcomes and longer-term developmental trajectories. METHODS We collected data from caregivers of Congolese refugee children residing in Rwamwanja Refugee Settlement at three timepoints. To assess short-term impact of CFSs, we compared indicators assessed shortly after refugees' arrival (baseline, T1) and endline (T2, three to six months after CFS implementation) amongst 430 CFS attenders and 161 nonattenders. Follow-up assessments after the end of CFS programming were conducted 18 months post-baseline (T3) with caregivers of 249 previous CFS attenders and 77 CFS nonattenders. RESULTS In the short-term, attendance at CFSs was associated with better maintenance of psychosocial well-being (PSWB; β = 2.093, p < .001, Cohen's d = .347) and greater increases in developmental assets (β = 2.517, p < .001, Cohen's d = .231), with significantly stronger impacts for girls. CFS interventions meeting higher programing quality criteria were associated with greater impact on both PSWB and development assets (β = 2.603 vs. β = 1.793 and β = 2.942 vs. β = 2.337 for attenders at higher and lower-quality CFSs c.f. nonattenders, respectively). Amongst boys, benefits of program attendance were only indicated for those attending higher-quality CFS (β = 2.084, p = .006 for PSWB). At follow-up, however, there were no discernable impacts of prior CFS attendance on any measures. Age and school attendance were the only characteristics that predicted an outcome - developmental assets - at follow-up. CONCLUSIONS Attendance at CFSs - particularly involving higher-quality programming - supported children's well-being and development. However, sustained impact beyond active CFS programming was not demonstrated. Intervention goals and strategies in humanitarian contexts need to address the challenge of connecting children to other resources to facilitate developmental progress in conditions of protracted displacement.
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Affiliation(s)
- Janna Metzler
- Department of Population and Family HealthMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Karin Diaconu
- Institute for Global Health and DevelopmentQueen Margaret UniversityEdinburghScotlandUK
| | | | | | | | - Kevin Savage
- Humanitarian and Emergency AffairsWorld Vision InternationalGenevaSwitzerland
| | - Alastair Ager
- Department of Population and Family HealthMailman School of Public HealthColumbia UniversityNew YorkNYUSA,Institute for Global Health and DevelopmentQueen Margaret UniversityEdinburghScotlandUK
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31
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Yoder - van den Brink HN. Reflections on "Building Back Better" Child and Adolescent Mental Health Care in a Low-Resource Postemergency Setting: The Case of Sierra Leone. Front Psychiatry 2019; 10:758. [PMID: 31736794 PMCID: PMC6834689 DOI: 10.3389/fpsyt.2019.00758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/20/2019] [Indexed: 12/30/2022] Open
Abstract
Over the past three decades, Sierra Leone has experienced two major humanitarian crises: an armed conflict (1991-2002) and an Ebola virus disease outbreak (2014-2015). In addition to these country-wide crises, the capital Freetown experienced a mudslide affecting thousands of people in 2017. In response to these emergencies, donors and aid organizations showed an increased interest in supporting and implementing mental health and psychosocial support interventions. Despite these efforts, the mental health infrastructure of the country remains frail. Specifically, systemic improvements in the implementation of evidence-based mental health care for children and adolescents appear to be lacking. In this article, the Interactive Systems Framework for Dissemination and Implementation is used as a tool to analyze issues related to the development of a sustainable, contextually relevant child and adolescent mental health-care delivery system. The author draws on her long-term experience as a child mental health specialist in Sierra Leone. Observations and hypotheses are tested and supplemented by formal and informal reports and national and international literature. The three systems described by the Interactive Systems Framework are explored in the context of Sierra Leone: (1) Synthesis and Translation, (2) Support, and (3) Delivery. Interaction between the three Systems is discussed as critical to the successful dissemination and implementation of interventions. Ample attention is given to contextual factors that are believed to be paramount to the development of child and adolescent mental health care in Sierra Leone. The article concludes with a reflection on the usefulness of the Interactive Systems Framework in the dissemination and implementation of child and adolescent mental health-care interventions in low-resource, postemergency settings. It is suggested that, in addition to funding and policies, the child and adolescent mental health system in Sierra Leone could benefit from the development of contextually relevant interventions, improvement of capacity-building efforts, and acknowledgment of the role of community-based practitioners in the delivery of services. Local mental health experts, especially those trained in child and adolescent mental health, should be empowered to work together with culturally competent expatriate professionals to improve child and adolescent mental health care in Sierra Leone.
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Affiliation(s)
- Hélène N.C. Yoder - van den Brink
- Department of Sociology and Anthropology, Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, Netherlands
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Lee C, Nguyen AJ, Haroz E, Tol W, Aules Y, Bolton P. Identifying research priorities for psychosocial support programs in humanitarian settings. Glob Ment Health (Camb) 2019; 6:e23. [PMID: 31662878 PMCID: PMC6796323 DOI: 10.1017/gmh.2019.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/18/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Given the range and reach of psychosocial support (PSS) interventions in humanitarian settings, within the continuum of mental health and psychosocial support services, evaluation of their impact is critical. Understanding stakeholders' perspectives on which PSS interventions of unknown effectiveness warrant rigorous evaluation is essential to identify research priorities. This project aimed to facilitate a process with stakeholders to reach consensus on PSS interventions that are of high priority for further research based on existing evidence and stakeholders' opinions. METHODS Interviews with 109 stakeholders working on PSS programming in humanitarian settings served as the foundation for two in-person regional meetings and four webinars. Nominal Group Technique (NGT) was used to develop a priority PSS program list. The top five priorities from each meeting were combined for a final online survey distributed globally. RESULTS Seventy participants across six meetings contributed to the prioritization process. Eighty-seven individuals completed the final online survey. 'Community based PSS' was the top-ranked research priority, followed by PSS integrated into basic services, providing PSS to caregivers to improve child wellbeing, PSS-focused gender-based violence programming, and classroom-based PSS interventions. CONCLUSIONS NGT and online surveys were effective methods to engage stakeholders in a priority setting exercise to development a research agenda. Information from this stage of the project will be combined with findings from a concurrent systematic review to form the base of a second phase of work, which will include the development and implementation of a research strategy to strengthen the evidence base for those prioritized interventions.
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Affiliation(s)
- C. Lee
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore MD, USA
| | - A. J. Nguyen
- Department of Human Services, Curry School of Education, University of Virginia, 405 Emmet St S., Charlottesville, VA, USA
| | - E. Haroz
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore MD, USA
| | - W. Tol
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore MD, USA
| | - Y. Aules
- Independent Contractor with the Applied Mental Health Research Group, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - P. Bolton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore MD, USA
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Hermosilla S, Metzler J, Savage K, Musa M, Ager A. Child friendly spaces impact across five humanitarian settings: a meta-analysis. BMC Public Health 2019; 19:576. [PMID: 31092239 PMCID: PMC6521445 DOI: 10.1186/s12889-019-6939-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies. METHODS We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen's d for difference in mean difference scores between attenders and non-attenders - who proved comparable on baseline measures - by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains. RESULTS Amongst children aged 6-11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen's d = 0.48, 95% CI 0.08-0.88), psychosocial wellbeing (Ethiopia, d = 0.51, 95% CI 0.10-0.91; and Uganda, d = 0.21, 95% CI 0.02-0.40), and developmental assets (Uganda, d = 0.37, 95% CI 0.15-0.59; and Iraq, d = 0.86, 95% CI 0.18-1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing (d = 0.18, 95% CI 0.03-0.33). Among children aged 12-17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07-1.09), with pooled analysis indicating no significant impacts. CONCLUSION CFS can provide - albeit inconsistently - a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required.
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Affiliation(s)
| | - Janna Metzler
- Columbia University, 1051 Riverside Drive, New York, 10032 USA
| | - Kevin Savage
- World Vision International, Chemin de Balexert 7-9, 1219 Châtelaine, Geneva, Switzerland
| | - Miriam Musa
- Columbia University, 1051 Riverside Drive, New York, 10032 USA
| | - Alastair Ager
- Columbia University, 1051 Riverside Drive, New York, 10032 USA
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland EH21 6UU UK
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Tay AK, Rees S, Tam N, Kareth M, Silove D. Developing a measure of adaptive stress arising from the psychosocial disruptions experienced by refugees based on a sample of displaced persons from West Papua. Int J Methods Psychiatr Res 2019; 28:e1770. [PMID: 30740811 PMCID: PMC6877204 DOI: 10.1002/mpr.1770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We report the testing and refinement of the Adaptive Stress Index (ASI), a psychosocial assessment tool designed to measure the longer terms stressors of adapting to the psychosocial disruptions experienced by refugees. METHODS The ASI is based on a theoretical model, the Adaptation and Development After Persecution and Trauma (ADAPT), which postulates that five psychosocial domains are disrupted by conflict and displacement, namely, safety and security, attachment, access to justice, roles and identities, and existential meaning. We used confirmatory factor analysis (CFA) and item response theory (IRT) to shorten and refine the measure based on data obtained from 487 refugees participating in a household survey in Papua New Guinea (response rate: 85.8%). RESULTS CFA allowed the exclusion of low loading items (<0.5) and locally dependent items. A good fit was found for single models representing each of the five ASI domains. A graded response IRT model identified items with the highest discrimination and information content in each of the five derived scales. CONCLUSIONS The analysis produced a shortened and refined ASI for use amongst refugee populations. The study offers a guide to adapting measures of stress for application to diverse populations exposed to mass conflict and refugee displacement.
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Affiliation(s)
- Alvin Kuowei Tay
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Rees
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalino Tam
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Moses Kareth
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Derrick Silove
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Allen CW, Siedlecki T, Nagel AG, Tan JS, Datta P, Henkler KC, Allen JP. Brief behavioral interventions at free medical fairs. Int J Psychiatry Med 2018; 53:371-383. [PMID: 30253715 PMCID: PMC6537097 DOI: 10.1177/0091217418791441] [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] [Indexed: 11/16/2022]
Abstract
Free medical fairs have emerged to compensate for the lack of access to affordable health care in rural areas of the United States. Mental health services are offered less frequently than other medical services, despite a documented need, perhaps due to a belief that mental health interventions could not be effective in a single session. We examined the types of problems presented at three rural medical fairs, and whether single session mental health interventions affected participants' health confidence, distress, or progress toward health-related goals. Problems presented included mental health, legal, financial, tobacco cessation, and relationship problems. Findings indicated that, on average, participants gained health confidence and reduced distress and found the service very helpful. The majority of those reached for phone follow-up reported progress on one or more health goals. Goals that involved manageable steps within the participants' own control, such as gratitude practices or progressive muscle relaxation, were the most likely to be completed. Implementation lessons included the importance of learning about the fairs' cultures, advertising the services, location of services, being proactive in connecting with patients, and preparing resources for community referrals. Overall, findings suggest that mental health interventions can have a positive impact on some people at free medical fairs. Given that tens of thousands of people attend each year, the fairs offer a fruitful opportunity to reach some of our most underserved citizens.
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Affiliation(s)
- Claudia W Allen
- Department of Family Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Theodore Siedlecki
- Department of Family Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Alison G Nagel
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Tan
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Pooja Datta
- Jefferson Digital Commons, Thomas Jefferson University, Curry School of Education, University of Virginia, Charlottesville, VA, USA
| | - Kelly C Henkler
- Department of Family Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Joseph P Allen
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Morina N, Stam K, Pollet TV, Priebe S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J Affect Disord 2018; 239:328-338. [PMID: 30031252 DOI: 10.1016/j.jad.2018.07.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/21/2018] [Accepted: 07/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions. METHODS To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions. RESULTS We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD. LIMITATIONS The findings are limited by poor psychometric reporting practices. CONCLUSIONS Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.
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Affiliation(s)
- Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany; Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Kimberly Stam
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas V Pollet
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, UK
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Lenglet A, Lopes-Cardozo B, Shanks L, Blanton C, Feo C, Tsatsaeva Z, Idrisov K, Bolton PA, Pintaldi G. Outcomes of an individual counselling programme in Grozny, Chechnya: a randomised controlled study. BMJ Open 2018; 8:e019794. [PMID: 30139892 PMCID: PMC6112398 DOI: 10.1136/bmjopen-2017-019794] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of individual counselling on functioning of clients participating in a mental health intervention in a humanitarian setting. DESIGN Randomised controlled trial. SETTING Mental health programme implemented by Médecins Sans Frontières in Grozny, Republic of Chechnya. PARTICIPANTS 168 eligible clients were randomly assigned to the intervention and waitlisted (2 months) arms between November 2014 and February 2015. INTERVENTION Individual counselling sessions. MAIN OUTCOME MEASURES Change in functioning was measured using the Short Form 6 (SF6) and gender-specific locally adapted Chechen functioning instruments in the intervention group at the end of counselling and the waitlisted group after their waitlisted period. Unadjusted differences in gain scores (DGSs) between intervention and waitlisted groups were calculated with effect size (Cohen's d) for both tools. Linear regression compared the mean DGS in both groups. RESULTS The intervention group (n=78) improved compared with waitlisted controls (n=80) on the SF6 measures with moderate to large effect sizes: general health (DGS 12.14, d=0.52), body pain (DGS 10.26, d=0.35), social support (DGS 16.07, d=0.69) and emotional functioning (DGS 16.87, d=0.91). Similar improvement was seen using the Chechen functioning instrument score (female DGS -0.33, d=0.55; male DGS -0.40, d=0.99). Adjusted analysis showed significant improvement (p<0.05) in the intervention group for all SF6 measures and for the Chechen functioning instrument score in women but not men (p=0.07). CONCLUSIONS Individual counselling significantly improved participants' ability to function in the intervention group compared with the waitlisted group. Further research is needed to determine whether similar positive results can be shown in other settings and further exploring the impact in male clients' population. TRIAL REGISTRATION NUMBER NTR4689.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Barbara Lopes-Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Shanks
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Kyuri Idrisov
- Psychiatry Department, Chechnya State University, Grozny, Republic of Chechnya
| | - Paul A Bolton
- Departments of International Health and Mental Health,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giovanni Pintaldi
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
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Rabaia Y, de Jong J, Abdullah A, Giacaman R, van de Ven P. Well-being and pressures of daily life in two West Bank villages-Exploring context and history. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2018; 54:510-520. [PMID: 29869785 DOI: 10.1002/ijop.12495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/24/2018] [Indexed: 11/06/2022]
Abstract
Interest in the well-being of people exposed to long-term violence and conflict has tended to focus on measurable effects of acute traumatic events, while attention to the pressures of their daily living context is relatively new. Using qualitative and quantitative data from a 2005 survey of all female family caretakers in 2 neighbouring Israeli-occupied West Bank villages (n = 820), we explored the associations of demographic, health-related and contextual factors with reported pressures and WHO-5 well-being index scores. The final model explained 17.8% of the variance with negative associations between health-related factors ("back-aches," "stomach aches" "psychological illness in the family") and family-related factors ("male head of household aggressive", "male head of household physically violent") and the WHO-5 well-being index scores. We found positive associations between socio-economic factors ("standard of living"; "number of rooms") and village-related factors ("residency in village A/B") and the WHO-5 well-being index score. Exploring the daily living context of villages A and B illuminated how the impact of historical and political events differed, even in villages that are geographically close. The paper lends support to calls for including politics and history in research on well-being in contexts of long-term violence and conflict.
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Affiliation(s)
- Yoke Rabaia
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Joop de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita Abdullah
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Peter van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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Focused psychosocial interventions for children in low-resource humanitarian settings: a systematic review and individual participant data meta-analysis. LANCET GLOBAL HEALTH 2018. [DOI: 10.1016/s2214-109x(18)30046-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Augustinavicius JL, Greene MC, Lakin DP, Tol WA. Monitoring and evaluation of mental health and psychosocial support programs in humanitarian settings: a scoping review of terminology and focus. Confl Health 2018; 12:9. [PMID: 29560023 PMCID: PMC5858133 DOI: 10.1186/s13031-018-0146-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 01/16/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Monitoring and evaluation of mental health and psychosocial support (MHPSS) programs is critical to facilitating learning and providing accountability to stakeholders. As part of an inter-agency effort to develop recommendations on MHPSS monitoring and evaluation, this scoping review aimed to identify the terminology and focus of monitoring and evaluation frameworks in this field. METHODS We collected program documents (logical frameworks (logframes) and theories of change) from members of the Inter-Agency Standing Committee Reference Group on MHPSS, and systematically searched the peer-reviewed literature across five databases. We included program documents and academic articles that reported on monitoring and evaluation of MHPSS in low- and middle-income countries describing original data. Inclusion and data extraction were conducted in parallel by independent reviewers. Thematic analysis was used to identify common language in the description of practices and the focus of each monitoring and evaluation framework. Logframe outcomes were mapped to MHPSS activity categories. RESULTS We identified 38 program documents and 89 peer-reviewed articles, describing monitoring and evaluation of a wide range of MHPSS activities. In both program documents and peer-reviewed literature there was a lack of specificity and overlap in language used for goals and outcomes. Well-validated, reliable instruments were reported in the academic literature, but rarely used in monitoring and evaluation practices. We identified six themes in the terminology used to describe goals and outcomes. Logframe outcomes were more commonly mapped to generic program implementation activities (e.g. "capacity building") and those related to family and community support, while outcomes from academic articles were most frequently mapped to specialized psychological treatments. CONCLUSIONS Inconsistencies between the language used in research and practice and discrepancies in measurement have broader implications for monitoring and evaluation in MHPSS programs in humanitarian settings within low- and middle-income countries. This scoping review of the terminology commonly used to describe monitoring and evaluation practices and their focus within MHPSS programming highlights areas of importance for the development of a more standardized approach to monitoring and evaluation.
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Affiliation(s)
- Jura L. Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205 USA
| | - M. Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205 USA
| | - Daniel P. Lakin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205 USA
| | - Wietse A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205 USA
- Peter C. Alderman Foundation, Mawanda Rd, Plot #855, Kampala, Uganda
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Dajani R, Hadfield K, van Uum S, Greff M, Panter-Brick C. Hair cortisol concentrations in war-affected adolescents: A prospective intervention trial. Psychoneuroendocrinology 2018; 89:138-146. [PMID: 29358120 DOI: 10.1016/j.psyneuen.2017.12.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
Temporal examinations of the biological signature of stress or trauma in war-affected populations are seldom undertaken. Moreover, few studies have examined whether stress biomarkers track biological sensitivity to brief interventions targeting the improvement of psychosocial wellbeing. Our study is the first to prospectively examine, in war-affected adolescents, the associations between hair cortisol concentrations (HCC) and self-reports of stress, insecurity, posttraumatic reactions, and lifetime trauma. We conducted a randomized controlled trial to test the impact of an 8-week intervention based on profound stress attunement. We collected data for a gender-balanced sample of 733 Syrian refugee (n = 411) and Jordanian non-refugee (n = 322) adolescents (12-18 years), at three time-points. We used growth mixture models to classify cortisol trajectories, and growth models to evaluate intervention impact on stress physiology. We observed three trajectories of HCC: hypersecretion, medium secretion, and hyposecretion (9.6%, 87.5% and 2.9% of the cohort, respectively). For every one percent increase in levels of insecurity, adolescents were 0.02 times more likely to have a trajectory of hypersecretion (95% CI: 1.00, 1.03, p = 0.01). For each additional symptom of posttraumatic stress reported, they were 0.07 times less likely to show hyposecretion (95% CI: 0.89, 0.98, p = 0.01). Indeed, stronger posttraumatic stress reactions were associated with a pattern of within-individual cortisol dysregulation and medium secretion. Overall, HCC decreased by a third in response to the intervention (95% CI: -0.19, -0.03, p = 0.01). While the intervention decreased HCC for youth with hypersecretion and medium secretion, it increased HCC for youth with hyposecretion (95% CI: 0.22, 1.16, p = 0.004), relative to controls. This suggests a beneficial regularization of cortisol levels, corroborating self-reports of improved psychosocial wellbeing. We did not find evidence to suggest that gender, resilience, or posttraumatic stress disorder influenced the strength or direction of responses to the intervention. This robust impact evaluation exemplifies the utility of biomarkers for tracking physiological changes in response to interventions over time. It enhances the understanding of trajectories of endocrine response in adverse environments and patterns of stress responsivity to ecological improvement.
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Affiliation(s)
- Rana Dajani
- Department of Biology and Biotechnology, Hashemite University, Zarqa 13115 Jordan; Radcliffe Institute for Advanced Study, Harvard University, 10 Garden Street, Cambridge, MA 02138, USA.
| | - Kristin Hadfield
- Department of Biological and Experimental Psychology, Fogg Building, Queen Mary University of London, London, E1 4NS, UK.
| | - Stan van Uum
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 268 Grosvenor St., London, Ontario, N6G 4L1, Canada.
| | - Michael Greff
- Robarts Research Institute, Western University, 1151 Richmond St. N., London, Ontario, N6A 5B7, Canada; Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Rd. E., London, Ontario, N6C 2R6, Canada.
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06511, USA; Jackson Institute for Global Affairs, Yale University, 55 Hillhouse Avenue, New Haven, CT 06511, USA.
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Kunovski I, Donker T, Driessen E, Cuijpers P, Andersson G, Sijbrandij M. Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder in international humanitarian aid workers: Study protocol. Internet Interv 2017; 10:23-28. [PMID: 30135749 PMCID: PMC6084880 DOI: 10.1016/j.invent.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Humanitarian aid workers are likely to be exposed or witness complex emergencies. Posttraumatic stress disorder (PTSD) is one of the most widespread and most commonly studied mental health problems after exposure to adversities and trauma. However, face-to-face treatment has limited utilization in the resource-constrained settings where humanitarian aid workers often operate. Internet-delivered cognitive behavioral therapy (iCBT) is a treatment option with the potential to improve the access to evidence-based care for humanitarian aid workers. Until now, only a few studies have evaluated iCBT in the treatment of PTSD. No studies have yet explored the feasibility of iCBT for humanitarian aid workers with PTSD. The aim of this study is to investigate the participants' experiences and progress with the treatment, in order to determine whether TELLUS is acceptable for humanitarian aid workers. METHODS AND DESIGN A pilot feasibility study will be conducted with 20 humanitarian aid workers with a full or subclinical PTSD diagnosis according to DSM-IV criteria. The intervention used is TELLUS, which is a therapist-assisted Internet-delivered treatment program based on trauma-focused CBT components for individuals with PTSD. It contains eight text-based modules, where each module is expected to be completed within one week. DISCUSSION This study may set the ground for a large-scale randomized control trial that would test the effectiveness and cost-effectiveness of the program. The study may contribute to the better understanding of PTSD treatment and increase the availability of evidence-based treatments in resource-constrained settings.
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Affiliation(s)
- Ivo Kunovski
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Tara Donker
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Ellen Driessen
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Sweden, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Marit Sijbrandij
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
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Zitko P, Borghero F, Zavala C, Markkula N, Santelices E, Libuy N, Pemjean A. Priority setting for mental health research in Chile. Int J Ment Health Syst 2017; 11:61. [PMID: 29026439 PMCID: PMC5625763 DOI: 10.1186/s13033-017-0168-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health. Methods A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research. Findings Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions. Conclusion A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0168-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro Zitko
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Unidad de Estudios Asistenciales, Complejo Asistencial Barros Luco, Gran Avenida José Miguel Carrera 3204, San Miguel, 8900085 Santiago, Chile.,Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | | | - Cynthia Zavala
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Department of Public Health, Pontificia Catholic University of Chile, Santiago, Chile
| | - Niina Markkula
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Emilio Santelices
- National Health Research Council, Ministry of Health of Chile', Santiago, Chile
| | - Nicolás Libuy
- Department of Psychiatry, Clinical Hospital of University of Chile, Santiago, Chile
| | - Alfredo Pemjean
- Mental Health Department, Ministry of Health of Chile, Santiago, Chile.,Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
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Morina N, Malek M, Nickerson A, Bryant RA. Meta-analysis of interventions for posttraumatic stress disorder and depression in adult survivors of mass violence in low- and middle-income countries. Depress Anxiety 2017; 34:679-691. [PMID: 28419625 DOI: 10.1002/da.22618] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most survivors of mass violence live in low- and middle-income countries (LMICs). We conducted a meta-analysis of randomized controlled psychotherapy trials for adult posttraumatic stress disorder (PTSD) and/or depression in LMICs. METHODS We included 18 clinical trials (3,058 participants), in which 25 and 18 treatment arms measured symptoms of PTSD and depression, respectively. RESULTS Active treatments for PTSD yielded a large aggregated pre-post effect size (g = 1.29; 95% CI = [0.99; 1.59]) and a small to medium effect size at posttreatment when compared to control conditions (g = 0.39; 95% CI = [0.24; 0.55]). Effect sizes were similar for pretreatment versus follow-up (g = 1.75; 95% CI = [1.17; 2.32]) and in comparison to waitlist at follow-up (g = 0.93; 95% CI = [0.56; 1.31]). Active treatments for depression produced large pre-post (g = 1.28; 95% CI = [0.96; 1.61]) and controlled effect sizes (posttreatment, comparison to control conditions, g = 0.86; 95% CI = [0.54; 1.18]). CONCLUSIONS Our findings suggest that psychological interventions can effectively reduce symptoms of PTSD and depression in LMICs. Future research needs to focus on cost-effective interventions that are likely to be disseminated to the large numbers of war survivors in LMICs.
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Affiliation(s)
- Nexhmedin Morina
- Department of Psychology, University of Münster, Münster, Germany
| | - Mina Malek
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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45
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Martineau T, Woodward A, Sheahan K, Sondorp E. Health systems research in fragile and conflict affected states: a qualitative study of associated challenges. Health Res Policy Syst 2017; 15:44. [PMID: 28592283 PMCID: PMC5461673 DOI: 10.1186/s12961-017-0204-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/10/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges. METHODS Guided by a purposely-selected steering group, this qualitative study collected respondents' perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited. RESULTS Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results. CONCLUSIONS This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts.
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Affiliation(s)
- Tim Martineau
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA United Kingdom
| | - Aniek Woodward
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kate Sheahan
- University of North Carolina, Chapel Hill, NC United States of America
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Morina N, Malek M, Nickerson A, Bryant RA. Psychological interventions for post-traumatic stress disorder and depression in young survivors of mass violence in low- and middle-income countries: meta-analysis. Br J Psychiatry 2017; 210:247-254. [PMID: 28153930 DOI: 10.1192/bjp.bp.115.180265] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 10/13/2016] [Accepted: 10/16/2016] [Indexed: 12/21/2022]
Abstract
BackgroundThe majority of survivors of mass violence live in low- and middle-income countries (LMICs).AimsTo synthesise empirical findings for psychological interventions for children and adolescents with post-traumatic stress disorder (PTSD) and/or depression in LMICs affected by mass violence.MethodRandomised controlled trials with children and adolescents with symptoms of PTSD and/or depression in LMICs were identified. Overall, 21 812 records were found through July 2016 in the Medline, PsycINFO and PILOTS databases; 21 met the inclusion criteria and were reviewed according to recommended guidelines.ResultsTwenty-one studies were included. Active treatments for PTSD yielded large pre-treatment to post-treatment changes (g = 1.15) and a medium controlled effect size (g = 0.57). Effect sizes were similar at follow-up. Active treatments for depression produced small to medium effect sizes. Finally, after adjustment for publication bias, the imputed uncontrolled and controlled effect sizes for PTSD were medium and small respectively.ConclusionsPsychological interventions may be effective in treating paediatric PTSD in LMICs. It appears that more targeted approaches are needed for depressive responses.
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Affiliation(s)
- Nexhmedin Morina
- Nexhmedin Morina, PhD, Department of Psychology, University of Münster, Münster, Germany; Mina Malek, MS, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Angela Nickerson, PhD, Richard A. Bryant, PhD, School of Psychology, University of New South Wales, NSW, Sydney, Australia
| | - Mina Malek
- Nexhmedin Morina, PhD, Department of Psychology, University of Münster, Münster, Germany; Mina Malek, MS, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Angela Nickerson, PhD, Richard A. Bryant, PhD, School of Psychology, University of New South Wales, NSW, Sydney, Australia
| | - Angela Nickerson
- Nexhmedin Morina, PhD, Department of Psychology, University of Münster, Münster, Germany; Mina Malek, MS, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Angela Nickerson, PhD, Richard A. Bryant, PhD, School of Psychology, University of New South Wales, NSW, Sydney, Australia
| | - Richard A Bryant
- Nexhmedin Morina, PhD, Department of Psychology, University of Münster, Münster, Germany; Mina Malek, MS, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Angela Nickerson, PhD, Richard A. Bryant, PhD, School of Psychology, University of New South Wales, NSW, Sydney, Australia
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Snodgrass JG, Most DE, Upadhyay C. Religious Ritual Is Good Medicine for Indigenous Indian Conservation Refugees: Implications for Global Mental Health. CURRENT ANTHROPOLOGY 2017. [DOI: 10.1086/691212] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Irankunda P, Heatherington L, Fitts J. Local terms and understandings of mental health problems in Burundi. Transcult Psychiatry 2017; 54:66-85. [PMID: 28121243 DOI: 10.1177/1363461516689004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A pilot study and two intensive studies were conducted to document the local vocabularies used by Burundians to describe mental health problems and their understandings about the causes. The pilot study-in which 14 different large groups of community members awaiting appointments at a village health clinic were engaged in open-ended discussions of the local terminology and causal beliefs about mental health problems-suggested three key syndromes: akabonge (a set of depression-like symptoms), guhahamuka (a set of trauma-related symptoms), and ibisigo (a set of psychosis-like symptoms). In Study 1 ( N = 542), individual interviews or surveys presented participants with the names of these syndromes and asked what they considered to be the symptoms and causes of them. Study 2 ( N = 143) cross-validated these terms with a different sample (also in individual interviews/surveys), by presenting the symptom clusters and asking what each would be called and about their causes. Findings of both studies validated this set of terms and yielded a rich body of data about causal beliefs. The influence of education level and gender on familiarity with these terms was also assessed. Implications for the development of mental health services and directions for future research are discussed.
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McNeely CA, Morland L, Doty SB, Meschke LL, Awad S, Husain A, Nashwan A. How Schools Can Promote Healthy Development for Newly Arrived Immigrant and Refugee Adolescents: Research Priorities. THE JOURNAL OF SCHOOL HEALTH 2017; 87:121-132. [PMID: 28076923 DOI: 10.1111/josh.12477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The US education system must find creative and effective ways to foster the healthy development of the approximately 2 million newly arrived immigrant and refugee adolescents, many of whom contend with language barriers, limited prior education, trauma, and discrimination. We identify research priorities for promoting the school success of these youth. METHODS The study used the 4-phase priority-setting method of the Child Health and Nutrition Research Initiative. In the final stage, 132 researchers, service providers, educators, and policymakers based in the United States were asked to rate the importance of 36 research options. RESULTS The highest priority research options (range 1 to 5) were: evaluating newcomer programs (mean = 4.44, SD = 0.55), identifying how family and community stressors affect newly arrived immigrant and refugee adolescents' functioning in school (mean = 4.40, SD = 0.56), identifying teachers' major stressors in working with this population (mean = 4.36, SD = 0.72), and identifying how to engage immigrant and refugee families in their children's education (mean = 4.35, SD = 0.62). CONCLUSION These research priorities emphasize the generation of practical knowledge that could translate to immediate, tangible benefits for schools. Funders, schools, and researchers can use these research priorities to guide research for the highest benefit of schools and the newly arrived immigrant and refugee adolescents they serve.
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Affiliation(s)
- Clea A McNeely
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Avenue, Suite 390, Knoxville, TN 37919
| | - Lyn Morland
- Innovation, Policy and Research, Bank Street College of Education, 610 West 112th Street, New York, NY 10025
| | - S Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205
| | - Laurie L Meschke
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Avenue, Suite 390, Knoxville, TN 37919
| | - Summer Awad
- Department of Public Health, University of Tennessee, Knoxville, 1212 Wallingford Road, Knoxville, TN 32923
| | - Altaf Husain
- Department of Social Work, Howard University, 601 Howard Place, NW, Washington, DC 20059
| | - Ayat Nashwan
- Yarmouk University, Shafiq Irshidat St, Irbid 21163, Jordan
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The effect of gender norms on the association between violence and hope among girls in the Democratic Republic of the Congo. Glob Ment Health (Camb) 2017; 4:e1. [PMID: 28596902 PMCID: PMC5454793 DOI: 10.1017/gmh.2016.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/14/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Girls at early stages of adolescence are vulnerable to violence victimization in humanitarian contexts, but few studies examine factors that affect girls' hope in these settings. We assessed attitudes toward traditional gender norms as an effect modifier of the relationship between violence exposure and future orientation in displaced girls. METHODS Secondary analysis, using multivariable regression of cross-sectional data from girls ages 10-14 in South Kivu, Democratic Republic of the Congo. Key variables of interest were attitudes toward intimate partner violence (IPV), Children's Hope Scale (CHS) score, and exposure to physical, emotional, and sexual violence within the last 12 months. Additional covariates included age, educational status, and territory. RESULTS The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for physical violence (β = -0.09, p = 0.040) and unwanted sexual touching (β = -0.20, p = 0.003) among girls age 10-14, when adjusting for other covariates. The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for forced sex (β = -0.22, p = 0.016) among girls age 13-14, when adjusting for covariates. Findings for emotional violence, any form of sexual violence, and coerced sex trended toward lower CHS scores for girls who reported higher acceptance of IPV, but did not reach significance. CONCLUSIONS Findings support the utility of gender norms-transformative programming in increasing resilience of girls who have experienced sexual violence in humanitarian contexts.
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