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Salelew E, Assefa YA, Getachew R, Nenko G, Fanta B, Amare T, Demilew D, Dellie E, Aschalew AY, Asrade G, Demeke Z, Shitu K, Eriku GA, Worku C, Kibret AK, Haile TG, Hunegnaw MT, Fekadu H, Molla A, Belew AK, Atnafu A, Guadu T, Yitayal M, Worku N, Gelaye KA, Azale T, Awoke T. Magnitude of psychological distress and associated factors among war survivor women in Northern, Ethiopia, 2022: a community-based cross-sectional survey. BMC Womens Health 2024; 24:356. [PMID: 38902665 PMCID: PMC11188300 DOI: 10.1186/s12905-024-03161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. METHODS A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. RESULT In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92). CONCLUSION The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality.
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Affiliation(s)
- Endalamaw Salelew
- Department of psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia.
| | - Yohannes Awoke Assefa
- Department of occupational therapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Rediet Getachew
- Department of occupational therapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Goshu Nenko
- Department of psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Biruk Fanta
- Department of psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare
- Department of psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Demeke Demilew
- Department of psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Andualem Yalew Aschalew
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Geta Asrade
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Zelalem Demeke
- Department of occupational therapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Kegnie Shitu
- Department of Health Promotion and Health Behavior, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Health Sciences, Western Sydney University, Campbell town, Sydney, NSW, 2560, Australia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Chanyalew Worku
- Department of Medical Nursing, School of Nursing, University of Gondar, Gondar, Ethiopia
| | - Alemu Kassaw Kibret
- Department of Physiotherapy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin Haile
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tamir Hunegnaw
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Aysheshim Kassahun Belew
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Guadu
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health system and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Netsanet Worku
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Promotion and Health Behavior, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Anbesaw T, Kassa MA, Yimam W, Kassaw AB, Belete M, Abera A, Abebe G, Yimer N, Melkam M, Ayano G. Factors associated with depression among war-affected population in Northeast, Ethiopia. BMC Psychiatry 2024; 24:376. [PMID: 38773453 PMCID: PMC11106904 DOI: 10.1186/s12888-024-05812-1] [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: 02/22/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia. METHOD A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULT The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression. CONCLUSION This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.
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Affiliation(s)
- Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, P.O. Box 1145, Dessie, Ethiopia.
| | - Mulat Awoke Kassa
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Wondossen Yimam
- Department of Comprehensive Nursing, College of Medicine and Health Sciences (CMHS), Wollo University (WU), P.O. Box 1145, Dessie, Ethiopia
| | - Altaseb Beyene Kassaw
- College of Medicine and Health Science, Department of Biomedical Science, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Mekonnen Belete
- College of Medicine and Health Science, School of Medicine, Department of Physiology, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Amare Abera
- College of Medicine and Health Science, School of Medicine, Department of Physiology, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Gashaw Abebe
- College of Medicine and Health Science, School of Medicine, Department of Biochemistry, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Nega Yimer
- Department of Adult Health Nursing, College of Medicine and Health Sciences (CMHS), Wollo University (WU), P.O. Box 1145, Dessie, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, University of Gondar College of Medicine and Health Sciences, PO. Box 196, Gondar, Ethiopia
| | - Getinet Ayano
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, Australia
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Tesfaye AH, Sendekie AK, Kabito GG, Engdaw GT, Argaw GS, Desye B, Angelo AA, Aragaw FM, Abere G. Post-traumatic stress disorder and associated factors among internally displaced persons in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0300894. [PMID: 38557637 PMCID: PMC10984478 DOI: 10.1371/journal.pone.0300894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Internally displaced people (IDPs), uprooted by conflict, violence, or disaster, struggle with the trauma of violence, loss, and displacement, making them significantly more vulnerable to post-traumatic stress disorder (PTSD). Therefore, we conducted a systematic review and meta-analysis to assess the prevalence and associated factors of PTSD among IDPs in Africa. METHODS A comprehensive search of electronic databases was conducted to identify relevant studies published between 2008 and 2023. The search included electronic databases such as PubMed, CABI, EMBASE, SCOPUS, CINHAL, and AJOL, as well as other search sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted using Microsoft Excel, and analysis was performed using STATA 17 software. The quality of the included studies was assessed using the JBI quality appraisal tool. A random-effects model was used to estimate the pooled prevalence of PTSD and its associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics was used to assess heterogeneity. The protocol for this review has been registered with PROSPERO (ID: CRD42023428027). RESULTS A total of 14 studies with a total of 7,590 participants met the inclusion criteria. The pooled prevalence of PTSD among IDPs in Africa was 51% (95% CI: 38.-64). Female gender (OR = 1.99, 95% CI: 1.65-2.32), no longer married (OR = 1.93, 95% CI: 1.43-2.43), unemployment (OR = 1.92, 95% CI: 1.17-2.67), being injured (OR = 1.94, 95% CI: 1.50-1.50), number of traumatic events experienced [4-7(OR = 2.09, 95% CI: 1.16-3.01), 8-11 (OR = 2.09, 95% CI: 2.18-4.12), 12-16 (OR = 5.37, 95% CI: 2.61-8.12)], illness without medical care (OR = 1.92, 95% CI: 1.41-2.29), being depressed (OR = 2.97, 95% CI: 2.07-3.86), and frequency of displacement more than once (OR = 2.13, 95% CI: 1.41-2.85) were significantly associated with an increased risk of PTSD. CONCLUSIONS The findings of this systematic review and meta-analysis highlight the alarming prevalence of PTSD among IDPs in Africa. Female gender, marital status, number of traumatic events, ill health without medical care, depression, and frequency of displacement were identified as significant risk factors for PTSD. Effective interventions and the development of tailored mental health programs are needed to prevent PTSD among IDPs, focusing on the identified risk factors.
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Affiliation(s)
- Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebisa Guyasa Kabito
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Shibeshi Argaw
- Department of Nursing, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Belay Desye
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abiy Ayele Angelo
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Giziew Abere
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Koshe T, Jarso MH, Walde MT, Ebrahim J, Mamo A, Esmael A, Wedajo LF, Seife S, Mohammedhussein M, Nigatu D, Debele GR, Gezmu W. A post-traumatic stress disorder among internally displaced people in sub-Saharan Africa: a systematic review. Front Psychiatry 2023; 14:1261230. [PMID: 38025413 PMCID: PMC10655091 DOI: 10.3389/fpsyt.2023.1261230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite the prevalence of post-traumatic disorder in internally displaced persons, which is well established, and the fact that respective international organizations are working on the issues, little attention is given in the context of sub-Saharan Africa, This study aims to review the available data about the prevalence and determinants of post-traumatic stress disorders among internally displaced people in sub-Saharan Africa. Methods Studies published in the English language that have a clear outcome of interest and are available in full text were included. Six electronic databases were searched to identify published studies on the prevalence and determinants of posttraumatic stress disorder among IDPs in sub-Saharan Africa. This includes PubMed/MEDLINE, Scopus, EMBASE, PsychInfo, and the Web of Science. All relevant studies till June, 2023 were assessed. The review was done as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD420222997111). Results Originally, 33,138 articles were found in six databases, and finally, eleven studies were reviewed. The prevalence of post-traumatic stress disorder in sub-Saharan African countries was disproportionately presented in this review, ranging from 12.3% in Central Sudan to 85.5% in Nigeria. From a total of 11 studies, eight of them reported more than 50% of the magnitude of post-traumatic stress disorder, pointing to a higher magnitude of the prevalence of post-traumatic stress disorders in the region. The study identified numerous factors that contributed to post-traumatic stress disorder among the internally displaced population. Female gender, depression, anxiety, stress, being single, low level of educational status, experiencing or witnessing traumatic events, and psychological trauma were evidenced for their association with post-traumatic stress disorder. Conclusion These results demonstrate a higher prevalence of post-traumatic stress disorder compared to other regions of the world. The participants' socio-demographic characteristics, including age, being single, being female, and a low level of education, were identified as factors contributing to PTSD. Moreover, the review identified that depression, anxiety, and experiencing or witnessing traumatic events were also influencing factors for PTSD among IDPs. The concerned bodies need to reinforce the monitoring and evaluation of the mental health programs of IDPs in the region. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299711, CRD42022299711.
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Affiliation(s)
- Tura Koshe
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | | | - Mandaras Tariku Walde
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jemal Ebrahim
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Aman Mamo
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Adem Esmael
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Lema Fikadu Wedajo
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Solomon Seife
- Department of Midwifery, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Mustefa Mohammedhussein
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Desalegn Nigatu
- Department of Nursing, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Wubishet Gezmu
- Department of Nursing, College of Health Sciences, Mattu University, Mattu, Ethiopia
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Castro-Camacho L, Barlow DH, García N, Farchione TJ, Idrobo F, Rattner M, Quant DM, González L, Moreno JD. Effects of a Contextual Adaptation of the Unified Protocol in Multiple Emotional Disorders in Individuals Exposed to Armed Conflict in Colombia: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:991-999. [PMID: 37466983 PMCID: PMC10357366 DOI: 10.1001/jamapsychiatry.2023.2392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023]
Abstract
Importance A transdiagnostic treatment, the Unified Protocol, is as effective as single diagnostic protocols in comorbid emotional disorders in clinical populations. However, its effects on posttraumatic stress disorder and other emotional disorders in individuals living in war and armed conflict contexts have not been studied. Objective To evaluate the efficacy of a cultural and contextual adaptation of the Unified Protocol (CXA-UP) on posttraumatic stress disorder, anxiety, and depression compared to waitlist control in individuals exposed to armed conflict in Colombia. Design, Setting, and Participants From April 2017 to March 2020, 200 participants 18 years and older were randomly assigned to the CXA-UP or to a waitlist condition. CXA-UP consisted of 12 to 14 twice-a-week or weekly individual 90-minute face-to-face sessions. Outcomes were assessed at baseline, posttreatment, and 3 months following treatment. Analyses were performed and compared for all randomly allocated participants (intent-to-treat [ITT]) and for participants who completed all sessions and posttreatment measures (per protocol [PP]). The study took place at an outpatient university center and included individuals who were registered in the Colombian Victims Unit meeting DSM-5 diagnostic criteria for posttraumatic stress disorder, anxiety, or depression or were severely impaired by anxiety or depression. Individuals who were receiving psychological therapy, were dependent on alcohol or drugs, were actively suicidal or had attempted suicide in the previous 2 months, had psychosis or bipolar disorder, or were cognitively impaired were excluded. Intervention CXA-UP or waitlist. Main Outcomes and Measures Primary outcomes were changes in anxiety, depression, and somatic scores on the Patient Health Questionnaire and Posttraumatic Stress Disorder Checklist for DSM-5. Results Among the 200 participants (160 women [80.0%]; 40 men [20.0%]; mean [SD] age, 43.1 [11.9] years), 120 were randomized to treatment and 80 to waitlist. Results for primary outcomes in the ITT analysis showed a significant pretreatment-to-posttreatment reduction when comparing treatment and waitlist on the posttraumatic stress disorder checklist for DSM-5 scores (slope [SE], -31.12 [3.00]; P < .001; Cohen d, 0.90; 90% CI, 0.63-1.19), 9-item Patient Health Questionnaire (PHQ-9) (slope [SE],-11.94 [1.30]; P < .001; Cohen d, 0.77; 90% CI, 0.52-1.06), PHQ-anxiety (slope [SE], -6.52 [0.67]; P < .001; Cohen d, 0.82; 90% CI, 0.49-1.15), and PHQ-somatic (slope [SE], -8.31 [0.92]; P < .001; Cohen d, 0.75; 90% CI, 0.47-1.04). Conclusions and Relevance In this study, significant reductions and large effect sizes in all measures of different emotional disorders showed efficacy of a single transdiagnostic intervention in individuals exposed to armed conflicts. Trial Registration ClinicalTrials.gov Identifier: NCT03127982.
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Affiliation(s)
| | - David H. Barlow
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Nicolás García
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Todd J. Farchione
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Fabio Idrobo
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Michel Rattner
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
- Department of Psychology, Palo Alto University, Palo Alto, California
| | - Diana M. Quant
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Laura González
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Julián D. Moreno
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
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Thomas FC, Divirgilio R, Jayawickreme N, Sivayokan S, McShane K, Jayawickreme E. Coping with the long-term impact of civil strife: A grief-centered analysis of Tamil Sri Lankan communities affected by ethnopolitical conflict. Appl Psychol Health Well Being 2023. [PMID: 37712290 DOI: 10.1111/aphw.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
Limited research has examined coping mechanisms in response to chronic war-related stressors, as opposed to war-exposure trauma. The current study sought to investigate the types of losses experienced by communities affected by the Sri Lankan conflict, how participants responded to their losses, and what coping mechanisms they employed. Data consisted of interviews from two independent investigations conducted following the end of the conflict in Northern Sri Lanka (total N = 103). Interview transcripts were analyzed using a directed content analysis approach. Participants most frequently described experiencing material loss and loss of loved ones. Relatedly, participants commonly reported experiencing ambiguous loss, that is, living with the uncertainty of their loved one's death. These losses were particularly pronounced by gender, with women experiencing higher rates of loss. Common coping strategies included support-seeking, including informal support from social networks and religion, and formal mental health services. Additionally, participants described a range of longer term coping strategies from establishing a future-oriented cognitive style to a sense of helplessness and resignation. The findings shed light on how conflict-affected groups cope with profound loss. We provide recommendations for how such findings can inform grief-related clinical interventions.
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Affiliation(s)
- Fiona C Thomas
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Richard Divirgilio
- Department of Psychology, School of Liberal Arts, Manhattan College, Bronx, New York, USA
| | - Nuwan Jayawickreme
- Department of Psychology, School of Liberal Arts, Manhattan College, Bronx, New York, USA
| | | | - Kelly McShane
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Ontario, Canada
- Human Resource Management and Organizational Behaviour, Ted Rogers School of Management, Toronto, Ontario, Canada
| | - Eranda Jayawickreme
- Department of Psychology and Program for Leadership and Character, Wake Forest University, Winston-Salem, North Carolina, USA
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Ugbe UMJ, Esu EB, Onwusaka OC, Bisongedam MM, Nji ELB, Efut JA, Ekpo OI, Okoi FU. Correlates of somatic symptom disorder among internally displaced persons in Ogoja displacement settlements, Nigeria: a cross-sectional study. Afr Health Sci 2023; 23:705-713. [PMID: 38357123 PMCID: PMC10862576 DOI: 10.4314/ahs.v23i3.81] [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] [Indexed: 02/16/2024] Open
Abstract
Background Experiences of displacement have been associated with the prevalence of mental health disorders owing to certain factors. Objectives This study aimed to identify the correlates of Somatic Symptom Disorder (SSD) among internally displaced adults in Ogoja displacement settlements, Nigeria. Methods This was a cross-sectional study of 335 respondents. SSD was assessed using the SOM-SCL section of the Common Mental Disorder Questionnaire while a semi-structured questionnaire was used to collect data on sociodemographic and displacement-related factors. Data were analysed using descriptive statistics, Chi-square, and multivariable logistic regression. Result The prevalence of somatoform disorder was 59.1%. Factors found to be significant in each bivariate Chi-square analysis were modelled for the mental disorder. The multivariate analysis revealed that being married (AOR=2.80; p=0.020) prolonged displacement (AOR=3.29; p=0.003), discrimination (AOR=2.25; p=0.010), disease outbreak (AOR=1.92; p=0.030), loss of loved ones (AOR=1.34; p=0.028), overcrowded households (AOR=2.30; p=0.008), and fear of reprisals (AOR=2.05; p=0.026) were significantly associated with somatoform disorder. Conclusion The findings suggest that the high prevalence of the studied outcome is related to several stressors and events among Internally displaced persons. Evidence-based mental health support efforts by different bodies in creating and routinely arranging mental health clinical interventions for this population is recommended.
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Affiliation(s)
| | | | | | | | | | - Joseph Ajah Efut
- Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Ofem Irom Ekpo
- Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Faith Ubi Okoi
- Department of Public Health, University of Calabar, Calabar, Nigeria
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, García T, González-Uribe C, Moreno-Serra R, Bernal O. Mental health disorders in population displaced by conflict in Colombia: Comparative analysis against the National Mental Health Survey 2015. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:121-129. [PMID: 37453820 DOI: 10.1016/j.rcpeng.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/21/2021] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. METHODS Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire-25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. RESULTS 1089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. CONCLUSIONS The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.
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Affiliation(s)
| | - Germán Casas
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | | | - Tatiana García
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Universidad Autónoma de Barcelona, Barcelona, Spain
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Makango B, Alemu ZA, Solomon T, Lemma N, Girma T, Mohammednur T, Alayu M, Fufa Y. Prevalence and factors associated with post-traumatic stress disorder among internally displaced people in camps at Debre Berhan, Amhara Region, Ethiopia: a cross-sectional study. BMC Psychiatry 2023; 23:81. [PMID: 36717807 PMCID: PMC9887899 DOI: 10.1186/s12888-023-04570-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a common mental disorder after traumatic exposure that can have long-lasting physical and mental health consequences. In 2021, Ethiopia saw the highest number of internally displaced people (IDP) due to conflict and war with the scope of the internal displacement being very high in the study area and less attention has been given to mental health. OBJECTIVE To determine the prevalence and associated factors of PTSD among internally displaced people in camps at Debre Berhan, Ethiopia. METHODS A cross-sectional study was conducted from December 1-30, 2021 among 406 IDPs, who were selected by random systematic sampling from the registration and proportionally allocated to three IDP camps in Debre Berhan. Post-traumatic stress disorder was measured by the PTSD checklist (DSM-5). Data were collected through an interviewer-administered pre-tested questionnaire, entered into EpiData version 3.1, and analyzed by Statistical Package for Social Sciences version 25. Bivariate binary logistic regression was used to select candidate variables with p < 0.25. Multicollinearity was checked by using the variance inflation factor and it was less than 10. Model adequacy was checked by Hosmer & Lemeshow goodness of test (p > 0.05). In the multivariable binary logistic regression, the association between outcome and independent variables was declared at p < 0.05 with its adjusted odds ratio (AOR) at a 95% confidence level. RESULTS The prevalence of PTSD among the respondents was 67.5% (95% CI: 63-72). Being a merchant (AOR = 0.41 [95% CI: 0.02-0.85]), witnessing the destruction of property (AOR = 1.67 [95% CI: 1.01-2.74]), facing trauma during displacement (AOR = 6.00 [95% CI: 2.75-13.10]), frequency of displacement (AOR = 0.31 [95% CI: 0.11-0.85]), being distressed (AOR = 5.42 [95% CI: 3.25-9.05]), and unemployment (AOR = 2.09 [95% CI: 1.24-3.54]) were factors significantly associated with PTSD. CONCLUSION This study provides evidence of the high prevalence of PTSD among internally displaced people. Therefore, mental health and psychosocial support are urgently required to address the identified factors and help the displaced people against long-term avoidable suffering.
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Affiliation(s)
- Belay Makango
- Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia.
| | - Zewdie Aderaw Alemu
- Department of Public Health, GAMBY Medical and Business College, Addis Ababa, Ethiopia ,grid.449044.90000 0004 0480 6730Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfaye Solomon
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Nigussie Lemma
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Tewodros Girma
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Tijani Mohammednur
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Mikias Alayu
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
| | - Yaregal Fufa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, P.O.Box: 1242, Addis Ababa, Ethiopia
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Biset G, Goshiye D, Melesse N, Tsehay M. Post-traumatic stress disorders among children and adolescents in conflict-affected zones of Amhara region, February 2022. Front Psychol 2023; 13:1052975. [PMID: 36687911 PMCID: PMC9845561 DOI: 10.3389/fpsyg.2022.1052975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Background To date, conflict is causing extreme social crises worldwide, with children representing the most vulnerable group, often experiencing severe trauma and violence in conflict-ridden areas. Posttraumatic stress disorders (PTSDs) are the most widely reported psychological problem in the aftermath of conflict. However, less attention has been given to children living in conflict-prone areas of the world. Objective The present study aimed to assess posttraumatic stress disorders among children and adolescents in conflict-affected zones of the Amhara region in Ethiopia from January to February 2022. Method A community-based cross-sectional study was employed from January to February 2022. A multistage random sampling technique was employed to recruit the study participants. A structured interviewer-administered questionnaire was designed to collect the desired data. Data were verified, coded, and entered into EpiData version 3.1 and analyzed using SPSS version 24 statistical software. Result A total of 846 children with a response rate of 94.33% were screened for trauma. Subsequently, 557 (69.80%) children had experienced trauma. Of these 557 children who had experienced trauma, 203 (36.45%) developed posttraumatic stress disorders. Based on these results, this study recommends that mass screening of children and adolescents for posttraumatic stress disorders and rehabilitation services be undertaken, including resilience training and psychosocial support.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Dream Science and Technology College, Dessie, Ethiopia
| | - Debrnesh Goshiye
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Mekonnen Tsehay
- Department of Psychiatric Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Ali M, Mutavi T, Mburu JM, Mathai M. Prevalence of Posttraumatic Stress Disorder and Depression Among Internally Displaced Persons in Mogadishu-Somalia. Neuropsychiatr Dis Treat 2023; 19:469-478. [PMID: 36879949 PMCID: PMC9985393 DOI: 10.2147/ndt.s398423] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Background Nearly 2.6 million people have been forced into displacement camps in Somalia as a result of frequent conflicts exacerbated by climate change disasters. Although the psychological impact of war and natural disasters is well documented elsewhere, little is known about the unseen scars of psychological trauma among internally displaced persons (IDPs) in Somalia. This study was carried out between January and February 2021 and sought to determine the prevalence of post-traumatic stress disorder (PTSD) and depression among IDPs and examine the association between displacement and these psychiatric conditions. Methodology A cross-sectional quantitative study was conducted among 401 IDPs in Mogadishu. The Harvard Trauma Questionnaire was used to determine the levels of trauma exposure and PTSD, and Hopkins Symptom Checklist-25 was used to estimate the prevalence of depression. Multivariate and bivariate analyses were performed to analyze the association between demographic and displacement variables and the outcomes of PTSD and depression. Results More than half (59%) of participants met the symptom criteria of depression, and nearly a third (32%) of respondents met the symptom criteria for PTSD. The most prevalent traumatic event was a lack of food or water (80.2%). Important predictive factors for the development of psychiatric morbidity were unemployment, cumulative traumatic exposure, and frequency and duration of displacement. Conclusion The study revealed high levels of depressive disorder and PTSD among IDPs in Mogadishu. Furthermore, this study provided evidence of IDPs' susceptibility to trauma exposure and lack of essential services and goods. The study highlighted the importance of the provision of Mental Health and Psychosocial Support (MHPSS) services in IDP camps.
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Affiliation(s)
- Mustafa Ali
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Teresia Mutavi
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Thomas FC, D’souza M, Magwood O, Thilakanathan D, Sukumar V, Doherty S, Dass G, Hart T, Sivayokan S, Wickramage K, Kirupakaran S, McShane K. Examining post-conflict stressors in northern Sri Lanka: A qualitative study. PLoS One 2022; 17:e0267018. [PMID: 36054085 PMCID: PMC9439197 DOI: 10.1371/journal.pone.0267018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
Forcibly displaced individuals typically encounter daily stressors, which can negatively impact mental health above and beyond direct exposure to war-related violence, trauma and loss. Understanding the perspectives of war affected communities regarding daily stressors can enhance the integration of mental health into local primary care. The aim of the current study was to explore how daily stressors are conceptualized in a post-conflict setting. Data collection was completed with 53 adult participants who were recruited from primary healthcare clinics in Northern Province, Sri Lanka. Individual interviews were conducted in Tamil, audio-recorded, translated from Tamil to English, and transcribed. Themes emerging from the data were organized into an analytical framework based on iterative coding and grounded in the daily stressors framework. Stressors were conceptualized as chronic stressors and systemic stressors. Findings indicate that chronic stressors, such as loss of property, permeate daily life and have a profound impact on psychological wellbeing. Interviewees additionally reported that systemic stressors stemmed from unresolved grief for missing family members and limited support from institutions. The results of the current study complement existing literature, suggesting the value of multipronged approaches which identify and address symptoms of complicated bereavement while simultaneously alleviating financial hardship. An understanding of stressors experienced by conflict-affected populations in times of chronic adversity can be informative for the design and implementation of culturally-tailored interventions.
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Affiliation(s)
- Fiona C. Thomas
- Department of Psychology, Faculty of Arts, Ryerson University, Toronto, Ontario, Canada
- * E-mail:
| | - Malasha D’souza
- Institute for Management and Innovation, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Magwood
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Shannon Doherty
- School of Allied Health, Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Tae Hart
- Department of Psychology, Faculty of Arts, Ryerson University, Toronto, Ontario, Canada
| | - Sambasivamoorthy Sivayokan
- Jaffna Teaching Hospital, Jaffna, Sri Lanka; Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Kolitha Wickramage
- International Organization for Migration (IOM), United Nations Migration Agency, Migration Health Division, Geneva, Switzerland
| | | | - Kelly McShane
- Department of Psychology, Faculty of Arts, Ryerson University, Toronto, Ontario, Canada
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Thomas FC, Coulombe S, Girard TA, Hart TL, Doherty S, Dass G, Wickramage K, Siriwardhana C, Surenthirakumaran R, McShane K. Displacement-related stressors in a Sri Lankan war-affected community: Identifying the impact of war exposure and ongoing stressors on trauma symptom severity. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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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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Wazir MNK, Fatima K, Ahmad HR, Kakakhel S, Yusuf N, Wahid F. Association and Effects of Trauma, Displacement, and Illicit Drug Use on Psychiatric Illnesses in Khyber Pakhtunkhwa, Pakistan. Cureus 2022; 14:e22079. [PMID: 35308687 PMCID: PMC8920808 DOI: 10.7759/cureus.22079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Abstract
Methodology Data were accumulated from all patients seen in outpatient clinics from October to December 2020. No inpatients or community samples were included in the research. Verbal consent and approval from the local ethical committee were obtained beforehand. ICD-10 diagnostic criteria were used for all psychiatric diagnoses. Results A total of 500 patients were seen with a gender distribution of 51% females and 49% males. Patients aged 18-65 years comprised 79% of this sample; 52% had no formal education. A total of 43% lived in settled areas; 37% were from Afghanistan; 13% from tribal areas, and 7% were from the Swat region. Thirty percent had no medical history, and 40% reported no prior contact with psychiatric service. Anxiety spectrum disorders were more prevalent in females, and psychotic and drug-related illnesses were more prevalent in males. More than half the patients seen were considered fit for psychotherapy referral but could not engage because of the lack of such services near their homes. The significance of the results obtained was assessed using the Chi-squared test, using SPSS v.22. A p-value of less than 0.05 was considered significant. Conclusion Almost 40% of patients were admitted due to some form of trauma history, predominantly terrorism-related, displacement, and other losses. Two in three people reported current or past drug use, with tetrahydrocannabinol (THC) being the most commonly used drug, followed by sedatives, opioids/pain relief medications, amphetamines, or methamphetamine (ICE), and others (e.g., alcohol). There was a significant rise in drug use/trauma history in the tribal areas, Afghanistan, and Swat region compared to the local population of settled areas. Common psychiatric illnesses were as expected in the sample studied.
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Doherty S, Dass G, Edwards A, Stewart R, Roberts B, Abas M. Protocol of a randomised clinical trial to integrate mental health services into primary care for postconflict populations in Northern Sri Lanka (COMGAP-S). BMJ Open 2022; 12:e051441. [PMID: 35105620 PMCID: PMC8804640 DOI: 10.1136/bmjopen-2021-051441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sri Lanka has a long history of armed conflict and natural disasters increasing the risk of mental health disorders in the population. Due to a lack of specialist services, there is a treatment gap between those seeking and those able to access mental health services. The aim of this research programme is to integrate mental health services into primary care to meet the needs of this postconflict population. METHODS AND ANALYSIS This is a stepped wedge cluster design randomised clinical trial of the WHO mental health Gap Action Programme primary care mental health training intervention. We will provide a 10-day training to primary care practitioners of 23 randomly selected primary care facilities aimed at increasing their ability to identify, treat and manage common mental health disorders. Public health professionals and community representatives will receive a tailored training intervention to increase mental health awareness. Refresher courses will occur at 3 and 6 months post training. Supervision and monitoring will occur for 1 month pre and post training. Target sample sizes have been calculated separately for each group of participants and for each outcome. ETHICS AND DISSEMINATION This trial has received ethical approval from the Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, UK (SC/jc/FMFREP/16/17 076) and from the Faculty of Medicine, University of Jaffna, Sri Lanka (J/ERC/17/81/NDR/0170) and non-engagement approval has been received from the funding body, the Centers for Disease Control and Prevention (2018-015). All participants gave written consent. Dissemination of study results will be completed through publication of academic articles, conference presentations, town hall meetings, written pamphlets in plain language, reports to Ministry of Health and other government organisations and through social media outlets. TRIAL REGISTRATION NUMBERS ISRCTN registry: ISRCTN62598070. SLCTR registration number: SLCTR/2018/008.
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Affiliation(s)
- Shannon Doherty
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | | | | | - Robert Stewart
- Institute of Psychiatry, King's College London, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Melanie Abas
- Section of Epidemiology, Health Services & Population Research, Institute of Psychiatry, King's College London, London, UK
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Vulnerabilidade social e transtornos mentais. TEXTOS & CONTEXTOS (PORTO ALEGRE) 2021. [DOI: 10.15448/1677-9509.2021.1.38616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A saúde mental representa parte essencial da vida das pessoas, podendo resultar no aumento da desigualdade de renda e de vulnerabilidade social. Assim, as relações entre saúde/doença mental e vulnerabilidade social incitam uma série de reflexões e de contextualizações para sua maior compreensão. Esta scoping review apresenta como objetivo mapear as produções científicas sobre as vulnerabilidades das pessoas com transtornos mentais em suas diferentes relações sociais. Divide-se em cinco etapas, com buscas nas bases de dados: MEDLINE via Pubmed; SCOPUS e Academic Search Premier, e busca nas referências dos artigos encontrados, a fim de responder à questão de pesquisa: “Como ocorre à vulnerabilidade das pessoas com transtorno mental em suas diferentes relações sociais?”. Foram encontrados 211 artigos e após as exclusões de estudos não pertinentes, foram incluídos 31 artigos. Os artigos foram organizados em 3 (três) categorias: 1 – a vulnerabilidade das pessoas com transtornos mentais e os serviços de saúde; 2 – a vulnerabilidade das pessoas com transtornos mentais e os determinantes sociais; e 3 – a vulnerabilidade das pessoas com transtornos mentais e a violência/vitimização. Dessa forma, sugere-se o desenvolvimento de mais estudos sobre a temática, assim como a reavaliação das políticas públicas voltadas às pessoas com transtornos mentais, no intuito de se tornarem mais eficazes, tanto na garantia dos direitos desse grupo como na manutenção de sua saúde mental.
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Cantor D, Swartz J, Roberts B, Abbara A, Ager A, Bhutta ZA, Blanchet K, Madoro Bunte D, Chukwuorji JC, Daoud N, Ekezie W, Jimenez-Damary C, Jobanputra K, Makhashvili N, Rayes D, Restrepo-Espinosa MH, Rodriguez-Morales AJ, Salami B, Smith J. Understanding the health needs of internally displaced persons: A scoping review. J Migr Health 2021; 4:100071. [PMID: 34820657 PMCID: PMC8600058 DOI: 10.1016/j.jmh.2021.100071] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022] Open
Abstract
We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDP health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.
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Affiliation(s)
- David Cantor
- Internal Displacement Research Programme, School of Advanced Study, University of London, UK
| | | | - Bayard Roberts
- Health Services Research and Policy Department, London School of Hygiene and Tropical Medicine, UK
| | - Aula Abbara
- Department of Infectious Disease, Imperial College London, London, UK; Syria Public Health Network
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
- Mailman School of Public Health, Columbia University, USA
| | | | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Switzerland
| | | | | | - Nihaya Daoud
- Department of Public Health, Ben-Gurion University of the Negev, Israel
| | | | | | | | | | - Diana Rayes
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Fundacion Universitaria Autónoma de las Americas, Colombia
- Universidad Cientifica del Sur, Peru
| | | | - James Smith
- Elrha; Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, UK
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, García T, González-Uribe C, Moreno-Serra R, Bernal O. Mental Health Disorders in Population Displaced by Conflict in Colombia: Comparative Analysis against the National Mental Health Survey 2015. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00089-5. [PMID: 34246471 DOI: 10.1016/j.rcp.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. METHODS Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire - 25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. RESULTS 1,089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. CONCLUSIONS The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.
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Affiliation(s)
- Sebastián León-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia; Centro de Estudios Sobre Desarrollo CIDER, Universidad de los Andes, Bogotá, Colombia.
| | - Germán Casas
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia; Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Tatiana García
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
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Doherty S, Sureshkumar DS, Thayakaran R, Surenthirakumaran R. Characteristics and Influencing Factors of Healthcare Utilization in Post-conflict Primary Care Attendees in Northern Sri Lanka. FRONTIERS IN HEALTH SERVICES 2021; 1:719617. [PMID: 36926487 PMCID: PMC10012669 DOI: 10.3389/frhs.2021.719617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022]
Abstract
Sri Lanka's healthcare systems attempts to provides access to universal healthcare services for all citizens and is designed to be free of out-of-pocket payments. Despite a 30-year civil conflict, natural disasters, and COVID-19, the healthcare system within the country remains robust and strong. However, due to a lack of formalized pathways and centralized record keeping, the pattern of service utilization is still relatively unknown, which raises concerns regarding effective allocation of scarce resources and efficiency of referral pathways. To address this gap in knowledge, part of the parent study (COMGAP-S), consisted of a survey on healthcare service use conducted among adults attending primary care facilities. The results from this quantitative data analysis indicate the majority of people seeking care originate from rural areas, are older (50+), attend divisional hospitals, and report paying fees at point of contact. Our findings indicate a need for more efficient use of healthcare services, creation of referral routes to ensure limited healthcare resources are used effectively. Additionally, further investment in services is needed to ensure Sri Lanka's healthcare system meets the standard of universal healthcare as proposed by the World Health Organization. These findings address a gap in knowledge for national decision-makers within Sri Lanka along with other similar post-conflict healthcare settings across the globe.
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Affiliation(s)
- Shannon Doherty
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | - Diliniya Stanislaus Sureshkumar
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, London, United Kingdom
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Prevalence and correlates of depressive symptoms among Rohingya (forcibly displaced Myanmar nationals or FDMNs) older adults in Bangladesh amid the COVID-19 pandemic. Glob Ment Health (Camb) 2021; 8:e23. [PMID: 34226848 PMCID: PMC8245337 DOI: 10.1017/gmh.2021.24] [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: 12/27/2020] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Depression is globally a crucial communal psychiatric disorder, which is more common in older adults. The situation is considerably worse among millions of older (forcibly displaced Myanmar nationals or FDMNs) Rohingya adults, and the coronavirus disease-2019 (COVID-19) pandemic may exacerbate the already existing precarious situation. The present study investigated depressive symptoms and their associated factors in older adult Rohingya FDMNs in Cox Bazar, Bangladesh, during the COVID-19 pandemic. METHOD A total of 416 older adults aged 60 years and above residing in Rohingya camps situated in the South Eastern part of Bangladesh were interviewed using a 15-item Geriatric Depression Scale (GDS-15) in Bengali language. Chi-square test was performed to compare the prevalence of depressive symptoms within different categories of a variable and a binary logistic regression model was performed to determine the factors associated with depressive symptoms. RESULTS More than 41% of Rohingya older adults had depressive symptoms (DS). Socio-demographic and economic factors such as living alone, dependency on family for living, poor memory, feelings of being left out, difficulty in getting medicine and routine medical care during COVID-19, perception that older adults are at highest risk of COVID-19 and pre-existing non-communicable chronic conditions were found to be significantly associated with developing DS. Higher DS was also evident among older female Rohingya FDMNs. CONCLUSION DS are highly prevalent in older Rohingya FDMNs during COVID-19. The findings of the present study call for immediate arrangement of mental health care services and highlight policy implications to ensure the well-being of older FDMNs.
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Elucidating Mental Health Disorders among Rohingya Refugees: A Malaysian Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186730. [PMID: 32942770 PMCID: PMC7559711 DOI: 10.3390/ijerph17186730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022]
Abstract
Mental health disorders (MHDs) among refugees has been recognized as a major public health issue. However, to date, there is limited evidence on the prevalence of MHDs among Rohingya refugees in Malaysia. This study aimed to examine the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) among Rohingya refugees in Malaysia. A total of 220 refugees were randomly selected to participate in this cross-sectional study, conducted from June 2019 to November 2019. Perceived social support, religious orientation, food security, and sociodemographic characteristics were assessed as independent variables. The dependent variables assessed were MDD, GAD, and PTSD. The prevalence of GAD, PTSD, and MDD was reported at 92 (41.8%), 84 (38.2%), and 71 (32.3%). Several factors were significantly associated with MDD following multivariate analysis such as perceived low to moderate social support (AOR = 2.17; 95% CI 1.13, 4.19) and food insecurity (AOR = 2.77; 95% CI 1.19, 6.47). Exposure to violence (AOR = 38.46; 95% CI 16.27, 90.91) and food insecurity (AOR = 3.74; 95% CI 1.41, 9.91) were significantly associated with PTSD. Addressing these risk factors could be key in improving mental health outcomes among this vulnerable population.
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Gichunge C, Mutiso D, Brynjarsdottir J. Predictors of social support, physical health and mental health among food insecure internally displaced persons in Turkana, Kenya. Confl Health 2020; 14:58. [PMID: 32782469 PMCID: PMC7412788 DOI: 10.1186/s13031-020-00303-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background Food insecurity and the mental and physical health of internally displaced persons (IDPs) is a public health concern. The aim of this study was to determine the predictors of social support, physical and mental health among food insecure IDPs in Nakwamekwei IDP camp in Turkana, Kenya. Methods A cross sectional study was conducted among 159 household heads living in the camp. Analysis was conducted using statistical summaries, logistic regression and linear regression. Results Ninety four percent (94%) of the households were severely food insecure and the rest of the households had moderate food insecurity. Majority of the household heads (77%) had symptoms of depression and those with five or more children were 3 times (95%CI, 1.31–9.24; p = 0.015) more likely to be have symptoms of depression, while those who were married were less likely to have the same (95%CI, 0.14–0.92; p = 0.038). Seventy six percent (76%) of the household heads had anxiety symptoms; none of the predictor variables were significantly associated with anxiety symptoms in the adjusted analysis. Those who had spent many years in the camp, were older, and had more children had significantly poorer physical health (p = 0.042, p = 0.001, and p = 0.047, respectively). Those who were married and those who had experienced violence in the current camp had significantly higher social support (p = 0.001 and p = 0.006, respectively). Conclusions Participants have been living in camp for the last 10 years hence the need to improve their living conditions, address their physical and mental health as well as food insecurity. This can be done by providing the participants with safe drinking water, constructing pit latrines to prevent communicable disease and adhere to the Sphere recommendations for sanitation and hygiene as well as training them in income generating activities to mitigate the high unemployment and food insecurity rates. The IDPs should be integrated into the local community to bring an end to their protracted displacement.
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Affiliation(s)
| | - Daniel Mutiso
- School of Science and Technology, Turkana University College, Turkana, Kenya
| | - Jenny Brynjarsdottir
- Department of Mathematics, Applied Mathematics, and Statistics, Case Western Reserve University, Cleveland, USA.,Faculty of Physical Sciences, University of Iceland, Reykjavik, Iceland
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Patil SS, Chaukimath SP. COVID-19: Mass exodus of migrant workers in India, are we staring at a mental health crisis? Ind Psychiatry J 2020; 29:360-361. [PMID: 34158730 PMCID: PMC8188920 DOI: 10.4103/ipj.ipj_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shailaja S Patil
- Department of Community Medicine, BLDE (Deemed to be University), Shri B M Patil Medical College Hospital and Research Center, Vijayapur, Karnataka, India
| | - Shivakumar P Chaukimath
- Department of Psychiatry, BLDE (Deemed to be University), Shri B M Patil Medical College Hospital and Research Center, Vijayapur, Karnataka, India
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Marroquín Rivera A, Rincón Rodríguez CJ, Padilla-Muñoz A, Gómez-Restrepo C. Mental health in adolescents displaced by the armed conflict: findings from the Colombian national mental health survey. Child Adolesc Psychiatry Ment Health 2020; 14:23. [PMID: 32467726 PMCID: PMC7236943 DOI: 10.1186/s13034-020-00327-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/05/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Colombia has one of the largest populations of internally displaced individuals by an armed conflict. However, there is no data demonstrating its effect on health, particularly in adolescents. PURPOSE To describe the prevalence and associations of mental illness in the adolescent population displaced by violence in Colombia. METHODS We conducted a secondary analysis of the 2015 National Mental Health Survey (NMHS), which provides data of mental health issues (SRQ), mental health disorders (CIDI-CAPI) and sociodemographic characteristics. RESULTS Of the 1754 adolescents interviewed 5.3% (95% CI 4.1 to 6.9) mentioned a change in residence due to violence. Among them 38.5% lived in poverty compared to 23.6% of those non-displaced by the conflict. Suicidal thoughts and suicide attempt were present in 19.8% and 9.1% of displaced adolescents respectively, compared to 5.8% and 2.1% of non-displaced adolescents. The prevalence of post-traumatic stress disorder (PTSD) and any mental health disorder (measured with the CIDI-CAPI) was higher in the displaced population 12.3%, 11% respectively, in contrast to 2.1% and 7% of those non-displaced. Finally, anxiety and depressive disorders were more common among displaced adolescents. CONCLUSION A higher prevalence of mental health conditions and disorders is observed among displaced adolescents.
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Affiliation(s)
- Arturo Marroquín Rivera
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Javier Rincón Rodríguez
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andrea Padilla-Muñoz
- Human Rights Research Group, Faculty of Law, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Department of Clinical Epidemiology and Biostatistics, Department of Psychiatry and Mental Health, Hospital Universitario San Ignacio, School of Medicine, Pontificia Universidad Javeriana, Kra. 7 N. 40–62 2nd Floor, Bogotá, Colombia
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Patterns of somatic distress among internally displaced persons in Ukraine: analysis of a cross-sectional survey. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1265-1274. [PMID: 30805693 DOI: 10.1007/s00127-019-01652-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/07/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE There are often high rates of mental disorders in low- and middle-income countries during humanitarian crises, but the prevalence of somatic distress (SD) is underreported in the existing health service research. We aim to examine the patterns of SD among internally displaced persons (IDPs) in Ukraine, who were forcibly displaced due to the ongoing conflict in the country's eastern region. METHODS The study design was a cross-sectional survey of 2203 adult IDPs throughout Ukraine. The survey collected data on sociodemographic characteristics, traumatic life events (Life Events Checklist), utilisation of mental health care services, and self-reported outcomes of SD (Patient Health Questionnaire 15), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), and post-traumatic stress (PTSD Checklist). Descriptive and multivariate regression analyses were used. RESULTS Over half of respondents (n = 1142, 55%) were identified as being at risk of SD (PHQ-15 score ≥ 6), and the prevalence of moderate (n = 377, 18%) and high severity SD risk (n = 275, 13%) was substantial. There were significant associations (p < 0.05) between SD and age, female gender, economic status, self-reported depression and post-traumatic stress, and multiple trauma exposures. Being at risk of SD was also significantly associated with increased functional disability. Use of mental health care services was low across this population and only high SD risk seemed to be a reliable predictor of care-seeking behaviour. CONCLUSIONS There is a significant risk of SD among IDPs in Ukraine. Our results illustrate the need for targeted health service research and regional programs to ensure that mental health needs are appropriately met.
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Al Balawi MM, Faraj F, Al Anazi BD, Al Balawi DM. Prevalence of Depression and Its Associated Risk Factors among Young Adult Patients Attending the Primary Health Centers in Tabuk, Saudi Arabia. Open Access Maced J Med Sci 2019; 7:2908-2916. [PMID: 31844457 PMCID: PMC6901847 DOI: 10.3889/oamjms.2019.789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The number of young depressive patients approaching the primary health care centres in Saudi Arabia for supportive care and treatment has enormously increased, but more cases of depression are not being diagnosed properly at the primary health care level. AIM To assess the prevalence and associated factors of depression among young adult patients attending the primary health centres in Tabuk, Kingdom of Saudi Arabia. METHODS A cross-sectional study was done in selected primary health care centres in Tabuk city from March 2018 to June 2018. Patient Health Questionnaire- PHQ-2 and PHQ-9 and a modified questionnaire were used to collect the necessary information and data were analysed by using SPSS (Version 25.0, SPSS Inc. Chicago, IL, USA). RESULTS The study included 384 patients aged between 20 and 40 years. Most of them (76.6%) were females. The prevalence of depression was 74%; mild among 37.8%, moderate among 20.8% whereas moderately severe to severe among 15.4% of them. Multivariate logistic regression analysis revealed that married patients were at lower risk for depression (Adjusted odds ratio "AOR" was 0.36, 95% confidence interval "CI" was 0.20-0.93), p < 0.001. Patients who reported a lack of social support were more likely to be depressed than those with social support (AOR = 2.05, 95% CI = 1.03-4.07), p = 0.041. Patients who reported disturbed marriage were at almost four-folded risk of depression compared to those without disturbed marriage (AOR = 3.50, 95% CI = 1.23-9.98), p = 0.019. Patients with financial problems were at almost double risk for developing depression compared to those without financial problems (AOR = 2.37, 95% CI = 1.16-4.85), p = 0.019. Those with stressful experience were significantly more likely to have depression compared to those without stressful experience (AOR = 4.75, 95% CI = 2.58-8.71), p < 0.001. Opposed to patients without a family history of depression, those with such history were at higher significant risk for depression (AOR = 2.75, 95% CI = 1.23-6.14), p = 0.014. Also, patients who reported sleep disorders were at nearly double folds of having depression compared to those without such disorders (AOR = 2.24, 95% CI = 1.16-4.30), p = 0.016. CONCLUSION Depression among young adult patients (20-40 years) attending primary healthcare centres in Tabuk is very high. However, it is mostly mild to moderate in its severity. Suicidal thoughts were reported by one-tenth of the participants. Some predictors for depression among them were identified.
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Affiliation(s)
- Maram Mohsen Al Balawi
- Department of Family Medicine, Family Medicine Residency Training Joint Program, King Salman Military Hospital, Tabuk, Saudi Arabia
| | - Fatma Faraj
- Department of Family Medicine, Consultant Family Medicine, Saudi and Arab Board certified, King Salman Military Hospital, Tabuk, Saudi Arabia
| | - Bashayer D Al Anazi
- Department of Family Medicine, Family Medicine Residency Training Joint Program, King Salman Military Hospital, Tabuk, Saudi Arabia
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Castro-Camacho L, Rattner M, Quant DM, González L, Moreno JD, Ametaj A. A Contextual Adaptation of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Victims of the Armed Conflict in Colombia. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Health and Health Seeking in Mosul During ISIS Control and Liberation: Results From a 40-Cluster Household Survey. Disaster Med Public Health Prep 2019; 13:758-766. [PMID: 30919800 DOI: 10.1017/dmp.2019.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES ISIS seized Mosul in June 2014. This survey was conducted to assess health status, health needs, and health-seeking behavior during ISIS control and the subsequent Iraqi military campaign. METHODS Forty clusters were chosen: 25 from east Mosul and 15 from west Mosul. In each, 30 households were interviewed, representing 7559 persons. The start house for each cluster was selected using satellite maps. The survey in east Mosul was conducted from March 13-31, 2017, and in west Mosul from July 18-31, 2017. RESULTS In the preceding 2 weeks, 265 (5.4%) adults reported being ill. Some 67 (25.3%) complaints were for emotional or behavioral issues, and 59 (22.3%) for noncommunicable diseases. There were 349 (13.2%) children under age 15 reportedly ill during this time. Diarrhea, respiratory complaints, and emotional and behavioral problems were most common. Care seeking among both children and adults was low, especially in west Mosul. During ISIS occupation, 640 (39.0%) women of childbearing age reported deliveries. Of these, 431 (67.3%) had received some antenatal care, and 582 (90.9%) delivered in a hospital. Complications were reported by 417 (65.2%). CONCLUSIONS Communicable and noncommunicable diseases were reported for both children and adults, with a high prevalence of emotional and behavioral problems, particularly in west Mosul. Care-seeking was low, treatment compliance for noncommunicable diseases was poor, and treatment options for patients were limited. (Disaster Med Public Health Preparedness. 2019;13:758-766).
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Doherty S, Hulland E, Lopes-Cardozo B, Kirupakaran S, Surenthirakumaran R, Cookson S, Siriwardhana C. Prevalence of mental disorders and epidemiological associations in post-conflict primary care attendees: a cross-sectional study in the Northern Province of Sri Lanka. BMC Psychiatry 2019; 19:83. [PMID: 30832646 PMCID: PMC6399832 DOI: 10.1186/s12888-019-2064-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experiencing conflict and displacement can have a negative impact on an individual's mental health. Currently, prevalence of mental health disorders (MHDs) at the primary care level in post-conflict areas within the Northern Province of Sri Lanka is unknown. We aimed to explore this prevalence in conflict-affected populations attending primary care, using a structured package of validated screening tools for MHDs. METHODS This cross-sectional study aimed to determine factors related to mental health disorders at the primary care level in Northern Province, Sri Lanka. A structured interview was conducted with internally displaced adults attending 25 randomly selected primary care facilities across all districts of Northern Sri Lanka (Jaffna, Mannar, Mullaitivu, Vavuniya). Participants were screened for depression, anxiety, psychosis, PTSD, and somatoform symptoms. RESULTS Among 533 female and 482 male participants (mean age 53.2 years), the prevalence rate for any MHD was 58.8% (95% CI, 53.8-61.4), with 42.4% screening positive for two or more disorders (95% CI, 38.6-46.1). Anxiety prevalence was reported at 46.7% (95% CI, 41.9-51.5), depression at 41.1% (95% CI, 38.7-44.5), PTSD at 13.7% (95% CI, 10.6-16.8), somatoform symptoms at 27.6% (95% CI, 23.6-31.5), and psychosis with hypomania at 17.6% (95% CI, 13.3-21.9). CONCLUSION This is the first study at the primary care level to investigate prevalence of MHDs among conflict-affected populations in the Northern Province, Sri Lanka. Results highlight unmet mental health needs in the region. Training intervention to integrate mental health services into primary care is planned.
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Affiliation(s)
- Shannon Doherty
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK.
| | - E. Hulland
- 0000 0001 2163 0069grid.416738.fCenters for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329 USA
| | - B. Lopes-Cardozo
- 0000 0001 2163 0069grid.416738.fCenters for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329 USA
| | - S. Kirupakaran
- THEME Institute, 81/7 Pagoda Rd, Nugegoda, Colombo, Sri Lanka
| | - R. Surenthirakumaran
- 0000 0001 0156 4834grid.412985.3University of Jaffna, Thirunelvely, Jaffna, 70140 Sri Lanka
| | - S. Cookson
- 0000 0001 2163 0069grid.416738.fCenters for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329 USA
| | - C. Siriwardhana
- 0000 0004 0425 469Xgrid.8991.9London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
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Chukwuorji JBC, Ifeagwazi CM, Eze JE. Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults. Aging Ment Health 2019; 23:113-121. [PMID: 29099623 DOI: 10.1080/13607863.2017.1396580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES There is substantial evidence regarding the role of event centrality (EC) in posttraumatic stress disorder (PTSD) symptoms, but little research has examined the explanatory pathways linking EC with PTSD symptoms severity. The present study examined whether core beliefs (CB) mediates the relationship between EC and PTSD symptoms in internally displaced older adults. METHOD Internally displaced older adults (N = 279; mean age = 62 years) sheltered in two camps located in north-central Nigeria, completed Tiv language versions of self-report measures, namely, the Harvard Trauma Questionnaire, the Centrality of Event Scale, Core Beliefs Inventory, and provided relevant demographic information. RESULTS Analysis indicated that EC and CB were linked to greater PTSD symptoms as well as re-experiencing/intrusion, avoidance and hyperarousal symptoms severity. The mediator path was significant which implies that CB was a pathway through which EC influences PTSD symptoms clusters and overall PTSD symptomatology. CONCLUSION A traumatic event becoming more central in a person's identity and life story distorts entrenched beliefs about oneself, others and the world, thereby resulting in greater PTSD symptoms. Our findings suggest that considerations of disrupted world assumptions may be a salient target for prevention and treatment efforts.
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Affiliation(s)
| | - Chuka Mike Ifeagwazi
- a Department of Psychology , University of Nigeria , Nsukka , Enugu state , Nigeria
| | - John E Eze
- a Department of Psychology , University of Nigeria , Nsukka , Enugu state , Nigeria
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Burns R, Wickramage K, Musah A, Siriwardhana C, Checchi F. Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: a cross-sectional survey. Confl Health 2018; 12:41. [PMID: 30305841 PMCID: PMC6166297 DOI: 10.1186/s13031-018-0176-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although the adverse impacts of conflict-driven displacement on health are well-documented, less is known about how health status and associated risk factors differ according to displacement experience. This study quantifies health status and quality of life among returning refugees, internally displaced persons, and the host community in a post-conflict district in Northern Sri Lanka, and explores associated risk factors. Methods We analysed data collected through a household survey (n = 570) in Vavuniya district, Sri Lanka. The effect of displacement status and other risk factors on perceived quality of life as estimated from the 36-item Short Form Questionnaire, mental health status from 9-item Patient Health Questionnaire, and self-reported chronic disease status were examined using univariable analyses and multivariable regressions. Results We found strong evidence that perceived quality of life was significantly lower for internally displaced persons than for the host community and returning refugees, after adjusting for covariates. Both mental health status and chronic disease status did not vary remarkably among the groups, suggesting that other risk factors might be more important determinants of these outcomes. Conclusions Our study provides important insights into the overall health and well-being of the different displaced sub-populations in a post-conflict setting. Findings reinforce existing evidence on the relationship between displacement and health but also highlight gaps in research on the long-term health effects of prolonged displacement. Understanding the heterogeneity of conflict-affected populations has important implications for effective and equitable humanitarian service delivery in a post-conflict setting.
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Affiliation(s)
- Rachel Burns
- 1Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kolitha Wickramage
- International Organisation for Migration (UN Migration Agency), Sri Lanka Country Mission, 62 Ananda Coomaraswamy Mawatha, Colombo, 00300 Sri Lanka
| | - Anwar Musah
- 1Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Chesmal Siriwardhana
- 1Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- 3Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Morina N, Akhtar A, Barth J, Schnyder U. Psychiatric Disorders in Refugees and Internally Displaced Persons After Forced Displacement: A Systematic Review. Front Psychiatry 2018; 9:433. [PMID: 30298022 PMCID: PMC6160546 DOI: 10.3389/fpsyt.2018.00433] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/23/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Protracted armed conflicts not only shape political, legal, and socio-economic structures, but also have a lasting impact on people's human migration. In 2017, the United Nations High Commissioner for Refugees reported an unprecedented number of 65.6 million individuals who were displaced worldwide as a result of armed conflicts. To date, however, little is known about these people's mental health status. Therefore, we conducted a systematic review of the prevalence of psychiatric disorders among forcibly displaced populations in settings of armed conflicts. Methods: We undertook a database search using Medline, PsycINFO, PILOTS, and the Cochrane Library, using the following keywords and their appropriate synonyms to identify relevant articles for possible inclusion: "mental health," "refugees," "internally displaced people," "survey," and "war." This search was limited to original articles, systematic reviews, and meta-analyses published after 1980. We reviewed studies with prevalence rates of common psychiatric disorders-mood and anxiety disorders, psychotic disorders, personality disorders, substance abuse, and suicidality-among adult internally displaced persons (IDPs) and refugees afflicted by armed conflicts. Results: The search initially yielded 915 articles. Of these references 38 studies were eligible and provided data for a total of 39,518 adult IDPs and refugees from 21 countries. The highest prevalence were for reported for post-traumatic stress disorder (3-88%), depression (5-80%), and anxiety disorders (1-81%) with large variation. Only 12 original articles reported about other mental disorders. Conclusions: These results show a substantial lack of data concerning the wider extent of psychiatric disability among people living in protracted displacement situations. Ambitious assessment programs are needed to support the implementation of sustainable global mental health policies in war-torn countries. Finally, there is an urgent need for large-scale interventions that address psychiatric disorders in refugees and internally displaced persons after displacement.
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Affiliation(s)
- Naser Morina
- Department of Consultation Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Posttraumatic Cognitions and Depressive Symptoms in War and Disaster Affected Widows in Sri Lanka: The Role of Community Support. CONTEMPORARY FAMILY THERAPY 2018. [DOI: 10.1007/s10591-017-9441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maharaj V, Tomita A, Thela L, Mhlongo M, Burns JK. Food Insecurity and Risk of Depression Among Refugees and Immigrants in South Africa. J Immigr Minor Health 2018; 19:631-637. [PMID: 26984226 DOI: 10.1007/s10903-016-0370-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.
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Affiliation(s)
- Varsha Maharaj
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
| | - Andrew Tomita
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, P.O. Box 198, Mtubatuba, Durban, 3935, South Africa
| | - Lindokuhle Thela
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Mpho Mhlongo
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
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Jayawickreme N, Mootoo C, Fountain C, Rasmussen A, Jayawickreme E, Bertuccio RF. Post-conflict struggles as networks of problems: A network analysis of trauma, daily stressors and psychological distress among Sri Lankan war survivors. Soc Sci Med 2017; 190:119-132. [PMID: 28858697 PMCID: PMC5607106 DOI: 10.1016/j.socscimed.2017.08.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 01/08/2023]
Abstract
A growing body of literature indicates that the mental distress experienced by survivors of war is a function of both experienced trauma and stressful life events. However, the majority of these studies are limited in that they 1) employ models of psychological distress that emphasize underlying latent constructs and do not allow researchers to examine the unique associations between particular symptoms and various stressors; and 2) use one or more measures that were not developed for that particular context and thus may exclude key traumas, stressful life events and symptoms of psychopathology. The current study addresses both these limitations by 1) using a novel conceptual model, network analysis, which assumes that symptoms covary with each other not because they stem from a latent construct, but rather because they represent meaningful relationships between the symptoms; and 2) employing a locally developed measure of experienced trauma, stressful life problems and symptoms of psychopathology. Over the course of 2009-2011, 337 survivors of the Sri Lankan civil war were administered the Penn-RESIST-Peradeniya War Problems Questionnaire (PRPWPQ). Network analysis revealed that symptoms of psychopathology, problems pertaining to lack of basic needs, and social problems were central to the network relative to experienced trauma and other types of problems. After controlling for shared associations, social problems in particular were the most central, significantly more so than traumatic events and family problems. Several particular traumatic events, stressful life events and symptoms of psychopathology that were central to the network were also identified. Discussion emphasizes the utility of such network models to researchers and practitioners determining how to spend limited resources in the most impactful way possible.
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Affiliation(s)
| | - Candace Mootoo
- Department of Psychology, Fordham University, New York, NY, USA
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Thela L, Tomita A, Maharaj V, Mhlongo M, Burns JK. Counting the cost of Afrophobia: Post-migration adaptation and mental health challenges of African refugees in South Africa. Transcult Psychiatry 2017; 54:715-732. [PMID: 29226791 PMCID: PMC5827949 DOI: 10.1177/1363461517745472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are few studies on the role of migration within sub-Saharan Africa and its relation to the development of mental illness. We investigated post-resettlement adaptation and mental health challenges of African refugees/migrants in Durban, South Africa. We interviewed 335 African help-seeking refugees/migrants for anxiety, depression (25-item Hopkins Symptom Checklist) and post-traumatic stress symptoms (30-item Harvard Trauma Questionnaire). Socio-demographic and migration history, focusing on post-migration circumstances and experiences of discrimination in the host country, were obtained. Association between migration and post-settlement factors and mental health outcomes were assessed using adjusted logistic regression models. Prevalence of mental distress was high: 49.4% anxiety, 54.6% depression and 24.9% post-traumatic stress symptoms. After adjustment for family separation since migration, recent arrival in South Africa was associated with increased risk for depression (aOR = 4.0, 95% CI:1.3-11.8) and post-traumatic stress (aOR = 5.2, 95% CI:1.7-15.9), while in unadjusted models, older age on arrival was associated with anxiety (aOR = 5.3, 95% CI:1.4-19.8) and depression (aOR = 6.2, 95% CI:1.6-24.3). History of family separation since migration was independently associated with depression and post-traumatic stress in all models. Discriminatory experiences since migration was also an independent risk factor for all three mental health outcomes. Finally, being divorced/widowed was associated with an increased risk for post-traumatic stress, while higher income earners were protected against post-traumatic symptoms, even after adjustment. Refugees/migrants in South Africa show a significant burden of mental distress that is linked to challenges of adjustment in an often hostile context. Services addressing these and other health-related, social-economic needs should be developed as a priority.
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Tay AK, Jayasuriya R, Jayasuriya D, Silove D. Twelve-month trajectories of depressive and anxiety symptoms and associations with traumatic exposure and ongoing adversities: a latent trajectory analysis of a community cohort exposed to severe conflict in Sri Lanka. Transl Psychiatry 2017; 7:e1200. [PMID: 28786977 PMCID: PMC5611733 DOI: 10.1038/tp.2017.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/29/2017] [Accepted: 04/20/2017] [Indexed: 11/18/2022] Open
Abstract
We conducted a 12-month follow-up of a population sample of adults from districts (Mannar, Killinochi, Mullaitivu and Jaffna) exposed to high levels of mass conflict in Sri Lanka, the aim of the present analysis being to identify trajectories of depression and anxiety symptoms and their associations with exposure to psychological trauma and ongoing living adversities. The cohort of 1275 adults (response 86%) followed-up in 2015 was a structured subsample drawn from the baseline nationally representative survey conducted in 2014 across 25 districts in Sri Lanka. Interviews were conducted using electronic tablets by field workers applying contextually adapted indices of trauma exposure, ongoing adversities and symptoms of depression and anxiety. Latent transition analysis revealed a three-class longitudinal model from which four composite trajectories were derived, comprising a persistent symptom trajectory (n=555, 43.5%), an incident or new onset trajectory (n=170, 13.3%), a recovery trajectory (n=299, 23.5%) and a persistently low-symptom trajectory (n=251, 19.7%). Factors associated with both the persistent symptom and incident trajectories were female gender, past trauma exposure and lack of access to health services. Loss of a job was uniquely associated with the persisting trajectory at follow-up. The recovery trajectory comprised a higher proportion of men, older persons and those without risk factors. Our findings assist in translating epidemiologic data into public policy and practice by indicating the importance of stable employment and the provision of healthcare as key factors that may act to reduce anxiety and depressive symptoms in the post-conflict phase. The findings also confirm that women are at high risk of mental distress. Brief screening for trauma exposure in populations with high levels of exposure to mass conflict may assist in defining those at risk of ongoing symptoms of anxiety and depression.
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Affiliation(s)
- A K Tay
- School of Psychiatry, Psychiatry Research and Teaching Unit, Academic Mental Health Unit, University of New South Wales, Sydney, NSW, Australia,Psychiatry Research and Teaching Unit, Academic Mental Health Unit, University of New South Wales, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, NSW 2170, Australia. E-mail:
| | - R Jayasuriya
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - D Jayasuriya
- Development Policy Center, Australian National University, Canberra, ACT, Australia
| | - D Silove
- School of Psychiatry, Psychiatry Research and Teaching Unit, Academic Mental Health Unit, University of New South Wales, Sydney, NSW, Australia
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Tay AK, Jayasuriya R, Jayasuriya D, Silove D. Measurement invariance of the Hopkins Symptoms Checklist: a novel multigroup alignment analytic approach to a large epidemiological sample across eight conflict-affected districts from a nation-wide survey in Sri Lanka. Confl Health 2017; 11:8. [PMID: 28450885 PMCID: PMC5405490 DOI: 10.1186/s13031-017-0109-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The alignment method, a novel psychometric approach, represents a more flexible procedure for establishing measurement invariance in geographically, ethnically, or linguistically diverse samples, especially in large epidemiological surveys. Although the Hopkins Symptoms Checklist (HSCL-25) has been used extensively in the field to assess anxiety and depressive symptoms, questions remain about the comparability of findings when the instrument is applied across regions in large-scale national surveys. METHODS The present study is the first in the field to apply the alignment method to test the structure and measurement invariance of the anxiety and depression dimensions of the HSCL-25 amongst Sri Lankan subpopulations (n = 8456) stratified by geographical regions, levels of past exposure to conflict, and ethnic composition. RESULTS Multigroup CFA analysis yielded non-converging models requiring substantial modifications to the models. As a result, multigroup alignment analysis was applied and the results supported the bifactorial structure and measurement invariance of the HSCL-25 across eight (severe and moderate) conflict-affected districts. The alignment analysis based on a good-fitting configural model yielded a metric non-invariance of 22.22% and scalar non-invariance of 5.88% (both under the established 25% threshold). The bifactorial model outperformed the tripartite and other models. In comparison to the anxiety items, the depressive items showed higher levels of metric non-invariance across districts. CONCLUSIONS Our findings demonstrate the methodological feasibility of applying the alignment method to test the structure and invariance of the HSCL across ethnically diverse populations living in conflict-affected districts in Sri Lanka. Further studies are needed to examine ethnicity and language factors more critically.
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Affiliation(s)
- Alvin Kuowei Tay
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, Liverpool Hospital; School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Rohan Jayasuriya
- Community Medicine and Public Health, Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Dinuk Jayasuriya
- Development Policy Centre, Australian National University, Canberra, Australian Capital Territory (ACT) Australia
| | - Derrick Silove
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, Liverpool Hospital; School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
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Lagos-Gallego M, Gutierrez-Segura JC, Lagos-Grisales GJ, Rodriguez-Morales AJ. Post-traumatic stress disorder in internally displaced people of Colombia: An ecological study. Travel Med Infect Dis 2017; 16:41-45. [PMID: 28242350 DOI: 10.1016/j.tmaid.2017.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/09/2017] [Accepted: 02/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-Traumatic Stress Disorder (PTSD) has been described as one of the most frequently reported mental condition among refugees and internally displaced populations (IDPs). Despite this, few has been reported about it in Latin America, even in Colombia, the country with the highest number of IDPs in the in the world. METHOD This ecological study assessed incidence and differences of PTSD in general population and IDPs in Colombia and its departments (32) during 2009-2012. Epidemiological data was collected from the National Health Records System (RIPS), retrieving the ICD-10 code F43.1 in both populations. We estimated PTSD incidence rates on both populations (cases/100,000 pop), using reference population of the IDPs (SISDHES and the general population was taken from the (DANE). Incidence rates ratios were calculated comparing both populations. RESULTS In general population, 6619 cases of PTSD occurred (14.5 cases/100,000 pop, 95%CI 14.0-15.0) while 177 among IDPs (73.8 cases/100,000 pop, 95%CI 63.0-85.0). PTSD was 5.1 times higher among IDPs than in general population. Ranging from 1.6 (Tolima) to 15.8 (Quindío) (median: 4.4). In departments with higher incidence, also it was in IDPs (r2 = 0.4899; p < 0.01). CONCLUSION This study evidenced a significantly higher PTSD incidence among IDPs, when compared with general population in the same territories. This has relevant implications for screening, diagnosis and management of PTSD among IDPs, especially in high incidence areas. More studies are required to improve the understanding of this condition among vulnerable populations, as well to provide better medical and psychological interventions and for the development of public policies in countries, such as Colombia, with IDPs.
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Affiliation(s)
- Mariana Lagos-Gallego
- Department of Psychiatry, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
| | - Julio César Gutierrez-Segura
- Department of Psychiatry, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
| | - Guillermo J Lagos-Grisales
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
| | - Alfonso J Rodriguez-Morales
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia; Committee on Travel Medicine, Asociación Panamericana de Infectología, Pereira, Risaralda, Colombia; Comission on Scientific Publications, Latin American Society for Travel Medicine (SLAMVI), Pereira, Risaralda, Colombia; European Society for Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Infections in Travellers and Migrants (ESGITM), Basel, Switzerland.
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Siriwardhana C, Wickramage K, Jayaweera K, Adikari A, Weerawarna S, Van Bortel T, Siribaddana S, Sumathipala A. Impact of economic labour migration: a qualitative exploration of left-behind family member perspectives in Sri Lanka. J Immigr Minor Health 2016; 17:885-94. [PMID: 24242226 DOI: 10.1007/s10903-013-9951-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sri Lanka is a major labour sending country in Asia, with a high proportion of female labour migrants employed as domestic housemaids in the Middle East with increasing remittances. Despite such financial gains for families and national economy, health and social effects on the left-behind families have had limited exploration. This qualitative study was carried out across five districts with high labour migration rates in Sri Lanka. Twenty in-depth interviews were conducted with participants recruited through purposive sampling. Data was analysed using content and thematic analysis and emerging themes were mapped. Pre-migration socio-economic situation, economic difficulties and higher earning possibilities abroad were considered to be the major push and pull factors for labour migration. Post-migration periods were shown to be of mixed benefit to left-behind families and children suffer the negative effects of parental absence. The absence of support mechanisms for dealing with adverse events such as serious injury, death, abuse or imprisonment were cited as major concerns. Post-migration periods affect the health, well-being and family structures of left-behind families. Promoting economic prosperity while ensuring health and social protection is a formidable policy challenge for 'labour sending' countries such as Sri Lanka.
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Witting AB, Lambert J, Wickrama T. War and disaster in Sri Lanka: Implications for widows' family adjustment and perception of self-efficacy in caring for one's family. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2016; 54:126-134. [PMID: 27943280 DOI: 10.1002/ijop.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 11/02/2016] [Indexed: 11/06/2022]
Abstract
The data for this study were collected in 2014 from widows in Eastern Sri Lanka whose spouses died in the civil war, tsunami, or from health-related problems. Conservation of resources (COR) theory was used as a lens to examine the extent to which war and tsunami-related damages and family problems predict variation in social support, family adjustment and a perception of self-efficacy in caring for one's family as reported by widowed women. We also investigated whether social support from the community and social support from family and friends mediated those relationships. Results of a path model fit to the data suggested variation in family adjustment to be negatively predicted by war-related family problems and positively predicted by the social support of friends and family. Additionally, a sense of self-efficacy in caring for one's family was found to be inversely predicted by war-related family problems and tsunami damages. Clinical, social and theoretical implications are discussed as well as directions for further research.
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Affiliation(s)
- Alyssa Banford Witting
- California School of Professional Psychology, Alliant International University, San Diego, CA, USA
| | - Jessica Lambert
- Department of Psychology, California State University Stanislaus, Turlock, CA, USA
| | - Thulitha Wickrama
- Department of Psychology, Kaatsu International University, Colombo, Sri Lanka
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Quitian H, Ruiz-Gaviria RE, Gómez-Restrepo C, Rondón M. Pobreza y trastornos mentales en la población colombiana, estudio nacional de salud mental 2015. ACTA ACUST UNITED AC 2016; 45 Suppl 1:31-38. [DOI: 10.1016/j.rcp.2016.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/27/2016] [Accepted: 02/28/2016] [Indexed: 11/26/2022]
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Banford Witting A, Lambert J, Wickrama T, Thanigaseelan S, Merten M. War and disaster in Sri Lanka: Depression, family adjustment and health among women heading households. Int J Soc Psychiatry 2016; 62:425-33. [PMID: 27282175 DOI: 10.1177/0020764016650213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The civil war, lasting from 1983 to 2009, and the tsunami that struck Southeastern Asia in 2004 were major stressors that changed the demographic landscape of the northern province of Sri Lanka. The composition of families changed dramatically, with an increase in female-headed households, largely due to casualties. The conservation of resources (COR) model was applied in this study to examine relationships between risk and resiliency factors among women heading households, including women widowed by war or disaster. AIMS This study represents an investigation of the association between predictive risk and resiliency factors (i.e. war damage and loss, social support, economic status, religious participation and discrimination) and outcomes representing well-being (depressive symptoms, family adjustment and a rating of physical health). METHODS Data from 514 women heading households living in the Kilinochchi district of Sri Lanka were collected through face-to-face interviews in 2013, and associations among the data were estimated using path analysis. RESULTS Results suggest that resiliency factors that are representative of greater resources generally predicted lower levels of distress and vice versa. CONCLUSION Further study informing intervention development with women heading households in Sri Lanka is warranted to better understand which individual, family and community resources are most important to mobilize for sustainable recovery efforts to be successful in the decades following war and natural disaster.
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Hamilton A, Foster C, Richards J, Surenthirakumaran R. Psychosocial wellbeing and physical health among Tamil schoolchildren in northern Sri Lanka. Confl Health 2016; 10:13. [PMID: 27385976 PMCID: PMC4933988 DOI: 10.1186/s13031-016-0081-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders contribute to the global disease burden and have an increased prevalence among children in emergency settings. Good physical health is crucial for mental well-being, although physical health is multifactorial and the nature of this relationship is not fully understood. Using Sri Lanka as a case study, we assessed the baseline levels of, and the association between, mental health and physical health in Tamil school children. METHODS We conducted a cross sectional study of mental and physical health in 10 schools in Kilinochchi town in northern Sri Lanka. All Grade 8 children attending selected schools were eligible to participate in the study. Mental health was assessed using the Sri Lankan Index for Psychosocial Stress - Child Version. Physical health was assessed using Body Mass Index for age, height for age Z scores and the Multi-stage Fitness Test. Association between physical and mental health variables was assessed using scatterplots and correlation was assessed using Pearson's R. RESULTS There were 461 participants included in the study. Girls significantly outperformed boys in the MH testing t (459) = 2.201, p < 0.05. Boys had significantly lower average Body Mass Index for age and height for age Z scores than girls (BMI: t (459) = -4.74, p <0.001; Height: t (459) = -3.54, p < 0.001). When compared to global averages, both sexes underperformed in the Multi-Stage Fitness Test, and had a higher prevalence of thinness and stunting. We identified no meaningful association between the selected variables. CONCLUSIONS Our results do not support the supposition that the selected elements of physical health are related to mental health in post-conflict Sri Lanka. However, we identified a considerable physical health deficit in Tamil school children.
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Affiliation(s)
- Alexander Hamilton
- />British Heart Foundation Centre of Population Approaches to NCD Prevention, University of Oxford, Oxford, UK
| | - Charlie Foster
- />British Heart Foundation Centre of Population Approaches to NCD Prevention, University of Oxford, Oxford, UK
| | - Justin Richards
- />School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Rajendra Surenthirakumaran
- />Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
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Abstract
BACKGROUND The worldwide elderly population fraction is increasing, with the greatest rise in developing countries. Older adults affected by conflict and forced migration mainly taking place in developing countries may be particularly vulnerable to poor mental health due to other age-specific risk factors. This review aims to explore global evidence on the effect of conflict-induced forced migration on the mental health of older adults. METHODS Seven bibliographic databases were searched. The title and abstract of 797 results were reviewed for qualitative and quantitative studies meeting inclusion and exclusion criteria. RESULTS Six studies were selected for the in-depth review. Five papers assessed mental health in older adult populations displaced as refugees. One paper assessed mental health of older adults with varying immigration status. CONCLUSIONS This review highlights the dearth of evidence about the impact of forced migration on the mental health of older adults. Further research is needed to explore the risk factors and processes that contribute to adverse mental health outcomes among older adult populations. This is essential to the development of interventions for this vulnerable and at-risk population, particularly in resource-poor settings.
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Keraite A, Sumathipala A, Siriwardhana C, Morgan C, Reininghaus U. Exposure to conflict and disaster: A national survey on the prevalence of psychotic experiences in Sri Lanka. Schizophr Res 2016; 171:79-85. [PMID: 26817400 DOI: 10.1016/j.schres.2016.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/22/2015] [Accepted: 01/14/2016] [Indexed: 01/03/2023]
Abstract
Recent research conducted in high-income countries suggests psychotic experiences are common in the general population, but evidence from low- and middle-income countries (LMIC) remains limited. Sri Lanka is a LMIC affected by three decades of civil conflict and, in 2004, a devastating tsunami. This study aimed to investigate the prevalence of psychotic experiences in a general population sample in Sri Lanka and associations with conflict- and tsunami-related trauma. This is a first National Mental Health Survey conducted in Sri Lanka. A cross-sectional, multi-stage, cluster sampling design was used to estimate the prevalence of psychotic symptoms. Data on socio-demographic characteristics, conflict- and tsunami-related trauma, and psychotic experiences were collected using culturally validated measures in a sample of 5927 participants. The weighted prevalence of psychotic symptoms was 9.7%. Exposure to one or more conflict-related events (adj. OR 1.79, 95% CI 1.40-2.31, p<0.001) and loss or injury of a family member or friend through conflict (adj. OR, 1.83, 95% CI 1.42-2.37, p<0.001) were associated with increased odds of reporting psychotic experiences. Psychotic experiences were more common in individuals directly exposed to tsunami disaster (adj. OR, 1.68, 95% CI 1.04-2.73, P=0.035) and in those who had a family member who died or was injured as result of tsunami (adj. OR, 1.42, 95% CI 1.04-1.94, p=0.029). Our findings suggest that psychotic experiences are common in the Sri Lankan population. Exposure to traumatic events in armed conflicts and natural disasters may be important socio-environmental factors in the development of psychotic experiences.
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Affiliation(s)
- Arune Keraite
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.
| | - Athula Sumathipala
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK; Institute for Research and Development, Colombo, Sri Lanka
| | - Chesmal Siriwardhana
- Institute for Research and Development, Colombo, Sri Lanka; Faculty of Medical Science, Anglia Ruskin University, UK
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands
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Siriwardhana C, Adikari A, Jayaweera K, Abeyrathna B, Sumathipala A. Integrating mental health into primary care for post-conflict populations: a pilot study. Int J Ment Health Syst 2016; 10:12. [PMID: 26925160 PMCID: PMC4769532 DOI: 10.1186/s13033-016-0046-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 02/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health care in post-conflict settings is often not prioritized, despite its important public health role. There is a salient gap in integrating mental health into primary care, especially in post-conflict settings. In the post-conflict Northern province of Sri Lanka, a pilot study was conducted to explore the feasibility of integrating mental health into primary care through a mhGAP-based training intervention. METHODS Using the mhGAP training intervention modules, a 24 h training programme was held over 3 days for primary care practitioners serving post-conflict populations (including internally displaced people and returnees). mhGAP intervention guide and video material was used in the training. Pre/post knowledge increase was measured. A qualitative study was also nested within the training programme to explore views, attitudes and perceptions of primary care practitioners on integrating mental health into primary care in the region. In-depth interviews were conducted. RESULTS Twelve primary care practitioners participated. The average service duration of the group was 7.6 years. The mean pre- and post-test scores of the PCP group were 72.8 and 77.2 % respectively. All 12 took part in the qualitative component. Participants highlighted their experiences of conflict and displacement, discussed the health profiles/needs of post-conflict populations in the region and provided insight into mental health care and training needs at primary care level. Participants also provided feedback on the mhGAP-based training; the cultural and contextual relevance of training material and content. CONCLUSION This study was planned as a local demonstrative project to explore the feasibility of training primary care practitioners to promote the integration of mental health into primary care for post-conflict populations. To our knowledge, this is the first such attempt in Sri Lanka. Findings highlight the practical, operational and attitudinal barriers to integrate mental health into primary care, especially in resource-poor, post-conflict settings. Important feedback on mhGAP intervention guide, its implementation and training material was gained.
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Affiliation(s)
- Chesmal Siriwardhana
- Global Public Health, Migration and Ethics Research Group, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, CM1 1SQ UK ; Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK ; Institute for Research and Development, Sri Jayawardenepura Kotte, Sri Lanka
| | - Anushka Adikari
- Institute for Research and Development, Sri Jayawardenepura Kotte, Sri Lanka
| | - Kaushalya Jayaweera
- Institute for Research and Development, Sri Jayawardenepura Kotte, Sri Lanka
| | - Buddhika Abeyrathna
- Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Athula Sumathipala
- Institute for Research and Development, Sri Jayawardenepura Kotte, Sri Lanka ; Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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Jayasuriya D, Jayasuriya R, Tay AK, Silove D. Associations of mental distress with residency in conflict zones, ethnic minority status, and potentially modifiable social factors following conflict in Sri Lanka: a nationwide cross-sectional study. Lancet Psychiatry 2016; 3:145-53. [PMID: 26796018 DOI: 10.1016/s2215-0366(15)00437-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The subject of post-conflict mental health lacks studies that are nationally representative or large enough to allow robust examination of levels of distress according to residency in geographical zones of conflict and ethnic minority status. We undertook a nationwide study in Sri Lanka to address these issues. METHODS We used tablet devices to survey 20,632 people across 18 of 25 districts in Sri Lanka, of which nine were purposefully selected and nine randomly selected districts. Based on their exposure to war and levels of population displacement, these districts were classified as being in the severe, moderate, or minimal conflict zones. Trained local fieldworkers did private interviews with the participants in the local language; responses were entered directly into the tablet devices. The questions assessed exposure to a wide range of stresses, including ongoing adversities, threat or protection issues, and service access factors, and respondents provided categorical responses (yes/no) to a list of items. We used the 25-item Hopkins Symptom Checklist to measure depression and anxiety in participants. We used multivariate analysis and calculated population-attributable fractions to estimate potential improvement in mental distress if modifiable factors were addressed. FINDINGS Our results showed a stepwise increase in symptoms of depression (10%, 33%, 40%) and anxiety (13%, 23%, 23%) across minimal, moderate, and severe conflict zones, respectively. Membership of an ethnic minority group was associated with depression (Tamil odds ratio [OR] 2·4 [95% CI 1·8-3·1], other ethnic minority OR 2·7 [2·1-3·6]) and anxiety (Tamil OR 1·5 [1·1-2·0], other ethnic minority OR 1·5 [1·2-1·8]). Other fixed characteristics associated with depression and anxiety were older age (both depression and anxiety; OR 2·7 [95% CI 2·0-3·7] for anxiety and 2·3 [1·7-3·0] for depression), being married (anxiety only; OR 1·5 [95% CI 1·1-2·1]), and time spent in camps for internally displaced people (anxiety only; OR 1·4 [95% CI 1·0-1·9]). Modifiable characteristics were threat or protection issues (depression OR 1·8 [95% CI 1·2-2·8], anxiety OR 1·8 [1·3-2·6]) and scarcity of food (depression OR 1·4 [1·2-1·6], anxiety OR 1·4 [1·2-2·7]), loss of job (OR 1·2 [95% CI 1·2-1·4] for anxiety), and proximity to army camps (OR 1·6 [95% CI 1·2-2·2] for depression). Allaying of safety concerns had the potential to reduce depression by 53% and anxiety by 57%, with other factors (removal of army camps from proximity and addressing food scarcity, loss of jobs and threat/protection issues) making smaller contributions to a reduction in depression and anxiety. INTERPRETATION Our findings offer a basis for detecting high-risk groups and provide directions in devising policies and programmes aimed at alleviating psychological distress in Sri Lanka. Restoration of safety seems to be crucial to mental health recovery. FUNDING Australian National University-Department of Immigration Border Protection Collaborative Research Program.
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Affiliation(s)
- Dinuk Jayasuriya
- Development Policy Centre, Australian National University, Canberra, ACT, Australia.
| | - Rohan Jayasuriya
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales and Academic Mental Health Unit, Southwest Sydney Local Health District, Sydney, NSW, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales and Academic Mental Health Unit, Southwest Sydney Local Health District, Sydney, NSW, Australia
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Siriwardhana C, Wickramage K. Mental distress and potentially modifiable social factors in post-conflict Sri Lanka. Lancet Psychiatry 2016; 3:96-8. [PMID: 26796017 DOI: 10.1016/s2215-0366(15)00535-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/02/2015] [Accepted: 11/06/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Chesmal Siriwardhana
- Global Public Health, Migration and Ethics Research Group, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Kolitha Wickramage
- Migration Health Department, International Organization for Migration, Geneva, Switzerland
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