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Skrodzka M, McMahon G, Griffin SM, Muldoon OT. New social identities in Ukrainian 'refugees': A social cure or social curse? Soc Sci Med 2024; 353:117048. [PMID: 38905922 DOI: 10.1016/j.socscimed.2024.117048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
Experiencing traumatic events often drives profound post-traumatic stress (PTS), but trauma also has the potential to engender positive consequences, such as post-traumatic growth (PTG). Traumatic experiences may also lead to gaining new identities which can have both protective (i.e., social cure) or damaging (i.e., social curse) effects on health and well-being. This study aims to examine the role of new social identities and related social identity resources acquired after war-related experiences (i.e., identification with a new host society and identification as a refugee) in contributing to different trauma trajectories. The sample included 468 participants who left Ukraine due to the war that commenced on February 24th, 2022, and became residents of Ireland or Poland. The findings indicate that identification with the host society was associated with lower PTS and greater PTG. Whereas identification with refugees was related to higher PTS, but it was not directly associated with PTG. Further, the psychological resources derived from these new identities mediated the relationship between identification strength and PTG. This study offers practical insights for interventions targeting refugees in their new countries of residence.
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Affiliation(s)
- Magdalena Skrodzka
- Centre for Social Issues Research, Department of Psychology, Faculty of Education & Health Sciences, University of Limerick, Ireland.
| | - Grace McMahon
- Centre for Social Issues Research, Department of Psychology, Faculty of Education & Health Sciences, University of Limerick, Ireland.
| | - Siobhán M Griffin
- Centre for Social Issues Research, Department of Psychology, Faculty of Education & Health Sciences, University of Limerick, Ireland.
| | - Orla T Muldoon
- Centre for Social Issues Research, Department of Psychology, Faculty of Education & Health Sciences, University of Limerick, Ireland.
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McElroy E, Hyland P, Shevlin M, Karatzias T, Vallières F, Ben-Ezra M, Vang ML, Lorberg B, Martsenkovskyi D. Change in child mental health during the Ukraine war: evidence from a large sample of parents. Eur Child Adolesc Psychiatry 2024; 33:1495-1502. [PMID: 37421462 PMCID: PMC11098962 DOI: 10.1007/s00787-023-02255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
The ongoing war in Ukraine is expected to negatively impact the mental health of the country's population. This study aims to provide a preliminary estimate of the degree of change in the mental health problems of Ukrainian children following Russia's invasion in February 2022, and to identify the sociodemographic and war-related risk factors associated with these changes. A nationwide, opportunistic sample of 1238 parents reported on a single randomly chosen child within their household as part of The Mental Health of Parents and Children in Ukraine Study. Data were collected between July 15th and September 5th, 2022. Participants completed modified versions of the Pediatric Symptom Checklist (PSC-17) which was adapted to capture change in the frequency of symptoms since the beginning of the war. Parents reported increases across all 17 indicators of internalizing, externalizing, and attention problems of the PSC-17. Increased problems were most pronounced within the internalizing domain, with 35% of parents reporting that their child worried more since the beginning of the war. A number of individual, parental, and war-related factors were associated with increases across the three domains. Exposure to war trauma, pre-existing mental health problems, and child age were among the strongest predictors of change. This survey provides preliminary evidence that the Russian war on Ukraine has led to an increase in common mental health problems among children in the general population. Further research is required to determine the extent and sequela of this increase, and to develop intervention strategies for those most in need.
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Affiliation(s)
- Eoin McElroy
- School of Psychology, Ulster University, Derry, Northern Ireland, UK.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
| | | | | | - Maria Louison Vang
- Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Boris Lorberg
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Dmytro Martsenkovskyi
- Department of Psychiatry and Narcology, Bogomolets National Medical University, Kyiv, Ukraine
- Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring, Ministry of Health of Ukraine, Kyiv, Ukraine
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Ahmad J, Okwuowulu C, Sanusi B, Bello SA, Talabi FO, Udengwu N, Gever VC. Impact of social media-based dance therapy in treating depression symptoms among victims of Russia-Ukraine war. Health Promot Int 2022; 37:6889368. [PMID: 36508393 DOI: 10.1093/heapro/daac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The objective of this study was to ascertain the impact of social media-based dance therapy in reducing symptoms of depression among evacuees of the Russia-Ukraine war. The participants were randomly assigned to no dance therapy (n = 162) and social media-based dance therapy groups (n = 162). The dance therapy group took part in 12 sessions of dance therapy while the no dance therapy group did not receive any intervention. The result showed that before the dance therapy intervention, participants in both groups reported severe depression symptoms. After the intervention, participants in the dance therapy group dropped from severe depression to normal depression while those in the no dance therapy group dropped to major depression. During the follow-up assessment after 3 months, participants in the no dance therapy group reported moderate depression while those in the dance therapy group still maintained their normal depression classification with a drop in their depression score from 46 to 26. Overall, the result showed that there was a significant main effect of time and the depression score of the participants, F(1,304) 203.143, p = 0.001, eta = 0.401. No interactive effect of gender and the impact of the treatment on reduction in depression symptoms was detected, F(1,304) 3.232, p = 0.073. However, there was a significant main effect of treatment condition on depression symptoms, F(1,304) 495.023, p = 0.001. We highlighted the implication of these results on health promotion.
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Affiliation(s)
- Jamilah Ahmad
- School of Communication, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia
| | - Charles Okwuowulu
- Department of Theatre Arts, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Abakaliki, Nigeria
| | - Bernice Sanusi
- Department of Mass Communication, Redeemer's University, Ede, Osun State, Nigeria
| | - Samson Adedapo Bello
- Department of Mass Communication, Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Felix Olajide Talabi
- Department of Mass Communication, Redeemer's University, Ede, Osun State, Nigeria
| | - Ngozi Udengwu
- Department of Theatre and Film Studies, University of Nigeria, Nsukka, Nigeria
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Demirchyan A, Khachadourian V, Armenian HK, Goenjian AK. The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study. Psychiatry Res 2022; 313:114640. [PMID: 35598565 DOI: 10.1016/j.psychres.2022.114640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012. Additionally, an adapted CES-D-16 scale was used to assess depressive symptoms in 2012. A fitted multi-nominal logistic regression model identified predictors of different trajectories of depression. For the whole group, the rate of clinical depression dropped from 51.5% in 1991 to 31.7% in 2012. Earthquake intensity and experiencing strong fear at baseline were strongly associated with chronic (depressed at both assessments, 18.1%) and recovered (depressed only in 1991, 33.5%) depression trajectories compared with the healthy group, with odds ratios (OR) over 4.0 and 3.0, respectively. Predictors distinguishing chronic depression included earthquake-related nuclear-family deaths (OR=3.79), chronic illnesses at baseline (OR=1.24), and social support (OR=0.91). Predictors of the late-onset trajectory (depressed only in 2012, 13.5% of the cohort) included post-earthquake trauma (OR=1.42), socioeconomic status (OR=0.45), and social support (OR=0.86). The factors associated with the different trajectories of depression provide guidance for planning more effective mental health interventions after disasters.
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Affiliation(s)
- Anahit Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia.
| | - Vahe Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroutune K Armenian
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, UCLA, CA, USA; Collaborative Neuroscience Network, CA, USA
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Elhadi M, Msherghi A, Khaled A, Alsoufi A, Alhadi A, Kareem A, Ashini A, Alsharif T, Alhodiri A, Altaeb E, Hamed M, Itrunbah A, Mohmmed S, Alameen H, Idheiraj H, Shuwayyah A, Alhudhairy S, Alansari A, Abraheem W, Akl H, Nagib T, Almugaddami A, Aljameel B, Muamr S, Alsuwiyah S, Alsghair A, Soula E, Buzreg A, Alagelli F, Aldireewi A, Bareem A, Alshareea E, Gemberlo A, Zaid A. Impact of lockdown due to the COVID-19 pandemic on mental health among the Libyan population. PLoS One 2022; 17:e0267426. [PMID: 35482687 PMCID: PMC9049310 DOI: 10.1371/journal.pone.0267426] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/09/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic may have a potentially serious effect on mental health and increase the risk of anxiety, depression, and post-traumatic stress disorders in people. In this study, we aimed to determine the prevalence of psychological illness and the impact of the COVID-19 pandemic on the Libyan population's mental health. METHOD A cross-sectional survey, conducted in both online and paper modes and consisting of five sections, was completed in more than 30 cities and towns across Libya. The first section consisted of questions on basic demographic characteristics. The second section contained a survey related to the lockdown status, activities, related stress levels, and quarantine. The third section comprised the self-administered 9-item Patient Health Questionnaire (PHQ-9). The fourth section contained the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the fifth section contained the Impact of Event Scale-Revised (IES-R). RESULT Of the 31,557 respondents, 4,280 (13.6%) reported severe depressive symptoms, with a mean [standard deviation (SD)] PHQ-9 score of 8.32 (5.44); 1,767 (5.6%) reported severe anxiety symptoms, with a mean (SD) GAD-7 score of 6 (4.6); and 6,245 (19.8%) of the respondents reported post-traumatic stress disorder (PTSD), with a mean (SD) score of 15.3 (18.85). In multivariate analysis, young age, being female, unmarried, educated, or victims of domestic violence or abuse, work suspension during the pandemic, and having increased workload, financial issues, suicidal thoughts, or a family member with or hospitalized due to COVID-19 were significantly associated with a high likelihood of depressive and anxiety symptoms, as well as PTSD. Internal displacement due to civil war was also associated with PTSD. CONCLUSION To our knowledge, this is the first study to analyze the psychological impacts of the COVID-19 pandemic and civil war in Libya. Further study on the development of strategies and interventions aimed at reducing the mental disease burden on the Libyan population is warranted.
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Affiliation(s)
| | - Ahmed Msherghi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Alsoufi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Asraa Kareem
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Aimen Ashini
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | - Emtenan Altaeb
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Mona Hamed
- Faculty of Medicine, University of Gharyan, Gharyan, Libya
| | - Ahmed Itrunbah
- Faculty of Medicine, University of Zawia, Az Zāwīyah, Libya
| | - Soha Mohmmed
- Faculty of Medicine, Al-Arab Medical University, Benghazi, Libya
| | - Hind Alameen
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Arowa Alansari
- Faculty of Medicine, University of Gharyan, Gharyan, Libya
| | - Wisam Abraheem
- Faculty of Medicine, Omar Al-Mukhtar University, Albayda, Libya
| | - Hend Akl
- Faculty of Medicine, Al-Arab Medical University, Benghazi, Libya
| | - Taha Nagib
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | - Siba Muamr
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Ateka Alsghair
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Enas Soula
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Anis Buzreg
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Fatma Alagelli
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Ahmed Bareem
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Ali D, Azale T, Wondie M, Tadesse J. About Six in Ten Survivors of the November 2020 Maikadra Massacre Suffer from Posttraumatic Stress Disorder, Northwest Ethiopia. Psychol Res Behav Manag 2022; 15:251-260. [PMID: 35177942 PMCID: PMC8845114 DOI: 10.2147/prbm.s338823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is characterized by recurrent, involuntary, and intrusive distressing memories of a traumatic event and dissociative reactions. Little is known about post-traumatic stress disorder in low and middle income countries such as Ethiopia where armed conflict, human rights violations, and ethnic-based violence are becoming everyday occurrences. OBJECTIVE This study aimed to assess the prevalence of post-traumatic stress disorder and associated factors among residents of Maikadra, North West Ethiopia. METHODS A community-based cross-sectional study was employed in April 2021. A multi-stage cluster sampling technique was employed to select the study participants. A post-traumatic stress disorder checklist (PCL-5) was used to assess post-traumatic stress disorder through a face-to-face interview. Bivariate and multi-variable binary logistic regression analyses were carried out to examine the association between posttraumatic stress disorder and several demographic and psychosocial variables. Statistical significance was declared at a P-value <0.05. RESULTS A total of 610 participants were interviewed with a response rate of 98.8%. The prevalence of PTSD in this study was 59.8% with a 95% CI of 55.7-63.9. Female sex (AOR=1.93, 95% CI=1.64-3.24), having a close family member killed or seriously injured (AOR=1.96, 95% CI=1.1-3.48), having moderate (AOR=3.35, 95% CI=1.98-5.68) and high perceived threat to life (AOR=3.66, 95% CI=1.85-6.95), having depression (AOR=1.67, 95% CI=1.13-2.47) and anxiety disorder (AOR=1.85, 95% CI=1.21-2.83), and being directly exposed to the event (AOR=3.27, 95% CI=1.09-9.83) were significantly associated with post-traumatic stress disorder. CONCLUSION The majority of the residents of Maikadra town where the November 2020 massacre took place experienced posttraumatic stress disorder. Female sex, having a family member or a friend murdered or seriously injured, having depression and anxiety disorders and being directly exposed to the trauma were found to be significant predictors of post-traumatic stress disorder. People who have been exposed to such an intense traumatic event need psychosocial support to help them recover from the horrible experiences.
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Affiliation(s)
- Dawed Ali
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Gondar, Ethiopia
| | - Telake Azale
- University of Gondar, College of Medicine and Health Sciences, Department Health Education and Behavioral Sciences, Gondar, Ethiopia
- Correspondence: Telake Azale, University of Gondar, College of Medicine and Health Sciences, Department of Health Education and Behavioral Sciences, PO Box 196, Gondar, Ethiopia, Tel +251 918771951, Email
| | - Melese Wondie
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Gondar, Ethiopia
| | - Jinenus Tadesse
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Gondar, Ethiopia
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Abdulshafea M, Rhouma AH, Gire N, AlMadhoob A, Arshad U, Husain N. The epidemiology of common mental disorders in Libya: a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00408-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
Introduction
There has been a global increase in the prevalence of common mental disorders (CMD), particularly in conflict hotspots. The limited amount of resources is one of the key barriers to effective treatment within Low- and Middle-income countries (LAMICs). The lack of service provision for mental health disorders in LAMICs has resulted in limited opportunities to conduct mental health research. Libya is a North African country that has suffered from ongoing conflict with the current political unrest in Libya further impacting the mental health of the population.
Main text
The aim of this review is to conduct a synthesis of evidence regarding the estimated prevalence and associated risk factors of CMD in Libya. A search was completed in the academic databases; PubMed, Medline, EMBASE, PsychINFO, CINHAL, and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC) from inception to March 2020. Only studies that investigated prevalence and associated risk factors of CMD in Libya were included. A total of 219 studies were identified of which 15 met the inclusion criteria for the review. There were (n = 3) papers investigated the prevalence of depression, (n = 4) studies were focused on stress-related disorders and the remaining papers looked at both anxiety and depression. Statistically, sample sizes of the included studies ranged from (n = 41–13,031) for the prevalence studies (mean = 1188.6, median = 233).
Conclusion
The status of Libya as a conflict hotspot has led to a reduced level of epidemiological data on mental health, with a vital need to conduct research in CMD. Libya requires better clinical governance which can allow for more scientific research into CMD and enabling the Libyan government to develop evidence-based policy initiatives for CMD.
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Patterns of conflict-related trauma exposure and their relation to psychopathology: A person-centered analysis in a population-based sample from eastern DRC. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kovnick MO, Young Y, Tran N, Teerawichitchainan B, Tran TK, Korinek K. The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:526-544. [PMID: 34622692 PMCID: PMC8633195 DOI: 10.1177/00221465211039239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Most Vietnamese young adults who experienced the American War were exposed to war-related violence, which can exert a lifelong impact. We analyze survey data collected among northern and central Vietnamese older adults in the 2018 Vietnam Health and Aging Study (N = 2,447) to examine the association between various war traumas, psychological distress, and suicidal ideation. Informed by life course and stress process perspectives, we use structural equation models with multiple mediators to analyze the relationship between mental health outcomes and five types of wartime stress exposure: loss of family and friends, witnessing death, malevolent living conditions, life threat, and moral injury. Our findings reveal enduring mental health impacts of war among survivors. Wartime stress exposure's influence on mental health is mediated by recent comorbidities and stressful life events. Loss of family members, witnessing death, and malevolent living conditions during war are particularly salient risks for psychological distress.
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Affiliation(s)
| | | | - Nhung Tran
- University of Utah, Salt Lake City, UT, USA
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Kekibiina A, Adong J, Fatch R, Emenyonu NI, Marson K, Beesiga B, Lodi S, Muyindike WR, Kamya M, Chamie G, McDonell MG, Hahn JA. Post-traumatic stress disorder among persons with HIV who engage in heavy alcohol consumption in southwestern Uganda. BMC Psychiatry 2021; 21:457. [PMID: 34535103 PMCID: PMC8449437 DOI: 10.1186/s12888-021-03464-z] [Citation(s) in RCA: 5] [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: 03/06/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to describe the prevalence of PTSD symptoms and its associated factors in persons living with HIV (PLWH) in Uganda who engage in heavy alcohol use. METHODS We analyzed baseline data from the Drinkers Intervention to Prevent Tuberculosis study which enrolls PLWH with latent tuberculosis who engage in heavy alcohol consumption. Using the primary care Post Traumatic Stress Disorder (PTSD) screening scale from the DSM-5 (PC-PTSD-5), probable PTSD was defined as reporting ≥3 of 5 assessed symptoms. We conducted the Alcohol Use Disorders Identification Test-Consumption and assessed demographics, smoking, symptoms of depression, and spirituality/religiosity. RESULTS Of 421 participants enrolled from 2018 through 2020, the majority (68.2%) were male, median age was 40 years (interquartile range [IQR]: 32-47), and median AUDIT-C score was 6 [IQR: 4-8]. Half (50.1%) of the participants reported ever experiencing a traumatic event, and 20.7% reported ≥3 symptoms of PTSD. The most commonly reported PTSD symptoms in the past 1 month in the entire sample were avoidance (28.3%), nightmares (27.3%), and being constantly on guard (21.6%). In multivariable logistic regression analyses, level of alcohol use was not associated with probable PTSD (adjusted odds ratio [AOR] for each AUDIT-C point: (1.02; 95% CI: 0.92-1.14; p = 0.69); however, lifetime smoking (AOR 1.89; 95% CI: 1.10-3.24) and reporting symptoms of depression (AOR 1.89; 95% CI: 1.04-3.44) were independently associated with probable PTSD. CONCLUSIONS AND RECOMMENDATIONS A history of traumatic events and probable PTSD were frequently reported among persons who engage in heavy drinking, living with HIV in Uganda. Level of alcohol use was not associated with probable PTSD in this sample of PLWH with heavy alcohol use, however other behavioral and mental health factors were associated with probable PTSD. These data highlight the high prevalence of PTSD in this group, and the need for screening and interventions for PTSD and mental health problems.
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Affiliation(s)
- Allen Kekibiina
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Nneka I. Emenyonu
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Kara Marson
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Brian Beesiga
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Sara Lodi
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Winnie R. Muyindike
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.459749.20000 0000 9352 6415Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moses Kamya
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Michael G. McDonell
- grid.30064.310000 0001 2157 6568Elson S Floyd College of Medicine, Washington State University, Spokane, WA USA
| | - Judith A. Hahn
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
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Latifeh Y, Hanafi I, Alhoulaiby S, Alahdab F. Crisis-based psychiatry curriculum update: A cross-sectional study and an expert reflection from Syria. Asian J Psychiatr 2021; 61:102681. [PMID: 34004462 DOI: 10.1016/j.ajp.2021.102681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/25/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Throughout human history, humanitarian catastrophes had a profound impact on the health and wellbeing of the local populations where they took place. The Syrian war was no different, rather it was the worst humanitarian crisis since World War II. Syrians' wellbeing was severely affected during this past decade, as had Syria's healthcare and mental health facilities. Syrian doctors have faced unprecedented difficulties and challenges across clinical disciplines and services, particularly in psychiatry. Medical students may play a central role in attenuating the burden of psychiatric diseases on their local community. However, a modification of the psychiatry curriculum to meet the current needs is an urgent necessity. Most of the published reports in psychiatry about Syrians were done on refugee populations in neighboring countries and worldwide. In contrast, this study captured the opinions of professors of psychiatry, specialists practicing psychiatrists, psychiatry residents, and a sample of senior medical students around Syria regarding the impact of war on different psychiatric diseases, and their suggestions to increase/reduce the teaching hours allocated to each of them. The votes were weighted then tested against crisis-related published psychiatry reports. The results suggested significant adjustments to the allocated training hours in the curriculum of psychiatry in Syrian medical schools. Increasing the focus of the curriculum of psychiatry on the prevalent disorders and conditions such as post-traumatic stress disorder, acute stress disorder, anxiety, and depression would empower fresh graduates to manage the basic cases of psychiatry, thus alleviating the consequences of the large shortage of psychiatrists inside Syria.
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Affiliation(s)
- Youssef Latifeh
- Department of Psychiatry, Faculty of Medicine, Damascus University, Damascus, Syria; Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Damascus, Syria.
| | - Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Sami Alhoulaiby
- Division of General Surgery, Department of Surgery, Damascus University, Damascus, Syria.
| | - Fares Alahdab
- Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA.
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Anand A, Ghani A, Sharma K, Kaur G, Khosla R, Devi C, Podder V, Sivapuram MS, Maity K, Kaur H. War-Related Mental Health Issues and Need for Yoga Intervention Studies: A Scoping Review. Int J Yoga 2021; 14:175-187. [PMID: 35017859 PMCID: PMC8691442 DOI: 10.4103/ijoy.ijoy_60_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022] Open
Abstract
Conflicts and humanitarian crises lead to serious mental health disorders, including depression, anxiety, stress, and cognitive decline. Exposure to these circumstances in early life can lead to the development of disorders such as mild cognitive impairment, dementia, and Alzheimer's disease (AD), for which no treatments are available. In this review, various research papers have been compiled to develop an understanding about mental health of population affected due to wars and conflicts and how stress and depression can accelerate the development of dementia and AD. Due to failure of drugs in the treatment of dementia and AD, yoga and mindfulness-based approach has been proposed for future investigations. Although studies have shown that yoga and mindfulness can be helpful in the management of stress, anxiety, depression, and posttraumatic stress disorder in the war-afflicted areas, limited mechanistic studies in yoga and mindfulness remain the chief cause precluding its clinical application in such warzones. The molecular studies in the field of yoga can be undertaken by targeting these warzones. This review provides a scientific evaluation of mind-body techniques as a justification for mental health rehabilitation in the war-afflicted zones in face of failed clinical trials for various drugs. This may help reduce the risk of developing dementia and AD in this susceptible population.
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Affiliation(s)
- Akshay Anand
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India,CCRYN Center for Mind Body Interventions through Yoga PGIMER, Chandigarh, India,Centre for Cognitive Sciences and Phenomenology, Panjab University, Chandigarh, India,Address for correspondence: Prof. Akshay Anand, Department of Neurology, Neuroscience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - Abdul Ghani
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanupriya Sharma
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Gurkeerat Kaur
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Radhika Khosla
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Chandra Devi
- Department of Neurology, Neuroscience Research Lab, Postgraduate Institute of Medical Education and Research, Panjab University, Chandigarh, India
| | - Vivek Podder
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Nalgonda, Telangana, India
| | - Madhava S. Sivapuram
- Department of Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
| | - Kalyan Maity
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| | - Harmandeep Kaur
- Department of Physical Education, Panjab University, Chandigarh, India
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Samara M, Hammuda S, Vostanis P, El-Khodary B, Al-Dewik N. Children's prolonged exposure to the toxic stress of war trauma in the Middle East. BMJ 2020; 371:m3155. [PMID: 33214133 PMCID: PMC7673908 DOI: 10.1136/bmj.m3155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Muthanna Samara
- Department of Psychology, Kingston University London, United Kingdom
| | - Sara Hammuda
- Department of Psychology, Kingston University London, United Kingdom
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, United Kingdom
| | | | - Nader Al-Dewik
- Department of Psychology, Kingston University London, United Kingdom
- Department of Paediatrics and Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC) and College of Health and Life Science (CHLS), Hamad Bin Khalifa University (HBKU), Doha, Qatar
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Elhadi M, Buzreg A, Bouhuwaish A, Khaled A, Alhadi A, Msherghi A, Alsoufi A, Alameen H, Biala M, Elgherwi A, Elkhafeefi F, Elmabrouk A, Abdulmalik A, Alhaddad S, Elgzairi M, Khaled A. Psychological Impact of the Civil War and COVID-19 on Libyan Medical Students: A Cross-Sectional Study. Front Psychol 2020; 11:570435. [PMID: 33192858 PMCID: PMC7649391 DOI: 10.3389/fpsyg.2020.570435] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022] Open
Abstract
Objective We aim to determine the psychological status of medical students during the COVID-19 outbreak and civil war in Libya. Methods A cross-sectional study was conducted among medical students from 15 medical schools between April 20 and May 1, 2020. The demographic characteristics, generalized anxiety disorder 7-item (GAD-7) scale, and patient health questionnaire (PHQ-9) results were collected. Results Of the 3,500 students, 2,430 completed the survey. The mean (± SD) score of anxiety symptoms determined by the GAD-7 was 7.2 (5.1). A total of 268 (11%) students had a GAD-7 score of ≥15, which is indicative of moderate to severe anxiety. A total of 1,568 (64.5%) students showed different degrees of anxiety: mild, 910 (37.5%); moderate, 390 (16%); and severe, 268 (11%). Anxiety was significantly associated with living status and internal displacement (P < 0.05). The mean (+ SD) score of depressive symptoms determined by the PHQ-9 was 9.7 (6.3). A total of 525 (21.6%) students had a PHQ-9 score of ≥15, which is indicative of moderate to severe depression. A total of 1,896 (88%) students were diagnosed with mild (PHQ ≥ 5) depression. Suicidal ideation was present in 552 patients (22.7%). Depression was only statistically associated with the year of study (P = 0.009). Conclusion These data highlight that medical students in Libya are at risk for depression, especially under the current stressful environment of the civil war and the COVID-19 outbreak.
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Affiliation(s)
| | - Anis Buzreg
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Ahmed Msherghi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Alsoufi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Hind Alameen
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Marwa Biala
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | - Amna Elmabrouk
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Sarah Alhaddad
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Ahmed Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Elhadi M, Khaled A, Malek AB, El-Azhari AEA, Gwea AZ, Zaid A, Elturki SM, Aburgegah A, Abu Ageila MAK, Alhadi A, Albashkar HA, Alshareef AM, Ben Nama AB, Sahboun NAM, Ahmed H. Prevalence of anxiety and depressive symptoms among emergency physicians in Libya after civil war: a cross-sectional study. BMJ Open 2020; 10:e039382. [PMID: 32859667 PMCID: PMC7454180 DOI: 10.1136/bmjopen-2020-039382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We aimed to identify the prevalence of depression and anxiety among physicians working in the emergency departments of nine tertiary care centres in Libya. DESIGN This was a cross-sectional study. SETTING Nine main tertiary centres in Libya PARTICIPANTS: Emergency department doctors were surveyed between December 2018 and February 2019. INTERVENTION The standardised Hospital Anxiety and Depression Scale (HADS) was selected as a measurement tool for analysing anxiety and depression symptoms; a HADS score of 8 indicated anxiety as well as depression symptoms. The primary outcomes were anxiety and depression, which were tabulated with independent sociodemographic variables. χ2 tests were conducted to compare the prevalence of anxiety and depression between the groups. Statistical analysis was performed using SPSS V.25. RESULTS A total of 108 out of 150 (72%) emergency physicians from all levels participated in the study and took the survey. The emergency physicians had a mean±SD age of 31.2±4.5 years, and were predominantly males (74 out of 108, 68.5%). Overall, 49 (45.4%) physicians reached the cut-off score to define both depression and anxiety (ie, a score ≥8). In terms of violence, 71 (65.7%) reported incidents of verbal violence, while 26 (24.1%) reported physical violence or abuse by militias. In addition, 28 reported being threatened by militias. CONCLUSION The high prevalence rate of anxiety and depression is of concern, and the high rate of physical and verbal abuse highlights the range of abuse endured by doctors in Libya. Therefore, screening for anxiety and depression at regular intervals is needed to avoid the deterioration of mental health, which can increase the risk of suicide and dropping out, and decrease the level of healthcare for patients.
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Affiliation(s)
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | | | | | | | | | | | - Hazem Ahmed
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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16
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Elhadi M, Msherghi A, Elgzairi M, Alhashimi A, Bouhuwaish A, Biala M, Abuelmeda S, Khel S, Khaled A, Alsoufi A, Elmabrouk A, Alshiteewi FB, Alhadi B, Alhaddad S, Gaffaz R, Elmabrouk O, Hamed TB, Alameen H, Zaid A, Elhadi A, Albakoush A. Psychological status of healthcare workers during the civil war and COVID-19 pandemic: A cross-sectional study. J Psychosom Res 2020; 137:110221. [PMID: 32827801 PMCID: PMC7428743 DOI: 10.1016/j.jpsychores.2020.110221] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Healthcare workers, particularly those working in departments that provide care for patients with coronavirus disease 2019 (COVID-19), are at a higher risk of this contagious disease than those who work in other departments. The aim of this study was to assess the psychological status of healthcare workers during the COVID-19 outbreak, which has compounded Libya's existing civil war-related problems. METHODS A multi-center cross-sectional survey on depressive symptoms, anxiety symptoms, and abuse was conducted. The Hospital Anxiety and Depression Scale (HADS) was used to measure the prevalence of anxiety and depressive symptoms among healthcare workers. RESULTS The data of 745 eligible healthcare workers from 15 hospitals were analyzed. Depressive and anxiety symptoms were compared to the basic characteristics of the participants to determine the association. A total of 420 (56.3%) participants had depressive symptoms, while 348 (46.7%) had anxiety symptoms. Age, residency status, department, stigmatization, and living in a conflict zone were significantly associated with depressive symptoms. Age, department, years of experience, working hours per week, internal displacement, stigmatization, living in a conflict zone, and verbal abuse were significantly associated with anxiety symptoms. CONCLUSION Our study presents important findings regarding depressive, anxiety symptoms, and abuse among physicians providing care during the COVID-19 outbreak and civil war in Libya. It also demonstrates several factors that can be associated with depressive and anxiety symptoms in this population.
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Affiliation(s)
- Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya.
| | - Ahmed Msherghi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | | | - Ayiman Alhashimi
- Faculty of Medicine, Al-Jabal Al Gharbi University, Gherian, Libya
| | | | - Marwa Biala
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Seraj Abuelmeda
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Samer Khel
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Alsoufi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Amna Elmabrouk
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Fatimah Bin Alshiteewi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Bushray Alhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Sarah Alhaddad
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Rwanda Gaffaz
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ola Elmabrouk
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Tasneem Ben Hamed
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Hind Alameen
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Elhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Albakoush
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
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17
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Jankovic-Rankovic J, Oka RC, Meyer JS, Gettler LT. Forced migration experiences, mental well-being, and nail cortisol among recently settled refugees in Serbia. Soc Sci Med 2020; 258:113070. [DOI: 10.1016/j.socscimed.2020.113070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
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Abstract
This paper begins by outlining the nature of the present conflict in Syria. It goes on to describe the psychological consequences of this conflict and the present state of the mental health services in the country.
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19
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Dowling A, Enticott J, Russell G. Measuring self-rated health status among resettled adult refugee populations to inform practice and policy - a scoping review. BMC Health Serv Res 2017; 17:817. [PMID: 29216897 PMCID: PMC5721386 DOI: 10.1186/s12913-017-2771-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The health status of refugees is a significant factor in determining their success in resettlement and relies heavily on self-rated measures of refugee health. The selection of robust and appropriate self-rated health measurement tools is challenging due to the number and methodological variation in the use of assessment tools across refugee health studies. This study describes the existing self-report health measures which have been used in studies of adult refugees living in the community to allow us to address the challenges of selecting appropriate assessments to measure health within refugee groups. METHODS Electronic databases of Ovid Medline, CINAHL, SCOPUS, Embase and Scopus. RESULTS This review identified 45 different self-rated health measurements in 183 studies. Most of the studies were cross sectional explorations of the mental health status of refugees living in community settings within Western nations. A third of the tools were designed specifically for use within refugee populations. More than half of the identified measurement tools have been evaluated for reliability and/or validity within refugee populations. Much variation was found in the selection, development and testing of measurement tools across the reviewed studies. CONCLUSION This review shows that there are currently a number of reliable and valid tools available for use in refugee health research; however, further work is required to achieve consistency in the quality and in the use of these tools. Methodological guidelines are required to assist researchers and clinicians in the development and testing of self-rated health measurement tools for use in refugee research.
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Affiliation(s)
- Alison Dowling
- School of Primary Health Care, Monash University, Melbourne, VIC Australia
| | - Joanne Enticott
- School of Primary Health Care, Monash University, Melbourne, VIC Australia
- Department of Psychiatry, Southern Synergy, Monash University, Melbourne, VIC Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Melbourne, VIC Australia
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20
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Arsenijević J, Schillberg E, Ponthieu A, Malvisi L, Ahmed WAE, Argenziano S, Zamatto F, Burroughs S, Severy N, Hebting C, de Vingne B, Harries AD, Zachariah R. A crisis of protection and safe passage: violence experienced by migrants/refugees travelling along the Western Balkan corridor to Northern Europe. Confl Health 2017; 11:6. [PMID: 28416965 PMCID: PMC5392386 DOI: 10.1186/s13031-017-0107-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/01/2017] [Indexed: 01/09/2023] Open
Abstract
Background Pushed by ongoing conflicts and pulled by the desire for a better life, over one million migrants/refugees transited Balkan countries and arrived in Europe during 2015 and early 2016. To curb this influx, European countries instituted restrictive migration policies often characterized by building of razor-wire border fences and border closures. Among migrants/refugees who received mental health care in Serbia while travelling through Balkan countries to Northern Europe, we assessed the prevalence and patterns of violent events experienced including physical trauma. Methods A mixed methods study among migrants/refugees attending mobile mental health clinics run by Médecins sans Frontières (MSF) between July 2015 and June 2016, in Serbia – a main transit hub to European countries. Clinics were conducted according to MSF guidelines by experienced psychologists who were supported by cultural mediators. The main outcome measures were violent events and associated physical trauma. Results Of 992 migrants/refugees attending MSF mental health clinics, the majority (72%) were from Syria and Afghanistan and included vulnerable groups (14%) such as unaccompanied minors and pregnant women. The most frequent mental health symptoms/signs were anxiety (29%) and adjustment reactions (26%). Of the 992 migrants/refugees, 270 (27%) had experienced violent events during their journey. Signs of physical trauma due to acts of violence were seen in 223(22%) of the 992 individuals, 144 (65%) being perpetrated by State authorities and involving women (11%) and children (13%). Border closures along the Balkan route were associated with a dramatic decrease in registered migrants/refugee arrivals in Serbia. Conversely, among those that made it across the borders, an increasing linear trend in reported violent events was observed at MSF mental health clinics (X2 for linear trend, P <0 · 001). Qualitative evidence corroborated with quantitative findings. Conclusions Nearly one-in-three migrants/refugees seen in MSF clinics experienced violent events including physical trauma along their journey. State authorities, including those in European countries were the perpetrators in over half of such events which were associated with border closures. There is “a crisis of protection and safe passage” which needs to change towards one of respect for the principles of international human rights and refugee law.
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Affiliation(s)
- Jovana Arsenijević
- Medecins Sans Frontières, Lekari Bez Granica Strahinica Ban, Belgrade, Serbia
| | - Erin Schillberg
- Médecins Sans Frontières, Operational Research Unit (LuxOR) MSF Brussels Operational Center, Luxembourg, Luxembourg
| | - Aurelie Ponthieu
- Operations and Medical Departments, Médecins Sans Frontières, Brussels Operational Centre, Rome, Italy.,Operations and Medical Departments, Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | - Lucio Malvisi
- Médecins Sans Frontières, Analysis and Advocacy Unit, MSF Brussels Operational Center, Brussels, Belgium
| | | | - Stefano Argenziano
- Médecins Sans Frontières, Analysis and Advocacy Unit, MSF Brussels Operational Center, Brussels, Belgium
| | - Federica Zamatto
- Médecins Sans Frontières, Analysis and Advocacy Unit, MSF Brussels Operational Center, Brussels, Belgium
| | - Simon Burroughs
- Medecins Sans Frontières, Lekari Bez Granica Strahinica Ban, Belgrade, Serbia
| | - Natalie Severy
- Médecins Sans Frontières, Analysis and Advocacy Unit, MSF Brussels Operational Center, Brussels, Belgium
| | - Christophe Hebting
- Médecins Sans Frontières, Operational Research Unit (LuxOR) MSF Brussels Operational Center, Luxembourg, Luxembourg
| | - Brice de Vingne
- Médecins Sans Frontières, Operational Research Unit (LuxOR) MSF Brussels Operational Center, Luxembourg, Luxembourg
| | - Anthony D Harries
- Center for Operational Research, International Union Against TB and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
| | - Rony Zachariah
- Médecins Sans Frontières, Operational Research Unit (LuxOR) MSF Brussels Operational Center, Luxembourg, Luxembourg
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21
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Charara R, Forouzanfar M, Naghavi M, Moradi-Lakeh M, Afshin A, Vos T, Daoud F, Wang H, El Bcheraoui C, Khalil I, Hamadeh RR, Khosravi A, Rahimi-Movaghar V, Khader Y, Al-Hamad N, Makhlouf Obermeyer C, Rafay A, Asghar R, Rana SM, Shaheen A, Abu-Rmeileh NME, Husseini A, Abu-Raddad LJ, Khoja T, Al Rayess ZA, AlBuhairan FS, Hsairi M, Alomari MA, Ali R, Roshandel G, Terkawi AS, Hamidi S, Refaat AH, Westerman R, Kiadaliri AA, Akanda AS, Ali SD, Bacha U, Badawi A, Bazargan-Hejazi S, Faghmous IAD, Fereshtehnejad SM, Fischer F, Jonas JB, Kuate Defo B, Mehari A, Omer SB, Pourmalek F, Uthman OA, Mokdad AA, Maalouf FT, Abd-Allah F, Akseer N, Arya D, Borschmann R, Brazinova A, Brugha TS, Catalá-López F, Degenhardt L, Ferrari A, Haro JM, Horino M, Hornberger JC, Huang H, Kieling C, Kim D, Kim Y, Knudsen AK, Mitchell PB, Patton G, Sagar R, Satpathy M, Savuon K, Seedat S, Shiue I, Skogen JC, Stein DJ, Tabb KM, Whiteford HA, Yip P, Yonemoto N, Murray CJL, Mokdad AH. The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. PLoS One 2017; 12:e0169575. [PMID: 28095477 PMCID: PMC5240956 DOI: 10.1371/journal.pone.0169575] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/19/2016] [Indexed: 01/17/2023] Open
Abstract
The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.
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Affiliation(s)
- Raghid Charara
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Mohammad Forouzanfar
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Khader
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Anwar Rafay
- Contech International Health Consultants, Lahore, Pakistan
| | - Rana Asghar
- South Asian Public Health Forum, Islamabad, Pakistan
| | - Saleem M. Rana
- Contech International Health Consultants, Lahore, Pakistan
| | - Amira Shaheen
- Department of Public Health, An-Najah University, Nablus, Palestine
| | | | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
| | - Laith J. Abu-Raddad
- Harvard University, Boston, MA, United States of America
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Tawfik Khoja
- Health Ministers’ Council for Cooperation Council States, Riyadh, Saudi Arabia
| | | | - Fadia S. AlBuhairan
- King Abdullah Specialized Children’s Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed Hsairi
- Ministry of Health—Tunisia (Faculty of Medicine Tunis), Tunis, Tunisia
| | - Mahmoud A. Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Raghib Ali
- University of Oxford, Oxford, United Kingdom
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States of America
- Department of Anesthesiology, King Fahad medical city, Riyadh, Saudi Arabia
- OUTCOMES RESEARCH Consortium, Cleveland, OH, United States of America
| | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Amany H. Refaat
- Suez Canal University, Ismailia, Egypt
- Walden University, Minneapolis, MN, United States of America
| | - Ronny Westerman
- Federal Institute for Population Research, Wiesbaden, Germany
| | - Aliasghar Ahmad Kiadaliri
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Ali S. Akanda
- University of Rhode Island, Kingston, RI, United States of America
| | | | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Imad A. D. Faghmous
- Tehran University of Medical Sciences, Tehran, Iran
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany
| | - Barthelemy Kuate Defo
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, Quebec, Canada
| | - Alem Mehari
- Howard University College of Medicine, Howard University, Washington DC, United States of America
| | - Saad B. Omer
- Emory University, Atlanta, GA, United States of America
| | | | - Olalekan A. Uthman
- Warwick—Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ali A. Mokdad
- Department of Surgery, University of Texas Southwestern, Dallas, Texas, United States of America
| | - Fadi T. Maalouf
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | | | - Nadia Akseer
- The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Dinesh Arya
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | | | - Ferrán Catalá-López
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Alize Ferrari
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
- School of Public Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu—CIBERSAM, Sant Boi de Llobregat, Spain
| | - Masako Horino
- Nevada Division of Behavior and Public Health, Carson City, NV, United States of America
| | - John C. Hornberger
- National Institutes of Health, Bethesda, MD, United States of America
- Cedar Associates, Menlo Park, CA, United States of America
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States of America
| | | | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Yunjin Kim
- Southern University College, Johor, Malaysia
| | - Ann Kristin Knudsen
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - George Patton
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Maheswar Satpathy
- UGC Centre for Advanced Studies in Psychology, Utkal University, Vani Vihar, Bhubaneswar, Odisha, INDIA
| | - Kim Savuon
- Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia
- Mental Health Association of Cambodia, Phnom Penh, Cambodia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Ivy Shiue
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Jens Christoffer Skogen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Karen M. Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | | | - Paul Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Social Work and Social Administration Department, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
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Wells R, Steel Z, Abo-Hilal M, Hassan AH, Lawsin C. Psychosocial concerns reported by Syrian refugees living in Jordan: systematic review of unpublished needs assessments. Br J Psychiatry 2016; 209:99-106. [PMID: 27103679 DOI: 10.1192/bjp.bp.115.165084] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Humanitarian organisations supporting Syrian refugees in Jordan have conducted needs assessments to direct resources appropriately. AIMS To present a model of psychosocial concerns reported by Syrian refugees and a peer review of research practices. METHOD Academic and grey literature databases, the United Nations Syria Regional Response website, key humanitarian organisation websites and Google were searched for needs assessments with Syrian refugees in Jordan between February 2011 and June 2015. Information directly reporting the views of Syrian refugees regarding psychosocial needs was extracted and a qualitative synthesis was conducted. RESULTS Respondents reported that psychological distress was exacerbated by both environmental (financial, housing, employment) and psychosocial outcomes (loss of role and social support, inactivity), which are themselves stressors. Need for improvement in research methodology, participatory engagement and ethical reporting was evident. CONCLUSIONS Participatory engagement strategies might help to address identified psychosocial outcomes. More rigorous qualitative methods are required to ensure accuracy of findings.
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Affiliation(s)
- Ruth Wells
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Zachary Steel
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Mohammad Abo-Hilal
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Abdul Halim Hassan
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Catalina Lawsin
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
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Abstract
Despite all the internal and external criticisms of mental health services in Libya, they remain underdeveloped across the country. The World Health Organization has made efforts to improve the country's mental health services; however, until a stable government is formed, patients with mental illness will continue to be deprived of their basic needs.
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Affiliation(s)
| | - Nusrat Husain
- Consultant EIS, Lancashire Care NHS Foundation Trust; Honorary Senior Lecturer, University of Manchester, UK
| | - Nadeem Gire
- EIS Research Assistant, Lancashire Care NHS Foundation Trust, UK
| | - Imran Bashir Chaudhry
- Lead EIS Consultant, EIS, Lancashire Care NHS Foundation Trust; Honorary Professor, General Adult Psychiatry, University of Manchester, UK
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Whiteford H, Ferrari A, Degenhardt L. Global Burden Of Disease Studies: Implications For Mental And Substance Use Disorders. Health Aff (Millwood) 2016; 35:1114-20. [DOI: 10.1377/hlthaff.2016.0082] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Harvey Whiteford
- Harvey Whiteford ( ) is a professor of population mental health in the School of Public Health, University of Queensland, in Brisbane, Australia
| | - Alize Ferrari
- Alize Ferrari is a research fellow at the Queensland Centre for Mental Health Research, in Brisbane
| | - Louisa Degenhardt
- Louisa Degenhardt is a professor at the National Drug and Alcohol Research Center at the University of New South Wales, in Sydney, Australia
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Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study. Glob Ment Health (Camb) 2016; 3:e8. [PMID: 28596877 PMCID: PMC5314753 DOI: 10.1017/gmh.2016.4] [Citation(s) in RCA: 5] [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: 09/23/2015] [Revised: 12/03/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Epidemiological models are frequently utilised to ascertain disease prevalence in a population; however, these estimates can have wider practical applications for informing targeted scale-up and optimisation of mental health services. We explore potential applications for a conflict-affected population, Syria. METHODS We use prevalence estimates of major depression and post-traumatic stress disorder (PTSD) in conflict-affected populations as inputs for subsequent estimations. We use Global Burden of Disease (GBD) methodology to estimate years lived with a disability (YLDs) for depression and PTSD in Syrian populations. Human resource (HR) requirements to scale-up recommended packages of care for PTSD and depression in Syria over a 15-year period were modelled using the World Health Organisation mhGAP costing tool. Associated avertable burden was estimated using health benefit analyses. RESULTS The total number of cases of PTSD in Syria was estimated at approximately 2.2 million, and approximately 1.1 million for depression. An age-standardised major depression rate of 13.4 (95% UI 9.8-17.5) YLDs per 1000 Syrian population is estimated compared with the GBD 2010 global age-standardised YLD rate of 9.2 (95% UI 7.0-11.8). HR requirements to support a linear scale-up of services in Syria using the mhGAP costing tool demonstrates a steady increase from 0.3 FTE in at baseline to 7.6 FTE per 100 000 population after scale-up. Linear scale-up over 15 years could see 7-9% of disease burden being averted. CONCLUSION Epidemiological estimates of mental disorders are key inputs into determining disease burden and guiding optimal mental health service delivery and can be used in target populations such as conflict-affected populations.
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Post-traumatic stress disorder and major depression in conflict-affected populations: an epidemiological model and predictor analysis. Glob Ment Health (Camb) 2016; 3:e4. [PMID: 28596873 PMCID: PMC5314754 DOI: 10.1017/gmh.2015.26] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/11/2015] [Accepted: 12/05/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite significant research examining mental health in conflict-affected populations we do not yet have a comprehensive epidemiological model of how mental disorders are distributed, or which factors influence the epidemiology in these populations. We aim to derive prevalence estimates specific for region, age and sex of major depression, and PTSD in the general populations of areas exposed to conflict, whilst controlling for an extensive range of covariates. METHODS A systematic review was conducted to identify epidemiological estimates of depression and PTSD in conflict-affected populations and potential predictors. We analyse data using Bayesian meta-regression techniques. RESULTS We identified 83 studies and a list of 34 potential predictors. The age-standardised pooled prevalence of PTSD was 12.9% (95% UI 6.9-22.9), and major depression 7.6% (95% UI 5.1-10.9) - markedly lower than estimated in previous research but over two-times higher than the mean prevalence estimated by the Global Burden of Disease Study [3.7% (95% UI 3.0-4.5) and 3.5% (95% UI 2.9-4.2) for anxiety disorders and MDD, respectively]. The age-patterns reveal sharp prevalence inclines in the childhood years. A number of ecological variables demonstrated associations with prevalence of both disorders. Symptom scales were shown to significantly overestimate prevalence of both disorders. Finding suggests higher prevalence of both disorders in females. CONCLUSION This study provides, for the first time, age-specific estimates of PTSD and depression prevalence adjusted for an extensive range of covariates and is a significant advancement on our current understanding of the epidemiology in conflict-affected populations.
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Farhood LF, Fares S, Sabbagh R, Hamady C. PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample. Eur J Psychotraumatol 2016; 7:31509. [PMID: 27414815 PMCID: PMC4944596 DOI: 10.3402/ejpt.v7.31509] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/30/2016] [Accepted: 06/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Armed conflict, occupation, and political and economic instability that are particularly experienced by the civilian Lebanese population of South Lebanon would almost inevitably affect these individuals psychologically. Therefore, identifying predictors of co-occurring mental disorders is paramount to sound assessment and intervention planning. OBJECTIVE This study aims to determine the prevalence and predictors of co-occurring posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in a post-war population from South Lebanon. METHOD A total of 991 citizens from 10 villages were interviewed using a cross-sectional design through random sampling. The prevalence of PTSD, MDD, or both was 23.4%. To identify predictors of PTSD and depression co-occurrence, multinomial logistic regression was used. Participants were divided into four groups (participants with no PTSD or depression, participants with PTSD only, participants with depression only, and participants with PTSD-depression comorbidity). RESULTS Among the significant predictors of PTSD-depression co-occurrence, female gender, health problems, social life events, and witnessed traumatic events were most consistently found. Additionally, employment and educational status, as well as social support, were found to significantly predict co-occurrence. CONCLUSIONS Results reveal the distinct risk and protective factors that characterize the PTSD-depression profile. These findings will hopefully assist in the development of interventions that are sensitive to individuals' psychosocial milieu.
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Affiliation(s)
- Laila F Farhood
- Hariri School of Nursing and Psychiatry Department, American University of Beirut, Beirut, Lebanon;
| | - Souha Fares
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Rachel Sabbagh
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Carmen Hamady
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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28
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Erskine HE, Moffitt TE, Copeland WE, Costello EJ, Ferrari AJ, Patton G, Degenhardt L, Vos T, Whiteford HA, Scott JG. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2015; 45:1551-1563. [PMID: 25534496 PMCID: PMC5922255 DOI: 10.1017/s0033291714002888] [Citation(s) in RCA: 347] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mental and substance use disorders are common and often persistent, with many emerging in early life. Compared to adult mental and substance use disorders, the global burden attributable to these disorders in children and youth has received relatively little attention. METHOD Data from the Global Burden of Disease Study 2010 was used to investigate the burden of mental and substance disorders in children and youth aged 0-24 years. Burden was estimated in terms of disability-adjusted life years (DALYs), derived from the sum of years lived with disability (YLDs) and years of life lost (YLLs). RESULTS Globally, mental and substance use disorders are the leading cause of disability in children and youth, accounting for a quarter of all YLDs (54.2 million). In terms of DALYs, they ranked 6th with 55.5 million DALYs (5.7%) and rose to 5th when mortality burden of suicide was reattributed. While mental and substance use disorders were the leading cause of DALYs in high-income countries (HICs), they ranked 7th in low- and middle-income countries (LMICs) due to mortality attributable to infectious diseases. CONCLUSIONS Mental and substance use disorders are significant contributors to disease burden in children and youth across the globe. As reproductive health and the management of infectious diseases improves in LMICs, the proportion of disease burden in children and youth attributable to mental and substance use disorders will increase, necessitating a realignment of health services in these countries.
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Affiliation(s)
- H. E. Erskine
- School of Population Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - T. E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Institute of Psychiatry, King’s College London, London, UK
| | - W. E. Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - E. J. Costello
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A. J. Ferrari
- School of Population Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G. Patton
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - L. Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Health Policy, Programs, and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - T. Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - H. A. Whiteford
- School of Population Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - J. G. Scott
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
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Jegannathan B, Kullgren G, Deva P. Mental health services in Cambodia, challenges and opportunities in a post-conflict setting. Asian J Psychiatr 2015; 13:75-80. [PMID: 25563073 DOI: 10.1016/j.ajp.2014.12.006] [Citation(s) in RCA: 18] [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] [Received: 08/27/2014] [Revised: 12/12/2014] [Accepted: 12/14/2014] [Indexed: 11/18/2022]
Abstract
Cambodia had suffered enormously due to war and internecine conflict during the latter half of the twentieth century, more so during the Vietnam War. Total collapse of education and health systems during the Pol Pot era continues to be a challenge for developing the necessary infrastructure and human resources to provide basic minimum mental health care which is compounded by the prevailing cultural belief and stigma over mental, neurological and substance abuse disorders (MNSDs). The mental health research and services in Cambodia had been predominantly 'trauma focused', a legacy of war, and there is a need to move toward epidemiologically sound public health oriented mental health policy and service development. Integrating mental health program with primary health care services with specifically stated minimum package of activities at primary level and complementary package of activities at secondary level is an opportunity to meet the needs and rights of persons with mental, neurological and substance abuse disorders (PWMNSDs) in Cambodia, provided there is mental health leadership, government commitment and political will.
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Affiliation(s)
- Bhoomikumar Jegannathan
- Center for Child and Adolescent Mental Health, Chey Chumneas Hospital Takhmau, Kandal Province, Cambodia.
| | - Gunnar Kullgren
- Psychiatry, Department of Clinical Sciences, University of Umeå, 901 85 Umeå, Sweden.
| | - Parameshvara Deva
- Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Sg. Long, Selangor, Malaysia.
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30
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Abstract
INTRODUCTION The purpose is to explore the consequences of war and its impact on mental health with attention to the Mediterranean area. METHODS Narrative review of consequences of war on mental health and on the mental health of the communities in the current crises in the Mediterranean region. RESULTS A series of outbreaks of war are still raging in the Mediterranean region and producing horrible effects with a considerable number of refugees with unsatisfied needs. Studies relating to conflicts of the past suggest that the mental health consequences of these wars may affect future generations for many years. While violations of human rights are not new, what is new are attacks on medical institutions perceived to be traditionally Western. CONCLUSION The scientific community has to fight violence through mediation of conflicts. The idea that science can improve lives is a concept that is found in the history of all Mediterranean cultures. The Greek and Roman medical tradition was saved thanks to doctors of the Arab courts when Christian fundamentalism fought science in the Middle Ages. Health institutions are the product of the great Islamic medical tradition as well as Western culture.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, Cagliari University, Cagliari, Italy Mediterranean Society on Mental Health Cagliari, Italy
| | - Maria Francesca Moro
- Department of Public Health and Clinical and Molecular Medicine, Cagliari University, Cagliari, Italy
| | - Judith Bass
- Johns Hopkins School of Public Health, Baltimore, MD, USA
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Stanford MS, Elverson TM, Padilla JI, Rogers EB. Feasibility and efficacy of a peer-led recovery group program for war-related trauma in Libya. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.1177/0081246313515847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
After 42 years under the brutal rule of Colonel Muammar al-Gaddafi, the people of Libya rose up on 17 February 2011 and demanded change. The 9-month civil war that followed resulted in the deaths of approximately 15,000 Libyans. This study reports on the feasibility and efficacy of a 10-week peer-led group-based recovery intervention for war-related trauma implemented at the Garyounis internally displaced person camp outside of the city of Benghazi. The results of this preliminary assessment show that the use of peers to lead recovery groups for war-related trauma is not only feasible but also appears to be highly efficacious in reducing posttraumatic stress disorder symptoms in civilians. The reported subjective experiences of those involved in facilitating the groups suggest that the use of peers, rather than mental health professionals, is a realistic option to minimize the long-term effects of war-related trauma.
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Affiliation(s)
| | | | | | - Edward B Rogers
- Department of Psychology and Neuroscience, Baylor University, USA
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32
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Carta MG, Oumar FW, Moro MF, Moro D, Preti A, Mereu A, Bhugra D. Trauma- and stressor related disorders in the tuareg refugees of a cAMP in burkina faso. Clin Pract Epidemiol Ment Health 2013; 9:189-95. [PMID: 24285982 PMCID: PMC3841965 DOI: 10.2174/1745017901309010189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/13/2013] [Accepted: 10/13/2013] [Indexed: 11/22/2022]
Abstract
Background: Post-traumatic stress disorder (PTSD) is reported to be common among refugees. We set out to explore risk of Trauma- and Stress-or-Related Disorders and the associated burden of psychological distress in a refugee camp of Malian Refugees in Burkina Faso. Methods: One out of five persons living in the camp was selected randomly and interviewed using the French version of the Short Screening Scale for PTSD and the validated K6 scale to measure psychiatric morbidity. Results: Around 60% of the interviewed sample (N=408) met the criteria for Trauma- and Stress-or-Related Disorders and also reported severe mental distress on K6 scores. Women aged 40 and over were found to be at higher risk of Trauma- and Stress-or-Related Disorders whereas young people (39 or younger) scored higher on K6 ratings. Around 83% of the surveyed subjects had a family member killed in the war, 91% a relative in the war, more than 80% had a family member suffering from physical injuries, and 90% reported problems with food and housing. The frequency of these life events was not surprisingly higher in persons with Trauma- and Stress-or-Related Disorders, with the death of a family member and severe problems with food being specifically related to them.Conclusion: These results point to important psychological suffering in a population that is often ignored by the media and international political authorities. Immediate steps are required to provide urgent legal and humanitarian protection to those who are forced to flee their homes and cross international borders because of disasters.
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Affiliation(s)
- M G Carta
- Department of Public Health, Clinical and Molecular Medicine, Cittadella, Universitaria di Monserrato, 09042 Monserrato, Calgiari, Italy
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Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, Vos T, Whiteford HA. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10:e1001547. [PMID: 24223526 PMCID: PMC3818162 DOI: 10.1371/journal.pmed.1001547] [Citation(s) in RCA: 1961] [Impact Index Per Article: 178.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/18/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease. METHODS AND FINDINGS Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8%) of global YLDs and dysthymia for 1.4% (0.9%-2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2%) of global DALYs and dysthymia for 0.5% (0.3%-0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8%) to 3.8% (3.0%-4.7%) of global DALYs. CONCLUSIONS GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Alize J Ferrari
- University of Queensland, School of Population Health, Herston, Queensland, Australia ; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
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Broadening the scope of epidemiology in conflict-affected settings: opportunities for mental health prevention and promotion. Epidemiol Psychiatr Sci 2013; 22:197-203. [PMID: 23941725 PMCID: PMC8367339 DOI: 10.1017/s2045796013000188] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This editorial proposes a shift in emphasis in the field of mental health epidemiology in conflict-affected settings. After a brief summary of the nature of contemporary armed conflicts, we consider the current and potential roles that epidemiology can play with regard to: (1) establishing the burden of mental disorders; (2) identifying risk and protective factors; and (3) intervention research. We advocate for improved methodological rigor; more attention to mixed methods approaches and multi-level longitudinal research; inclusion of the determinants of mental health beyond conflict-related violence; and consideration of a wider array of mental health outcomes. We particularly highlight the importance of expanding interest to epidemiological research that advances prevention and promotion interventions (e.g., in the early childhood period), in order to fill the gap between epidemiology and mental health practice in conflict-affected settings.
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Abou-Saleh M, Mobayed M. Mental health in Syria. Int Psychiatry 2013; 10:58-60. [PMID: 31507735 PMCID: PMC6735115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This paper begins by outlining the nature of the present conflict in Syria. It goes on to describe the psychological consequences of this conflict and the present state of the mental health services in the country.
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Affiliation(s)
- Mohammed Abou-Saleh
- Chief Executive Officer, Naufar (Qatar Addiction Treatment and Rehabilitation Centre) , Doha, Qatar; and Professor of Psychiatry, St George's, University of London, UK, email
| | - Mamoun Mobayed
- Senior Consultant Psychiatrist, Al-Aween Social Rehabilitation Centre, Doha, Qatar
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Abstract
This Commentary considers the health system and policy challenges of addressing non-communicable diseases (NCDs) in Egypt, Libya, and Tunisia, countries in the process of re-framing state policies and institutions, including in the health sector. Against this backdrop, a neglected issue of the rapidly rising burden of NCDs threatens both health and economic development. Tackling this worrisome rise in NCDs has been impeded by inadequate policies. Weak health systems, little attention to determinants of health, and limited access to affordable health care complicate effective responses to NCDs, especially in a fragile transitional phase. There remains an opportunity to confront the neglected challenge of NCDs by substantially strengthening policies and scaling up comprehensive health systems to more effectively address the causes and treatment of NCDs, including mental health, ultimately to improve population health overall.
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Tashani OA. Prevalence of chronic pain in Libya before and after the uprising of 17 February 2011. Libyan J Med 2013; 8:20125. [PMID: 23401725 PMCID: PMC3568675 DOI: 10.3402/ljm.v8i0.20125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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