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van der Boor CF, Taban D, Ismail K, Simon J, Roberts B, Fuhr D, Tol WA, Greco G. Measuring refugees' capabilities: translation, adaptation, and valuation of the OxCAP-MH into Juba Arabic for use among South Sudanese male refugees in Uganda. J Patient Rep Outcomes 2024; 8:40. [PMID: 38564035 PMCID: PMC10987405 DOI: 10.1186/s41687-024-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Forcibly displaced populations are highly vulnerable to psychosocial distress and mental disorders, including alcohol misuse. In an ongoing trial that seeks to develop a transdiagnostic intervention addressing psychological distress and alcohol use disorders among conflict-affected populations, we will carry out a cost-effectiveness evaluation using a capability-based Oxford Capabilities Mental Health (OxCAP-MH) measure. The OxCAP-MH is a 16-item questionnaire developed from the Capability Approach, that covers multiple domains of functioning and welfare. The aim of the current paper is to present the results of the translation, cultural adaptation and valuation of the OxCAP-MH into Juba Arabic for South Sudanese refugees living in Uganda. We adhered to the official Translation and Linguistic Validation process of the OxCAP-MH. To carry out the translation, the Concept Elaboration document, official English version of the OxCAP-MH, and the Back-Translation Review Template were used. Four independent translators were used for forward and back translations. The reconciled translated version was then piloted in two focus group discussions (N = 16) in Rhino refugee settlement. A most important to least important valuation of the sixteen capability domains covered in the OxCAP-MH was also done. RESULTS The Juba Arabic version of the OxCAP-MH was finalized following a systematic iterative process. The content of the Juba Arabic version remained unchanged, but key concepts were adapted to ensure cultural acceptability, feasibility, and comprehension of the measure in the local context of Rhino refugee settlement. Most participants had low levels of literacy and required support with filling in the tool. Participants suggested an additional capability that is currently not reflected in the OxCAP-MH, namely access to food. Furthermore, discussions around the valuation exercise of the sixteen domains led to two separate importance scales, which showed relevant differences. CONCLUSIONS In this context, the OxCAP-MH was considered culturally acceptable. The valuation exercise proved cognitively demanding. Participants voiced confusion over how to answer the questions on the OxCAP-MH instrument due to low levels of literacy. These concerns invite consideration for future research to consider how measures such as the OxCAP-MH can be made more accessible to individuals with low literacy rates in resource poor settings.
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Affiliation(s)
- C F van der Boor
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - D Taban
- HealthRight International, Plot 855, Mawanda Road -Kamwokya, Kampala, Uganda
| | - K Ismail
- HealthRight International, Plot 855, Mawanda Road -Kamwokya, Kampala, Uganda
| | - J Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - B Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - D Fuhr
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Achterstraße, 30D-28359, Bremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
| | - W A Tol
- Department of Public Health, University of Copenhagen, Bartholinsgade 4, bg. 9, 1356 København K, CSS, bg. 9, Building: 9.2.16, Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Greco
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Miller KE, Jordans MJD, Tol WA, Galappatti A. A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings. Epidemiol Psychiatr Sci 2021; 30:e5. [PMID: 33413736 PMCID: PMC8057504 DOI: 10.1017/s2045796020001110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. METHODS We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. RESULTS Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. CONCLUSIONS Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
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Affiliation(s)
| | - M. J. D. Jordans
- War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - W. A. Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Tol WA, Murray SM, Lund C, Bolton P, Murray LK, Davies T, Haushofer J, Orkin K, Witte M, Salama L, Patel V, Thornicroft G, Bass JK. Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review. BMC Womens Health 2019; 19:34. [PMID: 30764813 PMCID: PMC6376658 DOI: 10.1186/s12905-019-0728-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/25/2019] [Indexed: 01/21/2023]
Abstract
Background Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC). Methods We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated. Results We identified seven studies reported in 11 papers conducted in five middle-income countries. With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers. The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions. Conclusions Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention. Electronic supplementary material The online version of this article (10.1186/s12905-019-0728-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- W A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH795, Baltimore, MD, 21205, USA. .,Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, USA.
| | - S M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH795, Baltimore, MD, 21205, USA
| | - C Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH795, Baltimore, MD, 21205, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - L K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH795, Baltimore, MD, 21205, USA
| | - T Davies
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Haushofer
- Department of Psychology and Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA.,National Bureau of Economic Research, Cambridge, MA, USA.,Busara Center for Behavioral Economics, Nairobi, Kenya
| | - K Orkin
- Blavatnik School of Government and Centre for the Study of African Economies, University of Oxford, Oxford, UK.,Merton College, University of Oxford, Oxford, UK
| | - M Witte
- Department of Economics and Centre for the Study of African Economies, University of Oxford, Oxford, UK
| | - L Salama
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH795, Baltimore, MD, 21205, USA
| | - V Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Global Health and Population, Harvard Chan School of Public Health, Boston, USA
| | - G Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, HH795, Baltimore, MD, 21205, USA
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Brown FL, Carswell K, Augustinavicius J, Adaku A, Leku MR, White RG, Ventevogel P, Kogan CS, García-Moreno C, Bryant RA, Musci RJ, van Ommeren M, Tol WA. Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda. Glob Ment Health (Camb) 2018; 5:e27. [PMID: 30128163 PMCID: PMC6094406 DOI: 10.1017/gmh.2018.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/20/2018] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women. METHODS A two-arm, single-blind cluster-randomised controlled trial will be conducted in 14 villages in Rhino Camp refugee settlement, with at least 588 women experiencing psychological distress. Villages will be randomly assigned to receive either SH+ with enhanced usual care (EUC), or EUC alone. SH+ is a five-session guided self-help intervention delivered in workshops with audio-recorded materials and accompanying pictorial guide. The primary outcome is reduction in overall psychological distress over time, with 3 months post-treatment as the primary end-point. Secondary outcomes are self-defined psychosocial concerns, depression and post-traumatic stress disorder symptoms, hazardous alcohol use, feelings of anger, interethnic relations, psychological flexibility, functional impairment and subjective wellbeing. Psychological flexibility is a hypothesised mediator, and past trauma history and intervention attendance will be explored as potential moderators. DISCUSSION This trial will provide important information on the effectiveness of a scalable, guided self-help intervention for improving psychological health and wellbeing among people affected by adversity. TRIAL REGISTRATION ISRCTN50148022; registered 13/03/2017.
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Affiliation(s)
- F. L. Brown
- War Child Holland, Amsterdam, The Netherlands
- Department of Global Health and Population, Research Program for Children and Global Adversity, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - K. Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - J. Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Adaku
- HealthRight International, New York, NY
- Arua Regional Referral Hospital, Arua, Uganda
| | | | - R. G. White
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - P. Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - C. S. Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - C. García-Moreno
- Department of Reproductive Health & Research, World Health Organization, Geneva, Switzerland
| | - R. A. Bryant
- University of New South Wales, Sydney, Australia
| | - R. J. Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M. van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - W. A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- HealthRight International, New York, NY
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Tol WA, Rees SJ, Tay AK, Tam N, da Costa Saldanha Segurado A, da Costa ZM, da Costa Soares ES, da Costa Alves A, Martins N, Silove DM. Cohort Profile: Maternal mental health and child development in situations of past violent conflict and ongoing adversity: the DILI birth cohort study. Int J Epidemiol 2018; 47:17-17h. [PMID: 29471471 DOI: 10.1093/ije/dyw130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- W A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S J Rees
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia
| | - A K Tay
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia
| | - N Tam
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia.,Alola Foundation, Dili, Timor-Leste
| | | | - Z M da Costa
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia.,Alola Foundation, Dili, Timor-Leste
| | - E S da Costa Soares
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia.,Alola Foundation, Dili, Timor-Leste
| | - A da Costa Alves
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia.,Alola Foundation, Dili, Timor-Leste
| | - N Martins
- Faculty of Medicine & Health Science, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste
| | - D M Silove
- Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia
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Silove DM, Tay AK, Tol WA, Tam N, Dos Reis N, da Costa Z, Soares C, Rees S. Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence. J Affect Disord 2016; 205:292-300. [PMID: 27552593 DOI: 10.1016/j.jad.2016.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 06/19/2016] [Accepted: 07/09/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors. METHODS In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors. RESULTS LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors. LIMITATIONS The study is cross-sectional, cautioning against inferring causal inferences. CONCLUSIONS The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy.
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Affiliation(s)
- D M Silove
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | - A K Tay
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | - W A Tol
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - N Tam
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | | | | | - C Soares
- Alola Women's Foundation, Timor-Leste
| | - S Rees
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia.
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Tol WA, Purgato M, Bass JK, Galappatti A, Eaton W. Mental health and psychosocial support in humanitarian settings: a public mental health perspective. Epidemiol Psychiatr Sci 2015; 24:484-94. [PMID: 26399635 PMCID: PMC8367376 DOI: 10.1017/s2045796015000827] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/27/2015] [Indexed: 11/07/2022] Open
Abstract
AIMS To discuss the potential usefulness of a public health approach for 'mental health and psychosocial support' (MHPSS) interventions in humanitarian settings. METHODS Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries. RESULTS A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between 'mental health' and 'psychosocial' practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology. CONCLUSIONS The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.
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Affiliation(s)
- W. A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Peter C. Alderman Foundation, Bedford, NY, USA and Kampala, Uganda
| | - M. Purgato
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - J. K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Galappatti
- Good Practice Group, Colombo, Sri Lanka and Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - W. Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
This paper focuses on the question of whether separate attention to children who have faced specific conflict-related events is justified, or whether the scarce resources for mental health should be spent on the development of services for children more broadly in low- and middle-income countries (where most contemporary armed conflicts are taking place). It is argued that a systems approach to mental health and psychosocial support for children is warranted.
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Affiliation(s)
- M J D Jordans
- Senior Lecturer, Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK, email
| | - W A Tol
- Dr Ali & Rose Kawi Assistant Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Jordans MJD, Tol WA, Ndayisaba A, Komproe IH. A controlled evaluation of a brief parenting psychoeducation intervention in Burundi. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1851-9. [PMID: 23224723 DOI: 10.1007/s00127-012-0630-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/19/2012] [Indexed: 01/27/2023]
Abstract
PURPOSE Conduct problems and emotional distress have been identified as key problems among children and adolescents in post-war Burundi. This pilot study aims to evaluate the impact of a brief parenting psychoeducation intervention on children's mental health. METHODS This study employs a controlled pre and post evaluation design. The two-session psychoeducation intervention was offered to groups of parents of children (mean age 12.3 years, 60.8 % female) who had been screened for elevated psychosocial distress. Children in the intervention group (n = 58) were compared to a waitlist control group (n = 62). Outcome indicators included child-reported levels of aggression (using the Aggression Questionnaire), depression symptoms (using the Depression Self Rating Scale) and perceived family social support. RESULTS The intervention had a beneficial effect on reducing conduct problems compared to the control condition (Cohen d = 0.60), especially among boys, while not showing impact on depression symptoms or family social support. Parents evaluated the intervention positively, with increased awareness of positive parenting strategies and appropriate disciplinary techniques reported as the most common learning points. CONCLUSION A brief parenting psychoeducation intervention conducted by lay community counselors is a promising public health strategy in dealing with widespread conduct problems in boys living in violence-affected settings and not so for social and emotional indicators and for girls. An efficacy study is warranted to confirm these preliminary findings.
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Affiliation(s)
- M J D Jordans
- Research and Development Department, HealthNet TPO, LizzyAnsinghstraat 163, 1072 RG, Amsterdam, The Netherlands,
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Jordans MJD, Komproe IH, Tol WA, De Jong JTVM. Screening for psychosocial distress amongst war-affected children: cross-cultural construct validity of the CPDS. J Child Psychol Psychiatry 2009; 50:514-23. [PMID: 19236527 DOI: 10.1111/j.1469-7610.2008.02028.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large-scale psychosocial interventions in complex emergencies call for a screening procedure to identify individuals at risk. To date there are no screening instruments that are developed within low- and middle-income countries and validated for that purpose. The present study assesses the cross-cultural validity of the brief, multi-informant and multi-indicator Child Psychosocial Distress Screener (CPDS). METHODS The CPDS data of total samples in targeted catchment areas of a psychosocial care program in four conflict-affected countries (Burundi n = 4193; Sri Lanka n = 2573; Indonesia n = 1624; Sudan n = 1629) were studied to examine the cross-cultural construct validity of the CPDS across settings. First, confirmatory factor analyses were done to determine the likelihood of pre-determined theory-based factor structures in each country sample. Second, multi-sample confirmatory factor analyses were done within each country sample to test measurement equivalence of the factor structure as a measure of construct validity. RESULTS A 3-factor structure reflecting the theoretical premises of the instrument (e.g., child distress, child resilience and contextual factors) was found in the samples from Burundi, Sri Lanka and Indonesia, albeit with context specific deviations. The robustness of the 3-factor structure as an indicator of construct validity was confirmed within these three samples by means of multi-sample confirmatory factor-analyses. A 3-factor structure was not found in the Sudan sample. CONCLUSIONS This study demonstrates the comparability of the assessment by the CPDS of the construct 'non-specific psychosocial distress' across three out of four countries. Robustness of the factor structure of the CPDS within different samples refers to the construct validity of the instrument. However, owing to context-specific deviations of inter-item relationships, the CPDS scores cannot be compared cross-culturally, a finding that confirms the need for attention to contextual factors when screening for non-specific psychosocial distress.
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Affiliation(s)
- M J D Jordans
- HealthNet TPO, Public Health & Research Department, Amsterdam, The Netherlands.
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