• Brief mental health interventions in conflict and emergency settings: an overview of four Medecins Sans Frontieres -- France programs

      Coldiron, M E; Llosa, A E; Roederer, T; Casas, G; Moro, M-R (BioMed Central, 2013-11-01)
      Mental health problems, particularly anxiety and mood disorders, are prevalent in the setting of humanitarian emergencies, both natural and man-made disasters. Evidence regarding best strategies for therapeutic interventions is sparse. Medecins Sans Frontieres has been providing mental health services during emergencies for over two decades, and here we compare data from four programs.Program Overview: In China, 564 patients were followed for an average of 7 sessions after a major earthquake. The most common diagnoses were PTSD and other anxiety disorders. Between program entry and exit, the median global assessment of functioning increased from 65 to 80. At program entry, 58% were considered moderately, markedly or severely ill; a proportion which fell to 14% at program exit. In Colombia in the setting of chronic violence, 2411 patients were followed for a median of two sessions. Anxiety disorders and major depression were the most common diagnoses, and 76% of patients were moderately or severely ill at program entry. 91% had symptomatic improvement at program exit. In Gaza, 1357 patients were followed for a median of 9 sessions; a majority was under age 15. PTSD and other anxiety disorders were the most common diagnoses, and 91% were moderately or severely ill at entry. 89% had improved symptoms at program exit. In the West Bank, the 1478 patients had similar characteristics to those enrolled in Gaza. 88% were moderately or severely ill at entry; 88% had improved at exit.Discussion and evaluation: It was feasible to implement brief yet effective mental health interventions in a wide variety of humanitarian contexts -- post-natural disaster, during acute violent conflict and during chronic violent conflict. The most common diagnoses were PTSD, other anxiety disorders and mood disorders. The use of local specially-trained counselors who were focused on coping skills and improving functionality over a brief time period, likely contributed to the symptomatic improvement seen in a large majority of patients across the four sites.
    • Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes

      Shanks, L; Ariti, C; Siddiqui, R; Pintaldi, G; Venis, S; de Jong, K; Denault, M (BioMed Central, 2013-09-16)
      Medecins Sans Frontieres (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes.
    • The Efficacy of Psychosocial Interventions for Adults in Contexts of Ongoing Man-Made Violence—A Systematic Review

      Jong, K d; Knipscheer, J W; Ford, N; Kleber, R J (Scientific Research Publishing, 2014-03-31)
      Compared to psychosocial programs implemented in post-conflict settings those executed in areas of ongoing conflicts may have different effects. Their evidence of efficacy has never been systematically reviewed. We searched PubMed, PsychInfo and the Dutch Tropical Institute Literature Portal from inception to31 January 2013 to identify studies on community-oriented psychosocial and psychiatric/clinical services for adults during ongoing man-made conflict or its direct aftermath.Of 6358 articles screened, 16 met our inclusion criteria. The interventions varied from psycho-educational to psychotropic drugs. The review is presented using outcome indicators such as PTSD, anxiety, depression, physical health, functioning and well being. A substantial improvement of some outcome was found though the small number of studies and their heterogeneity did not justify strong conclusions. PTSD symptoms improved significantly by treatments that included exposure (such as narrative exposure therapy). A number of studies (eight) showed notable improvement of the client’s functioning through counseling interventions. Depression and anxiety both improved considerably using that culturally adapted interventions (two studies), whereas non-culturalized interventions did not. We found a notable lack of studies on the efficacy of medication and on preferred western, evidence-based interventions for PTSD such Eye Movement Desensitization.To measure outcomes only two studies applied locally-developed diagnostic labels and validated instruments. Future research should encourage the use of robust research methods that are culturally valid, including mixed-methods research to combine measurable outputs with qualitative research aimed at improved understanding from the client’s perspective.
    • Mental health services for children exposed to armed conflict: Médecins Sans Frontières' experience in the Democratic Republic of Congo, Iraq and the occupied Palestinian territory

      Lokuge, K; Shah, T; Pintaldi, G; Thurber, K; Martínez-Viciana, C; Cristobal, M; Palacios, L; Dear, K; Banks, E; The Australian National University, Canberra, ACT, 0200, Australia (W.S. Maney & Son Ltd, 2013)
      Armed conflict has broad-ranging impacts on the mental health and wellbeing of children and adolescents. Mental health needs greatly exceed service provision in conflict settings, particularly for these age groups. The provision and targeting of appropriate services requires better understanding of the characteristics and requirements of children and adolescents exposed to armed conflict.