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Alemi Q, Panter-Brick C, Oriya S, Ahmady M, Alimi AQ, Faiz H, Hakim N, Sami Hashemi SA, Manaly MA, Naseri R, Parwiz K, Sadat SJ, Sharifi MZ, Shinwari Z, Ahmadi SJ, Amin R, Azimi S, Hewad A, Musavi Z, Siddiqi AM, Bragin M, Kashino W, Lavdas M, Miller KE, Missmahl I, Omidian PA, Trani JF, van der Walt SK, Silove D, Ventevogel P. Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions. BJPsych Open 2023; 9:e125. [PMID: 37424447 PMCID: PMC10375890 DOI: 10.1192/bjo.2023.502] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. AIMS We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. METHOD In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. RESULTS Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. CONCLUSIONS We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.
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Affiliation(s)
- Qais Alemi
- School of Behavioral Health, Loma Linda University, California, USA
| | - Catherine Panter-Brick
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, Connecticut, USA
| | | | - Mariam Ahmady
- Department of Counselling, Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan
| | | | - Hafizullah Faiz
- Jalalabad Regional Management Office, Swedish Committee for Afghanistan, Jalalabad, Afghanistan
| | - Nadia Hakim
- Migration Health Unit, International Organization for Migration, Kabul, Afghanistan
| | | | | | - Roman Naseri
- Mental Health and Psychosocial Support Unit, International Medical Corps, Kabul, Afghanistan
| | | | - Sayed Javid Sadat
- Mental Health and Peacebuilding Program, International Assistance Mission, Herat, Afghanistan
| | | | - Zalmai Shinwari
- Mental Health and Psychosocial Support Unit, HealthNet TPO, Kabul, Afghanistan
| | | | - Rohullah Amin
- Faculty of Humanities and Social Sciences, Helmut-Schmidt University, Germany
| | - Sayed Azimi
- Independent Mental Health Specialist, Geneva, Switzerland
| | - Atal Hewad
- Department of Ipso Academy and Quality Management, International Psychosocial Organisation, Konstanz, Germany
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | - Martha Bragin
- Silberman School of Social Work, The City University of New York, New York, USA
| | - Wataru Kashino
- Prevention Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Michalis Lavdas
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | | | - Inge Missmahl
- International Psychosocial Organisation, Konstanz, Germany
| | | | | | - Sarah Kate van der Walt
- Mental Health and Psychosocial Support Unit, Première Urgence – Aide Médicale Internationale, Kabul, Afghanistan
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Shayan NA, Hooshmand AM, Rahimi A, Shayan S, Ozcebe H. Exploring the Relationship between Drug Addiction and Quality of Life in Herat, Afghanistan: A Cross-sectional Study. ADDICTION & HEALTH 2023; 15:112-118. [PMID: 37560395 PMCID: PMC10408765 DOI: 10.34172/ahj.2023.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Addiction is a global public health problem, with over 36 million people suffering from drug-use disorders. Afghanistan, the world's leading opium producer, has high rates of drug use owing to the easy access to drugs in this country. This study aimed to investigate drug users' quality of life in Herat, Afghanistan, and identify the factors affecting it. METHODS This cross-sectional study examined health-related quality of life at six rehabilitation camps in Herat, Afghanistan, from March to July 2019, using the short form-36 questionnaire (SF-36). Data collected through interviews were analyzed using SPSS software (version 25). FINDINGS A total of 240 participants from six rehabilitation camps in Herat, Afghanistan participated in this study. The majority of participants (80%) rated their overall health as "good" or "very good". Men had higher average scores for mental health and vitality than women and those aged 30-39 had the highest quality of life. Statistically significant differences were found in bodily pain (P=0.038), vitality (P=0.042), and social functioning (P=0.046) among users of different types of drugs. Opium abusers had the highest scores for the physical and mental components, followed by heroin, methamphetamine, hashish, and crack abusers. CONCLUSION This study explored the relationship between drug addiction and quality of life in Herat, Afghanistan. The findings showed that young adults were more vulnerable to drug use and male addicts and opium users had the highest quality of life. This study can inform the development of effective rehabilitation programs but more research is needed for addiction treatment strategies.
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Affiliation(s)
- Nasar Ahmad Shayan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Ali Rahimi
- Scientific Research Center, Jami University, Herat, Afghanistan
| | - Sharareh Shayan
- Faculty of Stomatology, Ghalib University, Herat, Afghanistan
| | - Hilal Ozcebe
- Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Davasaz Irani R, Ahmadi R, Norouzi S, Ghazanfari A. Comparing the Effectiveness of Cognitive-Behavioral Therapy and Brief Intervention on Relapse Prevention among Drug Users. ADDICTION & HEALTH 2022; 14:263-267. [PMID: 37559795 PMCID: PMC10408754 DOI: 10.34172/ahj.2022.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/04/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND This study aimed to compare the effectiveness and stability of group cognitive-behavioral therapy (CBT) and brief intervention (BI) for relapse prevention (RP) among drug users of drop-in-centers (DICs) in Ahvaz, Iran. METHODS The present study was a quasi-experimental one with a pretest-posttest design, a follow-up phase, and a control group. The statistical population included all drug users of drop- in-centers of Ahvaz in 2021. The sample of the study included 78 drug users selected randomly and assigned to two experimental groups and one control group (each 26 members). A morphine test (special kits) that detects the presence of morphine in urine was used to check the relapse. Data were analyzed using repeated measures ANOVA with SPSS (version 24). FINDINGS The results showed BI and CBT had a significant effect on reducing RP in drug users (P<0.001). The BI was more effective than CBT for RP. CONCLUSION It can be concluded that both BI and CBT can be effective in reducing the likelihood of relapse among drug users but BI is more effective than CBT for RP.
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Affiliation(s)
- Reza Davasaz Irani
- Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Reza Ahmadi
- Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Shahin Norouzi
- Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
- Department of Psychiatry, Golestan Hospital, Ahvaz Jandishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Ghazanfari
- Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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O’Brien S, Jaramillo MM, Roberts B, Platt L. Determinants of health among people who use illicit drugs in the conflict-affected countries of Afghanistan, Colombia and Myanmar: a systematic review of epidemiological evidence. Confl Health 2022; 16:39. [PMID: 35799203 PMCID: PMC9264525 DOI: 10.1186/s13031-022-00467-9] [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: 11/10/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan, Colombia and Myanmar are the world's leading heroin and cocaine producers and have also experienced prolonged periods of armed conflict. The link between armed conflict and drug markets is well established but how conflict impacts on the health and social determinants of people who use drugs is less clear. The aim was to investigate health outcomes and associated factors among people who use illicit drugs in Afghanistan, Colombia and Myanmar. METHODS We conducted a systematic review searching Medline, EMBASE, PsychINFO and Global Health databases using terms relating to Afghanistan, Colombia and Myanmar; illicit drug use (all modes of drug administration); health and influencing factors. Quality assessment was assessed with the Newcastle-Ottawa-Scale and papers were analysed narratively. RESULTS 35 studies were included in Afghanistan (n = 15), Colombia (n = 9) and Myanmar (n = 11). Health outcomes focused predominantly on HIV, Hepatitis C (HCV), Hepatitis B and sexually transmitted infections (STIs), with one study looking at human rights violations (defined as maltreatment, abuse and gender inequality). Drug use was predominantly injection of heroin, often alongside use of amphetamines (Myanmar), cocaine and cocaine-based derivatives (Colombia). Only one study measured the effect of a period of conflict suggesting this was linked to increased reporting of symptoms of STIs and sharing of needles/syringes among people who inject drugs. Findings show high levels of external and internal migration, alongside low-income and unemployment across the samples. External displacement was linked to injecting drugs and reduced access to needle/syringe programmes in Afghanistan, while initiation into injecting abroad was associated with increased risk of HCV infection. Few studies focused on gender-based differences or recruited women. Living in more impoverished rural areas was associated with increased risk of HIV infection. CONCLUSIONS More research is needed to understand the impact of armed-conflict and drug production on the health of people who use drugs. The immediate scale-up of harm reduction services in these countries is imperative to minimize transmission of HIV/HCV and address harms associated with amphetamine use and other linked health and social care needs that people who use drugs may face.
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Affiliation(s)
- Sally O’Brien
- grid.8991.90000 0004 0425 469XFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Margarita Marin Jaramillo
- grid.10689.360000 0001 0286 3748Observatorio de Restitución Y Regulación de los Derechos de Propiedad Agraria, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bayard Roberts
- grid.8991.90000 0004 0425 469XFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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