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Rushwan S, Skipalska H, Capasso A, Navario P, Castillo T. Understanding Domestic Violence Among Older Women in Ukraine: A Secondary Analysis Using Gender-Based Violence Screening Data. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1760-1784. [PMID: 38102836 DOI: 10.1177/08862605231214594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
This secondary descriptive analysis sought to understand Gender-Based Violence (GBV), with a focus on Domestic Violence (DV), among older women in Ukraine's conflict setting. Analysis was conducted on a subsample of 150 women aged 60+ from GBV-Information Management System intake data of 12,480 GBV survivors. Fisher's exact tests were used to compare differences in GBV incidents among women who experienced DV compared to other types of GBV. Using United Nations humanitarian and aging frameworks, qualitative analysis was completed following two rounds of coding. Sixty percent of women aged ≥60 experienced DV. Local women were more likely to experience DV versus displaced women (85.6% vs. 48.3%, p < .001). Six core themes emerged: experiencing versus witnessing violence, intergenerational conflict, livelihoods, alcohol, humiliation, and neglect. Deeper understanding of DV among older women in humanitarian settings is needed, strengthening a call to action to prioritize protection against, and prevention of, GBV more broadly among this marginalized group.
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Affiliation(s)
| | | | - Ariadna Capasso
- School of Global Public Health at New York University, New York, NY, USA
| | - Peter Navario
- HealthRight International, New York, NY, USA
- School of Global Public Health at New York University, New York, NY, USA
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Salas-Ortiz A, Moreno-Serra R, Kreif N, Suhrcke M, Casas G. The effect of conflict-related violence intensity and alcohol use on mental health: The case of Colombia. SSM Popul Health 2024; 25:101626. [PMID: 38405166 PMCID: PMC10884503 DOI: 10.1016/j.ssmph.2024.101626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
We investigated the causal impact of conflict-related violence on individual mental health and its potential pathways in Colombia. Using data from before and after the 2016 peace accord between the Colombian government and the Revolutionary Armed Forces of Colombia (FARC), we adopted a difference-in-differences empirical design combined with instrumental variables estimation. We also used formal mediation analysis to investigate a possible mediating role of alcohol consumption in the relationship between conflict exposure and mental health. Our results did not support the hypothesis that changes in exposure to conflict violence after the peace accord causally led to any changes in individual mental health. We were unable to identify a statistically significant mediating effect of alcohol consumption in the relationship between exposure to conflict violence and mental health.
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Affiliation(s)
| | | | - Noemi Kreif
- Centre for Health Economics, University of York. United Kingdom
| | - Marc Suhrcke
- Luxembourg Institute of Socioeconomic Research. Luxembourg
| | - German Casas
- Universidad de Los Andes, School of Medicine and Santa Fe University Hospital. Bogotá, Colombia
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Schoenweger P, Kirschneck M, Biersack K, Di Meo AF, Reindl-Spanner P, Prommegger B, Ditzen-Janotta C, Henningsen P, Krcmar H, Gensichen J, Jung-Sievers C. Community indicators for mental health in Europe: a scoping review. Front Public Health 2023; 11:1188494. [PMID: 37538274 PMCID: PMC10396773 DOI: 10.3389/fpubh.2023.1188494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background Community indicators may predict and influence individuals` mental health, and support or impede mental health management. However, there is no consensus on which indicators should be included in predictions, prognostic algorithms, or management strategies for community-based mental health promotion and prevention approaches. Therefore, this scoping review provides an overview of relevant community-level indicators for mental health in the general as well as risk populations in a European context. Methods We conducted a scoping review in the following electronic databases: PubMed, Embase, and PsycInfo. Eligible studies focused on context factors such as either the physical or social environment, reporting at least one mental health outcome and referring to a European population. Publications between 2012 and March 8, 2022 are considered. Results In total, the search yielded 12,200 identified records. After the removal of duplicates, 10,059 records were screened against the eligibility criteria. In total, 169 studies were included in the final analysis. Out of these included studies, 6% focused on pan-European datasets and 94% on a specific European country. Populations were either general or high-risk populations (56 vs. 44%, respectively) with depressive disorder as the main reported outcome (49%), followed by general mental health (33%) and anxiety (23%). Study designs were cross-sectional studies (59%), longitudinal (27%), and others (14%). The final set of indicators consisted of 53 indicators, which were grouped conceptually into 13 superordinate categories of community indicators. These were divided into the domains of the physical and social environment. The most commonly measured and reported categories of community indicators associated with mental health outcomes were social networks (n = 87), attitudinal factors toward vulnerable groups (n = 76), and the characteristics of the built environment (n = 56). Conclusion This review provides an evidence base of existing and novel community-level indicators that are associated with mental health. Community factors related to the physical and social environment should be routinely recorded and considered as influencing factors or potentially underestimated confounders. The relevance should be analyzed and included in clinical outcomes, data, monitoring and surveillance as they may reveal new trends and targets for public mental health interventions.
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Affiliation(s)
- Petra Schoenweger
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Kirschneck
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Biersack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Anna-Francesca Di Meo
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Philipp Reindl-Spanner
- TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Barbara Prommegger
- TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Claudia Ditzen-Janotta
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Helmut Krcmar
- TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Caroline Jung-Sievers
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Mantzari E, Ventsel M, Pechey E, Lee I, Pilling M, Hollands GJ, Marteau TM. Impact on sales of adding a smaller serving size of beer and cider in licensed premises: an A-B-A reversal design. BMC Public Health 2023; 23:1239. [PMID: 37365548 PMCID: PMC10294394 DOI: 10.1186/s12889-023-16163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Smaller serving sizes of alcoholic drinks could reduce alcohol consumption across populations thereby lowering the risk of many diseases. The effect of modifying the available range of serving sizes of beer and cider in a real-world setting has yet to be studied. The current study assessed the impact on beer and cider sales of adding a serving size of draught beer and cider (2/3 pint) that was between the current smallest (1/2 pint) and largest (1 pint) standard serving sizes. METHODS Twenty-two licensed premises in England consented to taking part in the study. The study used an ABA reversal design, set over three 4-weekly periods, with A representing the non-intervention periods, during which standard serving sizes were served and B the intervention period when a 2/3 pint serving size of draught beer and cider was added to the existing range, along with smaller 1/2 pint and larger 1 pint serving sizes. The primary outcome was the daily volume of beer and cider sold, extracted from sales data. RESULTS Fourteen premises started the study, of which thirteen completed it. Twelve of those did so per protocol and were included in the primary analysis. After adjusting for pre-specified covariates, the intervention did not have a significant effect on the volume of beer and cider sold per day (3.14 ml; 95%CIs -2.29 to 8.58; p = 0.257). CONCLUSIONS In licensed premises, there was no evidence that adding a smaller serving size for draught beer and cider (2/3 pint) when the smallest (1/2 pint) and largest (1 pint) sizes were still available, affected the volume of beer and cider sold. Studies are warranted to assess the impact of removing the largest serving size. TRIAL REGISTRATION ISRCTN: https://doi.org/10.1186/ISRCTN33169631 (08/09/2021), OSF: https://osf.io/xkgdb/ (08/09/2021).
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Minna Ventsel
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Ilse Lee
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Belay GM, Lam KKW, Liu Q, Wu CST, Mak YW, Ho KY. Magnitude and determinants of alcohol use disorder among adult population in East Asian countries: A systematic review and meta-analysis. Front Public Health 2023; 11:1144012. [PMID: 36926176 PMCID: PMC10011711 DOI: 10.3389/fpubh.2023.1144012] [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: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Alcohol use disorder is a medical condition characterized by an impaired ability to control or stop alcohol use despite adverse health outcomes. Despite several studies that have analyzed the prevalence and determinants, their results have been equivocal, and the reasons for the differences in prevalence rates and determinants of AUD across nationalities are unknown. Hence, this study estimated the pooled prevalence of alcohol use disorder and its determinant among adults in East Asian countries. Methods Articles were searched from PubMed, Web of Science, EMBASE, PsycINFO, and Scopus. All observational study designs that fulfilled the predefined criteria were included in the study. The findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The quality and heterogeneity of articles were assessed using the new castle-Ottawa scale (NOS) and I2, respectively. Additionally, publication bias was checked through funnel plot and Egger's regression test. Results A total of 14 articles with 93, 161 study participants were considered in the study. Of which 9 studies were included in the meta-analysis of the 1-year prevalence of alcohol use disorder, 6 in the lifetime, 9 in alcohol abuse, and 8 in alcohol dependency. Consequently, the overall pooled prevalence of one-year alcohol use disorder was 8.88% (95% CI: 6.32, 11.44), lifetime 13.41% (95%CI: 8.48, 18.34), alcohol abuse 5.4% (95% CI: 2.66, 8.13), and alcohol dependency 4.47% (95% CI: 2.66, 6.27). In the subgroup analysis by country, the highest 1-year and lifetime pooled prevalence of alcohol use disorder was observed in Korea at 9.78% (95% CI:4.40, 15.15) and 16.73% (95% CI: 15.31, 18.16), respectively. Besides, smoking (OR: 3.99; 95% CI: 1.65, 6.33) and male gender (OR: 5.9; 95% CI: 3.3, 8.51) were significant determinants of alcohol use disorder. Conclusions The magnitude of alcohol use disorder was high among adults in East Asian countries. Smoking and male gender were the key determinants of alcohol use disorders.
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Affiliation(s)
| | | | | | | | | | - Ka Yan Ho
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review. Glob Ment Health (Camb) 2023; 10:e5. [PMID: 36843880 PMCID: PMC9947613 DOI: 10.1017/gmh.2022.63] [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: 09/02/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.
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Bahati R, Ashaba S, Sigmund CD, Rukundo GZ, Ainamani HE. Gender differences in substance use and associated factors among urban refugees in Uganda. Eur J Psychotraumatol 2023; 14:2238583. [PMID: 37534475 PMCID: PMC10402830 DOI: 10.1080/20008066.2023.2238583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Alcohol and other substances use related problems among refugees is a global public health concern. Although there is substantial research on the use of alcohol and other substances among the refugees, little is known about gender and other factors that might be associated with the use of alcohol and other substances. Our study aimed to assess the prevalence of alcohol and substance use across gender and other specific associated factors among urban refugees living in Mbarara city, Southwestern Uganda. METHODS In a cross-sectional study, 343 refugees were interviewed on the use of alcohol and other substances using the Alcohol Use Disorder Identification Test and the Drug Abuse Screening Test. The associated factors included, age, marital status, occupation, duration (length of stay) in Uganda, educational levels, stigma and depression. Linear regression analysis was used to examine the associations between the predictor and outcome variables. RESULTS No significant gender difference in alcohol use was found, and the overall prevalence of hazardous, harmful or dependent alcohol use among our sample of refugees living in Mbarara city was 43%. There were however, statistically significant gender differences in the use of other substances, with a significantly higher percentage of men than women reporting intermediate, substantial, or severe substance use (45% among men, 37% among women). Higher levels of depression and being separated from one's spouse were associated with higher levels of alcohol and substance use. In addition, higher age and being male were associated with the use of substances other than alcohol. CONCLUSIONS Our findings indicate a high prevalence of problematic alcohol and substance use among both male and female refugees. Clinical interventions focused on the treatment and prevention of alcohol and substance use among the refugee communities may benefit from focusing on depressive symptoms as well.
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Affiliation(s)
- Ronald Bahati
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Public Health and Biomedical Sciences, Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cathy Denise Sigmund
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Crown College, St. Bonifacius, MN, USA
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Herbert Elvis Ainamani
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Public Health and Biomedical Sciences, Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
- Department of Mental Health, School of Medicine, Kabale University, Kabale, Uganda
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Kane JC, Kamanga M, Skavenski S, Murray LK, Shawa M, Bwalya B, Metz K, Paul R, Mushabati N, Ventevogel P, Haddad S, Kilbane G, Sienkiewicz M, Chibemba V, Chiluba P, Mtongo N, Chibwe M, Figge CJ, Alto M, Mwanza D, Mupinde E, Kakumbi S, Tol WA, Vaughan K, Banda Z, Busse A, Ezard N, Zulu A, Loongo H, Greene MC. Testing a Screening, Brief Intervention, and Referral to Treatment Intervention Approach for Addressing Unhealthy Alcohol and Other Drug Use in Humanitarian Settings: Protocol of the Ukuundapwa Chapamo Randomised Controlled Trial. INTERVENTION (AMSTELVEEN, NETHERLANDS) 2023; 21:58-69. [PMID: 37228642 PMCID: PMC10206531 DOI: 10.4103/intv.intv_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Refugees and other displaced persons are exposed to many risk factors for unhealthy alcohol and other drug (AOD) use and concomitant mental health problems. Evidence-based services for AOD use and mental health comorbidities are rarely available in humanitarian settings. In high income countries, screening, brief intervention and referral to treatment (SBIRT) systems can provide appropriate care for AOD use but have rarely been used in low- and middle-income countries and to our knowledge never tested in a humanitarian setting. This paper describes the protocol for a randomised controlled trial to compare the effectiveness of an SBIRT system featuring the Common Elements Treatment Approach (CETA) to treatment as usual in reducing unhealthy AOD use and mental health comorbidities among refugees from the Democratic Republic of the Congo and host community members in an integrated settlement in northern Zambia. The trial is an individually randomised, single-blind, parallel design with outcomes assessed at 6-months (primary) and 12-months post-baseline. Participants are Congolese refugees and Zambians in the host community, 15 years of age or older with unhealthy alcohol use. Outcomes are: unhealthy alcohol use (primary), other drug use, depression, anxiety and traumatic stress. The trial will explore SBIRT acceptability, appropriateness, cost-effectiveness, feasibility, and reach.
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Affiliation(s)
- Jeremy C. Kane
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Muzi Kamanga
- Women in Law and Development in Africa, Lusaka, Zambia
| | | | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mbaita Shawa
- Women in Law and Development in Africa, Lusaka, Zambia
| | | | - Kristina Metz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ravi Paul
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Stephanie Haddad
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Grace Kilbane
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Megan Sienkiewicz
- Columbia University Mailman School of Public Health, New York, New York, USA
| | | | | | - Nkumbu Mtongo
- Women in Law and Development in Africa, Lusaka, Zambia
| | | | - Caleb J. Figge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Mwanza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Mupinde
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shira Kakumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse A. Tol
- University of Copenhagen, Copenhagen, Denmark
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Anja Busse
- United Nations Office on Drug Use and Crime, Vienna, Austria
| | - Nadine Ezard
- University of New South Wales, Sydney, Australia
| | | | | | - M. Claire Greene
- Columbia University Mailman School of Public Health, New York, New York, USA
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Endashaw Hareru H, Kaso AW, Debela BG, Abebe L, Sisay W/Tsadik D, Kassa Abebe R, Kassaw C. Alcohol use disorder and its associated factors among residents in Southern Ethiopia during the era of COVID-19. SAGE Open Med 2022; 10:20503121221105031. [PMID: 35756350 PMCID: PMC9218489 DOI: 10.1177/20503121221105031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/14/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: To determine the prevalence of alcohol use disorder and associated factors among residents of Dilla town, Gedeo zone, Southern Ethiopia, 2021. Methods: A community-based cross-sectional study was conducted among 666 randomly selected participants. Interview-assisted structured questionnaire was used to collect data, and alcohol use disorder identification test was employed to measure alcohol use disorder. The data were entered in to Epi info version 7 and exported in to SPSS version 25 for analysis. Both bivariate and multivariate binary logistic regression analysis were used to identify significant factors related with alcohol use disorder. In the multivariate model, variables with p value < 0.05 were considered as a statistical significant factor for the outcome variable. Finally, adjusted odds ratio with 95% confidence interval was computed to assess the strength of association. Results: The magnitude of alcohol used disorder during the past year was 30.6% (95% confidence interval: 25.5%–35.7%). Being male (adjusted odds ratio = 8.33, 95% confidence interval: (4.34, 15.98)), age of less than 33 years old (adjusted odds ratio = 1.78, 95% confidence interval: (1.06, 3.00)), current cigarette smoking (adjusted odds ratio = 2.49, 95% confidence interval: (1.42, 4.37)), current khat chewing (adjusted odds ratio = 6.23, 95% confidence interval: (3.8, 9.92)), high level of psychological distress (adjusted odds ratio = 7.69, 95% confidence interval: (4.16, 14.28)) and poor social support (adjusted odds ratio = 2.30, 95% confidence interval: (1.27, 4.18)) were significantly associated with alcohol use disorder. Conclusion: A large percentage of respondents in our sample had an alcohol use disorder. Alcohol use problems were linked to being men, under the age of 33 years old, current khat chewing, current cigarette smoking, a high level of psychological distress, and poor of social support. As a result, early screening, public health intervention programs and establishing appropriate referral linkages with mental health facilities are recommended.
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Abdene Weya Kaso
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Berhanu Gidisa Debela
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Lulu Abebe
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay W/Tsadik
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Reta Kassa Abebe
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Chalachew Kassaw
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Olufadewa II, Adesina MA, Oladele RI, Ayorinde TA. “Watching my family being killed by terrorists made me really depressed”: Mental health experiences, challenges and needed support of young internally displaced persons in northern Nigeria. J Migr Health 2022; 6:100121. [PMID: 35694419 PMCID: PMC9178342 DOI: 10.1016/j.jmh.2022.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background Over 3.9 million people have been displaced in Nigeria as a result of the over one-decade-long Boko Haram insurgency and about 2.1 million of this population are internally displaced within the country. Young internally displaced persons (IDPs) are at higher risk of mental illness such as depression, anxiety, post-traumatic stress disorder (PTSD) among others, however, there are sparse studies on this population. Therefore, this study explored the mental health experiences, challenges, and needed support for young internally displaced persons in Durumi and New Kuchingoro Internally Displaced Persons Camps in Nigeria. Methods This qualitative study was conducted among young IDPs in Durumi and New Kuchingoro IDP camps in Northern Nigeria. Fourteen (14) focus group discussions comprising 89 participants and 30 in-depth interviews with 30 participants were conducted with young IDPs. The interviews were in Hausa and Pidgin English, audio-recorded, transcribed, translated into English, and applied thematic analysis was done using MAXQDA Analytics Pro 2020 Results A total of 89 participants consisting of 47 males and 42 females participated in the FGDs and IDIs. Five key themes emerged from the FGDs and IDI: (1) knowledge about mental health, (2) mental Health Experiences, (3) coping strategies, (4) availability of mental health and other health Support, and (5) needed support. Young IDPs had fair knowledge about mental healthcare. Participants reported their experience before displacement as being peaceful with members of the family together in a good environment while they experienced stress, trauma, shock, sadness, and symptoms of anxiety, depression, and PTSD during and post displacement. Personal coping strategies such as listening to music, engaging in sports, reading books, farming, and other economic activities were reported by participants. Participants reported the absence of structured and specialized mental health support in the IDP camps and solicited mental health, physical health, economic and educational support. Conclusion Young IDPs had negative experiences that led to symptoms of mental health disorders such as depression, anxiety disorders, PTSD among others with little or no access to quality mental healthcare. Hence, they require specialized and structured mental health support to lead healthy and productive lives. Policy and programs aimed at increasing access to mental health information and services for forced migrants are recommended.
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Marlow HM, Kunnuji M, Esiet A, Bukoye F, Izugbara C. The Sexual and Reproductive Health Context of an Internally Displaced Persons' Camp in Northeastern Nigeria: Narratives of Girls and Young Women. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3:779059. [PMID: 36303961 PMCID: PMC9580675 DOI: 10.3389/frph.2021.779059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/02/2022] Open
Abstract
In humanitarian settings, ~35 million girls and young women of reproductive age (15–24) are in urgent need of sexual and reproductive health (SRH) information and services. Young women and girls in humanitarian contexts are particularly vulnerable to unwanted pregnancies, unsafe abortion, gender-based violence, and early and forced marriage. We sought to understand girls' and young women's experiences with unwanted pregnancy, abortion, contraception, sexually transmitted infections (STIs), gender-based violence (GBV), and forced marriage in an IDP camp in Northeastern Nigeria. We conducted 25 in-depth interviews with girls aged 15–19 (N = 13; 8 single and 5 married) and young women aged 20–24 (N = 12; 3 single and 9 married). All interviews were audiotaped, transcribed, translated, computer recorded and coded for analysis. The participants in our study fled from and witnessed violence to arrive in the IDP camp with little material support. Lack of necessities, especially food, has driven many to sex in exchange for goods or into forced marriages. This, in turn, leads to increased unwanted pregnancies and unsafe abortions. Participants had limited knowledge about contraception, and some information about SRH services available in the camp, but overall, knowledge and utilization of SRH services was low.
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Affiliation(s)
- Heather M. Marlow
- International Center for Research on Women, Global Health Youth and Development, Washington, DC, United States
- *Correspondence: Heather M. Marlow
| | - Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | | | | | - Chimaraoke Izugbara
- International Center for Research on Women, Global Health Youth and Development, Washington, DC, United States
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12
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Kreif N, Mirelman A, Suhrcke M, Buitrago G, Moreno-Serra R. The impact of civil conflict on child health: Evidence from Colombia. ECONOMICS AND HUMAN BIOLOGY 2022; 44:101074. [PMID: 34839051 DOI: 10.1016/j.ehb.2021.101074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 06/28/2021] [Accepted: 10/20/2021] [Indexed: 05/24/2023]
Abstract
Internal armed conflicts have become more common and more physically destructive since the mid-20th century, with devastating consequences for health and development in low- and middle-income countries. This paper investigates the causal impacts of the long-term internal conflict on child health in Colombia, following an identification strategy based on the temporal and geographic variation of conflict intensity. We estimate the effect of different levels of conflict intensity on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height z-scores among children under five years old, and explore the underlying potential mechanisms, through maternal health behavior and health care utilization. We find a harmful effect of exposure to conflict violence in utero and in early childhood for HAZ and WAZ, in the full sample and even more strongly in the rural sample, yet these estimates are smaller than those found for shorter term conflicts. The underlying pathways appear to operate around the time of the pregnancy and birth (in the form of maternal alcohol use, use of antenatal care and skilled birth attendance), rather than during the post-birth period (via breastfeeding or vaccination), and the impacts accumulate over the childhood. The most adverse impacts of conflict violence on child health and utilization of maternal healthcare were observed in municipalities which suffered from intermittent presence of armed groups.
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Affiliation(s)
- Noémi Kreif
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.
| | - Andrew Mirelman
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK; Luxembourg Institute of Socio-economic Research, 11 Porte des Sciences, 4366 Esch-sur-Alzette, Luxembourg
| | - Giancarlo Buitrago
- Clinical Research Institute, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogota, DC, Colombia
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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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14
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Lindert J, Neuendorf U, Natan M, Schäfer I. Escaping the past and living in the present: a qualitative exploration of substance use among Syrian male refugees in Germany. Confl Health 2021; 15:26. [PMID: 33845859 PMCID: PMC8042941 DOI: 10.1186/s13031-021-00352-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background Syrians have been the largest group of refugees in Germany since 2014. Little is known about Syrian refugees` perspectives on substance use. The aim of this study is to investigate the perspective of male refugees from Syria and to foster specific knowledge and understanding of substance use. Methods We applied a qualitative study design. Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed. We used a hybrid approach by integrating inductive and deductive thematic frameworks. Results We identified common themes. Firstly, refugees perceived that substances are widely available and accepted in Germany. Secondly, refugees perceived that rules and norms in Germany differ from rules and norms in the home country and favor availability of substances. Thirdly, substance use is related to the intention to escape the past. Fourthly, substance use is related to living in the present through connecting with others and being part of the community. Finally, mental health professional treatment for substance use is associated with shame. Conclusions Findings support Syrian refugees` perspectives of substance use as a way of both escaping the past and coping with psychosocial difficulties in the present in a socio-ecological understanding. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees` perspectives on substance use. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00352-x.
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Affiliation(s)
- Jutta Lindert
- Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg, Hamburg, Germany. .,Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ulrike Neuendorf
- Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg, Hamburg, Germany
| | - Marta Natan
- Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg, Hamburg, Germany
| | - Ingo Schäfer
- University Hospital Hamburg / Eppendorf, Hamburg, Germany
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15
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Mehus CJ, Wieling E, Thomas Oloya O, Laura A, Ertl V. The impact of alcohol misuse on fathering in Northern Uganda: An ethnographic study of fathers. Transcult Psychiatry 2021; 58:14-26. [PMID: 32727316 DOI: 10.1177/1363461520943315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Acholi people of northern Uganda experienced decades of conflict. Alcohol misuse is high among northern Ugandan men. This is common in displaced or post-war communities. Because parents are often the most significant and proximal influence in a child's development, it is important to understand the relationships between parental behavioral health and parenting. The purpose of this ethnographic study was to understand the impact of alcohol misuse on fathering, from fathers' perspectives. We collected qualitative data from several sources, including in-depth interviews with 19 fathers. Informants identified three ways in which a father can "overdrink": drinking to drunkenness, spending too much money on alcohol, or spending too much time drinking alcohol. Fathers described the specific ways in which overdrinking impacted each of the three primary roles of a father, which were identified as providing, educating, and creating a stable home. Of the negative effects of overdrinking, a compromised ability to provide for basic needs was described as the most salient. The findings suggest that support for families in this region should include support for father's substance misuse, as a father's overdrinking is widely understood to be problematic for the entire family.
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Affiliation(s)
| | | | | | | | - Verena Ertl
- Katholische Universität Eichstätt-Ingolstadt and vivo International, Germany
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16
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Singh NS, Bogdanov S, Doty B, Haroz E, Girnyk A, Chernobrovkina V, Murray LK, Bass JK, Bolton PA. Experiences of mental health and functioning among conflict-affected populations: A qualitative study with military veterans and displaced persons in Ukraine. AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 91:499-513. [PMID: 33900102 PMCID: PMC10015420 DOI: 10.1037/ort0000537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: This article reports findings from a qualitative study that sought to identify and describe psychosocial and mental health consequences of conflict among internally displaced persons (IDPs) and military veterans in Ukraine. The study was the first phase of a clinical intervention trial and was designed to understand local experiences of mental health problems and function, inform the selection and adaptation of local measures, and guide the modification, and implementation of a psychotherapy intervention that could support conflict-affected persons. Method: Free-list interviews (FLs), key informant interviews (KIIs), and focus group discussions (FDGs) were conducted with IDPs, military veterans, and providers working with these two groups. A total of 227 respondents were interviewed from two study regions in eastern Ukraine-Zaporizhia and Kharkiv-including 136 IDPs and 91 military veterans. Results: Both IDPs and veterans were described as experiencing high levels of psychological stress symptoms, including depression, isolation, anxiety, and intrusive memories. Although IDPs and veterans were exposed to different traumas, they both identified struggles with social adaptation, including feeling isolated and misunderstood by their communities. Both groups also described relational conflict within and outside the family. Social support mechanisms were considered essential for recovery, and positive social interaction was described as a key example of healthy functioning. Conclusion: Findings suggest a need for community-based programming that facilitates social adaptation, supports social network building, and helps engage conflict-affected people into mental health services. Programs that promote greater awareness, interaction, and understanding among the general public, military veterans, and IDPs are also warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Namrita S Singh
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health
| | - Sergiy Bogdanov
- Center for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy
| | - Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Emily Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Andriy Girnyk
- Department of Psychology and Pedagogy, National University of Kyiv-Mohyla Academy
| | - Vira Chernobrovkina
- Department of Psychology and Pedagogy, National University of Kyiv-Mohyla Academy
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Paul A Bolton
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health
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17
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Ramachandran A, Makhashvili N, Javakhishvili J, Karachevskyy A, Kharchenko N, Shpiker M, Ezard N, Fuhr DC, Roberts B. Alcohol use among conflict-affected persons in Ukraine: risk factors, coping and access to mental health services. Eur J Public Health 2020; 29:1141-1146. [PMID: 31230084 DOI: 10.1093/eurpub/ckz117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours. METHODS A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours. RESULTS Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours. CONCLUSIONS AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.
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Affiliation(s)
- Anu Ramachandran
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Nino Makhashvili
- Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia.,Ilia State University, Tbilisi, Georgia
| | - Jana Javakhishvili
- Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia.,Ilia State University, Tbilisi, Georgia
| | | | | | - Marina Shpiker
- Kiev International Institute of Sociology (KIIS), Kiev, Ukraine
| | - Nadine Ezard
- University of New South Wales Sydney, Sydney, Australia.,St Vincent's Hospital Sydney, Sydney, Australia
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
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18
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Preusse M, Neuner F, Ertl V. Effectiveness of Psychosocial Interventions Targeting Hazardous and Harmful Alcohol Use and Alcohol-Related Symptoms in Low- and Middle-Income Countries: A Systematic Review. Front Psychiatry 2020; 11:768. [PMID: 32903779 PMCID: PMC7438922 DOI: 10.3389/fpsyt.2020.00768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In low- and middle-income countries (LMIC), the mismatch between the number of individuals needing and those receiving treatment for alcohol use disorders (AUD) is substantial. In order to provide suggestions for the scaling up of effective service provision we systematically reviewed the current evidence on the effectiveness of AUD-focused psychosocial interventions in LMIC. METHODS We used a systematic review methodology following the PRISMA guidelines. Twelve electronic databases listing published and grey literature were searched and only randomized-controlled trials (RCTs) were included. Where possible, effect sizes were calculated using Hedges' g indices. RESULTS Twenty-one RCTs conducted in 15 different LMIC between 1992 and 2018 fulfilled inclusion criteria. Most studies employed brief one-on-one interventions facilitated by trained primary care staff. Eighty-six percent of RCTs based their interventions on the principles of motivational interviewing (MI) with the majority supplementing MI-based interventions with alcohol-tailored elements of cognitive-behavioral therapy (CBT). The remaining RCTs employed CBT-components exclusively. Just over 40% of studies included in quantitative analyses (n=17) yielded an at least medium-sized effect (g≥.50) of the respective intervention compared to alcohol-related and unrelated control conditions or waiting list. Only half of the trials implementing the widely applied MI-based approaches (or MI-based approaches blended with CBT-elements) were superior to their respective control conditions. CONCLUSION To date, a relatively small number of RCTs investigating AUD-focused treatments has been conducted in LMIC. The majority of between condition effect size estimates were small and no type of intervention can clearly be recommended over another. No RCTs were conducted in conflict-affected areas in LMIC although they would merit particular attention since AUD is often linked to trauma-related mental health disorders. More RCTs in LMIC are required and alternatives to MI-based approaches should be investigated. This systematic review summarizes properties of effective interventions and provides implications for future research.
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Affiliation(s)
- Melissa Preusse
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Verena Ertl
- vivo international, Konstanz, Germany
- Department of Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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Abstract
Background: Georgia is leading one of the world’s first hepatitis C (HCV) elimination programs alongside interventions to combat a HIV epidemic concentrated among high-risk groups. Although progress has been substantial, neither strategy accounts for the nearly 150,000 internally displaced persons residing in collective centers (CC-IDPs) who are susceptible to deeply integrated risk environments that could promote infection. Achieving dedicated goals for HCV elimination and HIV suppression requires a clear understanding of the risks facing CC-IDPs. Objectives: This literature review aims to consolidate what is known about the socio-economic and physical/mental health status of IDPs living in collective centers in Georgia, and to assess their vulnerability to HIV and HCV in light of local and global epidemiological trends. Methods: Sources were compiled from journal publications, reports by government ministries and transnational organizations, and the Integrated Household Survey database (2009–2018; updated annually by the National Statistics Office of Georgia) through manual searches in PUBMED, Google Scholar and Search, ProQuest, and digital repositories of government offices. Findings: Reports indicate that CC-IDPs are more susceptible to poverty, poor living conditions, mental illness, disability, substance use, and in some cases infectious disease; although, the correlation is not always present and subject to variability. These factors were linked to increased transmission and acquisition of HIV/HCV in both displacement and non-displacement contexts abroad. The geographic concentration of HIV/HCV in areas with greater clusters of CC-IDPs, and shared characteristics with local high-risk groups, indicate the possibility of inordinate transmission among CC-IDPs in Georgia. Conclusions: The disproportionate prevalence of psychosocial and clinical harms among CC-IDPs testifies to the serious potential of a greater burden of HIV and hepatitis C. Going forward, targeted research is needed to inform interventions and clarify the health status of CC-IDPs in Georgia.
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Salama ES, Castaneda AE, Lilja E, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study. Addiction 2020; 115:1160-1171. [PMID: 31797477 PMCID: PMC7317749 DOI: 10.1111/add.14904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/01/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds. DESIGN Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language. SETTING Population-based data were collected from six cities in Finland during 2010-12. PARTICIPANTS The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%). MEASUREMENTS The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for. FINDINGS Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18). CONCLUSIONS In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.
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Affiliation(s)
- Essi S. Salama
- Faculty of MedicineUniversity of TurkuTurkuFinland
- Child PsychiatryTurku University HospitalTurkuFinland
| | - Anu E. Castaneda
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Faculty of Medicine, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Eero Lilja
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Jaana Suvisaari
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Shadia Rask
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote)JoensuuFinland
| | - Solja Niemelä
- Department of PsychiatryUniversity of TurkuTurkuFinland
- Addiction Psychiatry UnitTurku University HospitalTurkuFinland
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Aham-Chiabuotu CB, Abel G, Thompson L. ‘Men don't have patience’: Sexuality, pleasure and danger in displacement settings in Northcentral Nigeria. Glob Public Health 2019; 16:801-813. [DOI: 10.1080/17441692.2019.1690539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Gillian Abel
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Lee Thompson
- Department of Population Health, University of Otago, Christchurch, New Zealand
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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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23
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Doty SB, Haroz EE, Singh NS, Bogdanov S, Bass JK, Murray LK, Callaway KL, Bolton PA. Adaptation and testing of an assessment for mental health and alcohol use problems among conflict-affected adults in Ukraine. Confl Health 2018; 12:34. [PMID: 30127843 PMCID: PMC6092824 DOI: 10.1186/s13031-018-0169-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia. Our purpose was to develop reliable and valid instruments to screen for common mental health and alcohol use problems in these populations. Methods We used a three-step process of instrument adaptation and testing. The instrument-the Mental Health Assessment Inventory (MHAI)-combines adapted standard screeners with items derived locally in Ukraine. A validity study was conducted using a sample of 153 adults (54% male) ages 18 years and older. All participants in the sample were IDPs or veterans living in or near the major urban areas of Kyiv and Zaporizhia. Reliability testing (internal consistency, test-retest) and validity testing (construct, criterion) of the MHAI were conducted using classical test theory. After initial testing, we used Item Response Theory (IRT) to shorten and further refine the instrument. Results The MHAI showed good internal consistency and test-retest reliability for the main outcomes: depression (α = 0.94; r = .84), post-traumatic stress (PTS; α = 0.97; r = 0.87), anxiety (α = 0.90; r = 0.80), and alcohol use (α = 0.86; r = 0.91). There was good evidence of convergent construct validity among the scales for depression, PTS, and anxiety, but not for alcohol use. Item Response Theory (IRT) analysis supported use of shortened versions of the scales for depression, PTS, and anxiety, as they retained comparable psychometric properties to the full scales of the MHAI. Conclusion The findings support the reliability and validity of the assessment-the MHAI-for screening of common mental health problems among Ukrainian IDPs and veterans. Use of IRT shortened the instrument to improve practicality and potential sustainability.
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Affiliation(s)
- S Benjamin Doty
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Emily E Haroz
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Namrita S Singh
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sergiy Bogdanov
- 3Center for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Judith K Bass
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Laura K Murray
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Karis L Callaway
- 4Department of Psychology, Western Michigan University, Kalamazoo, MI USA
| | - Paul A Bolton
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.,2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Mootz JJ, Muhanguzi FK, Panko P, Mangen PO, Wainberg ML, Pinsky I, Khoshnood K. Armed conflict, alcohol misuse, decision-making, and intimate partner violence among women in Northeastern Uganda: a population level study. Confl Health 2018; 12:37. [PMID: 30127845 PMCID: PMC6091151 DOI: 10.1186/s13031-018-0173-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 07/20/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest. METHODS We surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016. We used Mplus 7.4 to estimate a moderated structural equation model of indirect pathways between armed conflict and intimate partner violence for currently partnered women (n = 558) to evaluate the strength of the relationships between the latent factors and determine the goodness-of-fit of the proposed model with the population data. RESULTS Most respondents (88.8%) experienced conflict-related violence. The lifetime/ past 12 month prevalence of experiencing intimate partner violence was 65.3%/ 50.9% (psychological) and 59.9%/ 43.8% (physical). One-third (30.7%) of women's partners reportedly consumed alcohol daily. The relative fit of the structural model was superior (CFI = 0.989; TLI = 0.989). The absolute fit (RMSEA = 0.029) closely matched the population data. The partner and joint decision-making groups significantly differed on the indirect effect through partner alcohol use (a1b1 = 0.209 [0.017: 0.467]). CONCLUSIONS This study demonstrates that male partner alcohol misuse is associated with exposure to armed conflict and intimate partner violence-a relationship moderated by healthcare decision-making. These findings encourage the extension of integrated alcohol misuse and intimate partner violence policy and emergency humanitarian programming to include exposure to armed conflict and gendered decision-making practices.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032 USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY 10032 USA
| | | | - Pavel Panko
- Department of Educational Psychology and Leadership, Texas Tech University, 3008 18th Street, Lubbock, TX 79409 USA
| | - Patrick Onyango Mangen
- Transcultural Psychosocial Organization Uganda, Plot 3271 Kansanga off Ggaba Road, P.O.Box 21646, Kampala, Uganda
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032 USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY 10032 USA
| | - Ilana Pinsky
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032 USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY 10032 USA
| | - Kaveh Khoshnood
- School of Public Health, Yale University, 60 College St, New Haven, CT 06510 USA
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Murphy A, Chikovani I, Uchaneishvili M, Makhashvili N, Roberts B. Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study. BMC Health Serv Res 2018; 18:306. [PMID: 29712551 PMCID: PMC5928589 DOI: 10.1186/s12913-018-3113-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/11/2018] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There is a paucity of evidence on access to services for mental health and psychosocial support for conflict-affected populations in low- and middle-income countries. In the Republic of Georgia, rates of utilization of mental health services among internally displaced people with mental disorders are low. We set out to identify the health system barriers leading to this treatment gap. METHODS We used rapid appraisal methods (collection and triangulation of multiple data sources) to investigate barriers to accessing mental health care services among adult IDPs in Georgia. Data collection included review of existing policy documents and other published data, as well as semi-structured interviews with 29 key informants including policy makers, NGO staff, health professionals and patients. RESULTS The following factors emerged as important barriers affecting access to mental health care services among IDPs in Georgia: inadequate insurance coverage of mental disorders and poor identification and referral systems, underfunding, shortage of human resources, poor information systems, patient out-of-pocket payments and stigmatization. CONCLUSION While rapid appraisal methods cannot control for potential biases or achieve representativeness, triangulation supports internal validity and reliability of the data collected, allowing data to be used to inform health care interventions. The appropriateness and potential effectiveness of policy interventions such as insurance coverage of a wider range of mental disorders, integration of services for these at the primary health care level, and community-based approaches in this context should be explored.
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Affiliation(s)
- Adrianna Murphy
- London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Ivdity Chikovani
- Curatio International Foundation, 3 Kavsadze str., Office 5, 0179 Tbilisi, Georgia
| | - Maia Uchaneishvili
- Curatio International Foundation, 3 Kavsadze str., Office 5, 0179 Tbilisi, Georgia
| | - Nino Makhashvili
- Ilia State University, 3/5, Kakuca Cholokashvili Ave, Tbilisi, Georgia
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH UK
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Ivlevs A, Veliziotis M. Beyond conflict: Long-term labour market integration of internally displaced persons in post-socialist countries. JOURNAL OF VOCATIONAL BEHAVIOR 2018. [DOI: 10.1016/j.jvb.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Odone A, McKee C, McKee M. The impact of migration on cardiovascular diseases. Int J Cardiol 2018; 254:356-361. [PMID: 29407123 DOI: 10.1016/j.ijcard.2017.11.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Odone
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Charlotte McKee
- Department of War Studies, Kings College London, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
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Nugawela MD, Lewis S, Szatkowski L, Langley T. Rapidly Increasing Trend of Recorded Alcohol Consumption Since the End of the Armed Conflict in Sri Lanka. Alcohol Alcohol 2017; 52:550-556. [PMID: 28854708 DOI: 10.1093/alcalc/agx044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/28/2017] [Indexed: 11/14/2022] Open
Abstract
Aim To evaluate temporal changes in recorded alcohol consumption in Sri Lanka during and after the armed conflict 1998-2013. Methods District level alcohol sales, and mid-year population data for the whole study period (1998-2013) were consistently available from the Department of Excise and the Department of Census and Statistics for 18 of 25 districts. These data were used to estimate the recorded per capita consumption for the areas that were not directly exposed to the armed conflict. An interrupted time series design was employed to estimate the impact of the end of the armed conflict on recorded adult per capita alcohol consumption of population lived in the 18 districts. Results Adult per capita recorded alcohol consumption among Sri Lankans living in the 18 districts was 1.59 l of pure alcohol in 1998. This increased up to 2.07 l in 2009 and 2.55 l in 2013. Prior to the end of the conflict in 2009 adult per capita recorded consumption increased by 0.051 l of pure alcohol per year (95% CI: 0.029-0.074, P < 0.001); after 2009 this was 0.166 l per year (95% CI: 0.095-0.236, P < 0.001). Beer consumption showed the highest per capita growth compared with other beverages. Conclusions Adult per capita recorded alcohol consumption among Sri Lankans living in areas that were not directly exposed to the conflict increased markedly after the end of the conflict. Rapid socio-economic development, alcohol industry penetration and lack of alcohol control strategies during the post-conflict period may have driven this increase. Short summary Adult per capita recorded alcohol consumption among Sri Lankans living in 18 districts that were not directly exposed to the armed conflict increased markedly after the end of the conflict in 2009, with a dramatic acceleration in the trend of per capita beer consumption.
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Affiliation(s)
- Manjula D Nugawela
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, UK.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol BS1 2NT, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Lewis
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NottinghamNG5 1PB, UK
| | - Lisa Szatkowski
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NottinghamNG5 1PB, UK
| | - Tessa Langley
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NottinghamNG5 1PB, UK
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Mootz JJ, Stabb SD, Mollen D. Gender-Based Violence and Armed Conflict: A Community-Informed Socioecological Conceptual Model From Northeastern Uganda. PSYCHOLOGY OF WOMEN QUARTERLY 2017; 41:368-388. [PMID: 29563663 PMCID: PMC5858720 DOI: 10.1177/0361684317705086] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The high prevalence of gender-based violence (GBV) in armed conflict has been documented in various national contexts, but less is known about the complex pathways that constitute the relation between the two. Employing a community-based collaborative approach, we constructed a community-informed socioecological conceptual model from a feminist perspective, detailing how armed conflict relates to GBV in a conflict-affected rural community in Northeastern Uganda. The research questions were as follows: (1) How does the community conceptualize GBV? and (2) How does armed conflict relate to GBV? Nine focus group discussions divided by gender, age, and profession and six key informant interviews were conducted. Participants' ages ranged from 9 to 80 years (n =34 girls/women, n = 43 boys/men). Grounded theory was used in analysis. Participants conceptualized eight forms of and 22 interactive variables that contributed to GBV. Armed conflict affected physical violence/quarreling, sexual violence, early marriage, and land grabbing via a direct pathway and four indirect pathways initiated through looting of resources, militarization of the community, death of a parent(s) or husband, and sexual violence. The findings suggest that community, organizational, and policy-level interventions, which include attention to intersecting vulnerabilities for exposure to GBV in conflict-affected settings, should be prioritized. While tertiary psychological interventions with women and girls affected by GBV in these areas should not be eliminated, we suggest that policy makers and members of community and organizational efforts make systemic and structural changes. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychology and Philosophy, Texas Woman’s University, Denton, TX, USA
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Sally D. Stabb
- Department of Psychology and Philosophy, Texas Woman’s University, Denton, TX, USA
| | - Debra Mollen
- Department of Psychology and Philosophy, Texas Woman’s University, Denton, TX, USA
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Saxon L, Makhashvili N, Chikovani I, Seguin M, McKee M, Patel V, Bisson J, Roberts B. Coping strategies and mental health outcomes of conflict-affected persons in the Republic of Georgia. Epidemiol Psychiatr Sci 2017; 26:276-286. [PMID: 26804972 PMCID: PMC5419062 DOI: 10.1017/s2045796016000019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/05/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS Adults who experienced the 1992 and 2008 armed conflicts in the Republic of Georgia were exposed to multiple traumatic events and stressors over many years. The aim was to investigate what coping strategies are used by conflict-affected persons in Georgia and their association with mental disorders. METHOD A cross-sectional survey was conducted with 3600 adults, representing internally displaced persons (IDPs) from conflicts in the 1990s (n = 1200) and 2008 (n = 1200) and former IDPs who returned to their homes after the 2008 conflict (n = 1200). Post-traumatic stress disorder, depression, anxiety and coping strategies were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety and adapted version of the Brief Coping Inventory, respectively. Descriptive and multivariate regression analyses were used. RESULTS Coping strategies such as use of humour, emotional support, active coping, acceptance and religion were significantly associated with better mental health outcomes. Coping strategies of behavioural and mental disengagement, denial, venting emotions, substance abuse and gambling were significantly associated with poorer mental health outcomes. The reported use of coping strategies varied significantly between men and women for 8 of the 15 strategies addressed. CONCLUSIONS Many conflict-affected persons in Georgia are still suffering mental health problems years after the conflicts. A number of specific coping strategies appear to be associated with better mental health and should be encouraged and supported where possible.
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Affiliation(s)
- L. Saxon
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - N. Makhashvili
- Global Initiative on Psychiatry, Tbilisi, Georgia
- Ilia State University, Tbilisi, Georgia
| | - I. Chikovani
- Curatio International Foundation, Tbilisi, Georgia
| | - M. Seguin
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - M. McKee
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - V. Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J. Bisson
- Cardiff University School of Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - B. Roberts
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
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Van Hout MC, Hearne E, Wells J. Economic and conflict based rapid mass population movement into Europe: The security and public health implications for future EU drugs policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 38:13-15. [DOI: 10.1016/j.drugpo.2016.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
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Horyniak D, Melo JS, Farrell RM, Ojeda VD, Strathdee SA. Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review. PLoS One 2016; 11:e0159134. [PMID: 27411086 PMCID: PMC4943736 DOI: 10.1371/journal.pone.0159134] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/28/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research. METHODS Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies. RESULTS Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use. CONCLUSION Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
- Centre for Population Health, Burnet Institute, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Jason S. Melo
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Risa M. Farrell
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Victoria D. Ojeda
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
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Ertl V, Saile R, Neuner F, Catani C. Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context. BMC Psychiatry 2016; 16:202. [PMID: 27342048 PMCID: PMC4921056 DOI: 10.1186/s12888-016-0905-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is likely that alcohol use and abuse increase during and after violent conflicts. The most prominent explanation of this phenomenon has been referred to as self-medication hypothesis. It predicts that psychotropic substances are consumed to deal with conflict-related psychic strains and trauma. In northern Uganda, a region that has been affected by a devastating civil war and is characterized by high levels of alcohol abuse we examined the associations between war-trauma, childhood maltreatment and problems related to alcohol use. Deducing from the self-medication hypothesis we assumed alcohol consumption moderates the relationship between trauma-exposure and psychopathology. METHODS A cross-sectional epidemiological survey targeting war-affected families in post-conflict northern Uganda included data of male (n = 304) and female (n = 365) guardians. We used standardized questionnaires in an interview format to collect data on the guardians' socio-demography, trauma-exposure, alcohol consumption and symptoms of alcohol abuse, PTSD and depression. RESULTS Symptoms of current alcohol use disorders were present in 46 % of the male and 1 % of the female respondents. A multiple regression model revealed the unique contributions of emotional abuse in the families of origin and trauma experienced outside the family-context in the prediction of men's alcohol-related symptoms. We found that alcohol consumption moderated the dose-effect relationship between trauma-exposure and symptoms of depression and PTSD. Significant interactions indicated that men who reported more alcohol-related problems experienced less increase in symptoms of PTSD and depression with increasing trauma-exposure. CONCLUSIONS The gradual attenuation of the dose-effect the more alcohol-related problems were reported is consistent with the self-medication hypothesis. Hence, the functionality of alcohol consumption has to be considered when designing and implementing addiction treatment in post-conflict contexts.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. .,vivo international, Konstanz, Germany. .,Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, P.O. Box 100131, 33501, Bielefeld, Germany.
| | - Regina Saile
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
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Seguin M, Roberts B. Coping strategies among conflict-affected adults in low- and middle-income countries: A systematic literature review. Glob Public Health 2015; 12:811-829. [PMID: 26609735 DOI: 10.1080/17441692.2015.1107117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mental health is recognised as a key issue for populations affected by conflict. The aim of this systematic literature review is to examine coping strategies among conflict-affected civilians in low- and middle-income countries. The objectives were to examine (1) the types of coping strategies used by conflict-affected civilians; (2) factors influencing coping strategies; (3) relationships between coping strategies and mental health outcomes. A database search was conducted on May 13, 2014. Qualitative and quantitative studies that report on coping strategies used by adult conflict-affected civilians in LMICs were included, yielding 50 articles. Coping strategies were organised into a typology of problem-solving, support seeking, escape-avoidance, distraction, and positive cognitive restructuring domains. Support-seeking, positive cognitive restructuring, and problem-solving domains were the most frequently reported coping domains across the articles. Significant factors influencing coping included gender and exposure to trauma. The relationship between coping and mental health outcomes was nuanced. The diverse findings reported across the studies reflect the variety of contexts from which the samples are drawn, the range of coping typologies, and differing methodological approaches to exploring coping and mental health. Context-specific studies are needed in order to capture the social and cultural influences on coping and mental health.
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Affiliation(s)
- Maureen Seguin
- a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - Bayard Roberts
- a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , UK
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Roberts B, Ezard N. Why are we not doing more for alcohol use disorder among conflict-affected populations? Addiction 2015; 110:889-90. [PMID: 25756739 DOI: 10.1111/add.12869] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/27/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Bayard Roberts
- ECOHOST-The Centre for Health and Social Change, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
| | - Nadine Ezard
- University of New South Wales, Sydney, Australia.,St Vincent's Hospital, Sydney, Australia
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Comellas RM, Makhashvili N, Chikovani I, Patel V, McKee M, Bisson J, Roberts B. Patterns of somatic distress among conflict-affected persons in the Republic of Georgia. J Psychosom Res 2015; 78:466-471. [PMID: 25676335 PMCID: PMC4390160 DOI: 10.1016/j.jpsychores.2015.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are substantial risk factors for somatic distress (SD) among civilian populations affected by armed conflict in low and middle income countries. However, the evidence is very limited. Our aim was to examine patterns of SD among conflict-affected persons in the Republic of Georgia, which has over 200,000 internally displaced persons (IDPs) from the wars over separatists regions in the 1990s and with Russia in 2008. METHODS A cross-sectional household survey was conducted with 3600 randomly selected IDPs and former IDPs (returnees). SD was measured using the Patient Health Questionnaire (PHQ-15). Post-traumatic stress disorder (PTSD), depression, anxiety, and disability were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and WHO Disability Assessment Schedule 2.0, respectively. Descriptive, tetrachoric and multivariate regression analyses were used. RESULTS Forty-two percent of respondents (29% men; 48% women) were recorded as at risk of SD (PHQ-15 score >5). In tetrachoric analysis, SD scores were highly correlated with depression (r = 0.60; p < 0.001), PTSD (r = 0.54; p < 0.001), and anxiety (r = 0.49; p < 0.001). Factors significantly associated with SD in the multivariate regression analysis were depression, PTSD, anxiety, individual trauma event exposure, cumulative trauma exposure, female gender, older age, bad household economic status, and being a returnee compared to an IDP. SD was also associated with increased levels of functional disability (b = 6.73; p < 0.001). CONCLUSIONS The high levels of SD among IDPs and returnees in Georgia indicate significant suffering. The findings have implications for both mental and physical health services in Georgia.
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Affiliation(s)
- Ruben Moreno Comellas
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nino Makhashvili
- Global Initiative on Psychiatry–Tbilisi, Tbilisi, Georgia,Ilia State University, Tbilisi, Georgia
| | | | - Vikram Patel
- Cardiff University School of Medicine and Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Bisson
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Chikovani I, Makhashvili N, Gotsadze G, Patel V, McKee M, Uchaneishvili M, Rukhadze N, Roberts B. Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study. PLoS One 2015; 10:e0122673. [PMID: 25853246 PMCID: PMC4390285 DOI: 10.1371/journal.pone.0122673] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/24/2015] [Indexed: 11/21/2022] Open
Abstract
Background There is large gap in mental illness treatment globally and potentially especially so in war-affected populations. The study aim was to examine health care utilization patterns for mental, behavioural and emotional problems among the war-affected adult population in the Republic of Georgia. Methods A cross-sectional household survey was conducted among 3600 adults affected by 1990s and 2008 armed conflicts in Georgia. Service use was measured for the last 12 months for any mental, emotional or behavioural problems. TSQ, PHQ-9 and GAD-7 were used to measure current symptoms of PTSD, depression and anxiety. Descriptive and regression analyses were used. Results Respondents were predominantly female (65.0%), 35.8% were unemployed, and 56.0% covered by the government insurance scheme. From the total sample, 30.5% had symptoms of at least one current mental disorder. Among them, 39.0% sought care for mental problems, while 33.1% expressed facing barriers to accessing care and so did not seek care. General practitioners (29%) and neurologists (26%) were consulted by the majority of those with a current mental disorder who accessed services, while use of psychiatric services was far more limited. Pharmacotherapy was the predominant type of care (90%). Female gender (OR 1.50, 95% CI: 1.25, 1.80), middle-age (OR 1.83, 95% CI: 1.48, 2.26) and older-age (OR 1.62, 95% CI: 1.19, 2.21), possession of the state insurance coverage (OR 1.55, 95% CI: 1.30, 1.86), current PTSD symptoms (OR 1.56, 95% CI: 1.29, 1.90) and depression (OR 2.12, 95% CI: 1.70, 2.65) were associated with higher rates of health service utilization, while employed were less likely to use services (OR 0.71, 95% CI: 0.55, 0.89). Conclusions Reducing financial access barriers and increasing awareness and access to local care required to help reduce the burden of mental disorders among conflict-affected persons in Georgia.
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Affiliation(s)
| | - Nino Makhashvili
- Global Initiative on Psychiatry, Tbilisi, Georgia and Ilia State University, Tbilisi, Georgia
| | | | - Vikram Patel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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