• The efficacy of a mental health program in Bosnia-Herzegovina: impact on coping and general health.

      Mooren, T T M; de Jong, K; Kleber, R J; Ruvic, J; De Vonk, Centrum '45, Noordwijkerhout, The Netherlands. T.Mooren@Centrum45.nl (Wiley-Blackwell, 2003-01)
      The efficacy of a community-based psychosocial program in Bosnia-Herzegovina during the war and immediate postwar years (1994-1999) was described in this article. Ten centers provided various kinds of psychological help in the besieged city of Sarajevo and the towns of Zenica, Travnik, and Vitez. Since 1994, an intensive monitoring system has documented data on clients, interventions, and outcomes. This study focused on the systematic evaluation of counseling interventions aimed to alleviate the distress in wartime. The sample consisted of 3,283 and 1,785 inhabitants of Sarajevo, Zenica, Travnik, and Vitez who filled out the GHQ-28 and IES respectively. Pre- and post-assessments were compared throughout consecutive years (1994-1999) and across age groups and both sexes. Outcomes of these scales reflected very high scores, especially among people between 30 and 40 years of age. Furthermore, intake scores increased in time rather than decreased. Differences between pre- and postmeasurements are highly significant--throughout the years. Analyses revealed substantial proportions of clinically recovered or generally improved individual functioning, although some clients revealed no improvement.
    • 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.
    • Emergency conflict-related psychosocial interventions in Sierra Leone and Uganda: lessons from Médecins Sans Frontières

      de Jong, K; Kleber, R J; Médecins Sans Frontières, Amsterdam, The Netherlands. Kaz.de.Jong@amsterdam.msf.org (2007-05)
      Médecins Sans Frontières has been involved in emergency mental health or psychosocial programmes since 1990. In this article the intervention model developed for emergency settings is shared. Psychosocial programmes distinguish two elements. The 'psycho'-component facilitates the reconnection of the affected individual to his environment. The 'socio'-element aims to create an environment that facilitates the individual to re-integrate. The nature of mental health and psychosocial programmes requires a multidisciplinary approach. Emotional support can also be provided by regular medical staff and does not always require a specialist. The years ahead of us are important for the development of psychosocial interventions. Fundamental issues such as programme evaluation need systematic research.
    • Emergency psychiatric care in North Kivu in the Democratic Republic of the Congo

      Goodfriend, M; ter Horst, R; Pintaldi, G; Junker, A; Frielingsdorf, H; Depeyrot, J; Matasci, L; Moroni, C; Musengetsi, A; Shanks, L (Lippincott Williams & Wilkins, 2014-10-15)
    • Evaluating Process and Clinical Outcomes of a Primary Care Mental Health Integration Project in Rural Rwanda: a Prospective Mixed-Methods Protocol

      Smith, SL; Misago, CN; Osrow, RA; Franke, MF; Iyamuremye, JD; Dusabeyezu, JD; Mohand, AA; Anatole, M; Kayiteshonga, Y; Raviola, GJ (BMJ Publishing Group Limited 2013, 2017-02-28)
      Integrating mental healthcare into primary care can reduce the global burden of mental disorders. Yet data on the effective implementation of real-world task-shared mental health programmes are limited. In 2012, the Rwandan Ministry of Health and the international healthcare organisation Partners in Health collaboratively adapted the Mentoring and Enhanced Supervision at Health Centers (MESH) programme, a successful programme of supported supervision based on task-sharing for HIV/AIDS care, to include care of neuropsychiatric disorders within primary care settings (MESH Mental Health). We propose 1 of the first studies in a rural low-income country to assess the implementation and clinical outcomes of a programme integrating neuropsychiatric care into a public primary care system.
    • Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

      Hustache, S; Moro, M R; Roptin, J; Souza, R; Gansou, G M; Mbemba, A; Roederer, T; Grais, RF; Gaboulaud, V; Baubet, T; et al. (2009-04-01)
      ABSTRACT: BACKGROUND: Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. METHODS: Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. RESULTS: The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment). CONCLUSION: We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings.
    • Exposure to violence and PTSD symptoms among Somali women

      de Jong, K; van der Kam, S; Swarthout, T; Ford, N; Mills, C; Yun, O; Kleber, R J; Médecins sans Frontières, Doctors without Borders, Amsterdam, Geneva, New York; Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Department of Clinical and Health Psychology, Utrecht University, and Foundation Arq, Diemen, the Netherlands (Wiley-Blackwell, 2011-12-05)
      Posttraumatic stress disorder (PTSD) symptoms, exposure to traumatic stressors, and health care utilization were examined in 84 women attending a primary health care clinic in Mogadishu, Somalia. The Somalia-Posttraumatic Diagnostic Scale was used in this active warzone to measure symptoms. Nearly all women reported high levels of confrontations with violence; half described being exposed to a potentially traumatizing event. Nearly one third had significant PTSD symptoms. Compared to those who did not, women who reported exposure to a traumatic stressor reported more confrontations with violence (7.1 vs. 3.3; p < . 001), health complaints (3.8 vs. 2.9; p = .03), and nearly 3 times as much (p = .03) health service utilization. A potentially traumatizing event was found to be a simplified proxy for assessing mental health distress in women attending a primary health care facility in highly insecure, unpredictable, resource-limited settings.
    • Health Services for Gender-Based Violence: Médecins Sans Frontières Experience Caring for Survivors in Urban Papua New Guinea

      Lokuge, K; Verputten, M; Ajakali, M; Tolboom, B; Joshy, G; Thurber, K A; Plana, D; Howes, S; Wakon, A; Banks, E (Public Library of Science, 2016-06-10)
      Levels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings.
    • HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide.

      Das, M; Isaakidis, P; Van den Bergh, R; Kumar, A M V; Nagaraja, S B; Valikayath, A; Jha, S; Jadhav, B; Ladomirska, J (Co-Action Publishing, 2014-09-09)
      Background: Management of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases. Objective: To address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9) tool, among HIV-infected patients. Design: This was a retrospective review of the medical records of an adult (aged >15 years) HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014. Results: A total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16%) were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up. Conclusion: Psychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB treatment, and help in improving overall treatment outcomes. We recommend regular monitoring of mental health status by trained counsellors or clinical staff, using simple, validated and cost-effective tools.
    • "I feel like I am less than other people": Health-related vulnerabilities of male migrants travelling alone on their journey to Europe

      Arsenijević, J; Burtscher, D; Ponthieu, A; Severy, N; Contenta, A; Moissaing, S; Argenziano, S; Zamatto, F; Zachariah, R; Ali, E; et al. (Elsevier, 2018-05-23)
      During 2015 and 2016, an unprecedented flow of approximately 800,000 migrants coming from Turkey towards Western Europe crossed the Balkans. Male migrants are perceived as being less vulnerable compared to other migrants and they are not given priority in service and support provision. This qualitative study examines the self-perceived vulnerabilities of male migrants travelling alone along the Balkan route to Europe. Twenty-four individual in-depth interviews, two group interviews and participant observation were conducted with male migrants in Belgrade, Serbia in 2017. Data was coded manually, and analysed thematically. Male migrants traveling alone face the cumulative vulnerability of various traumatic events and migration-related contextual circumstances. Three main themes emerged: the ongoing desperate journey, the better treatment of 'traditionally' well recognised vulnerable sub-groups and the impact of the continuous stress on mental health. Deterrence measures imposed for border control purposes in the form of push-backs, expulsions, detention and degrading, inhumane treatment amplify the psychological distress of male migrants. Feelings of hopelessness, desperation, lack of self-value and self-esteem were reported. 'Traditionally vulnerable' populations were said to have had better treatment throughout the journey from smugglers, border state authorities, governmental officials, civil society and international organizations. The devastating experiences of male migrants, as well as the better treatment offered to other groups of migrants like women and children, results in a perceived neglect of the needs of men in humanitarian response, rendering them vulnerable and exposing them to further health and protection risks. In a context where needs are unmet and people's dignity and health are at risk, specific strategies should be developed to include men in the assistance and protection offered, particularly in relation to exposure to violence.
    • "I prefer dying fast than dying slowly", how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese migrants on Lesbos island following the implementation of EU-Turkey deal

      Eleftherakos, C; van den Boogaard, W; Barry, D; Severy, N; Kotsioni, I; Roland-Gosselin, L (BioMed Central, 2018-09-05)
      Background In 2015 and early 2016, close to 1 million migrants transited through Greece, on their way to Western Europe. In early 2016, the closure of the “Balkan-route” and the EU/Turkey-deal led to a drastic reduction in the flow of migrants arriving to the Greek islands. The islands became open detention centers, where people would spend months or years under the constant fear of being returned to Turkey. Syrians were generally granted refugee status in Greece and those arrived before the 20th of March 2016 had the option of being relocated to other European countries. Afghans had some chances of being granted asylum in Greece, whilst most migrants from the Democratic Republic of Congo were refused asylum. In a clinic run by Médecins sans Frontières on Lesbos Island, psychologists observed a deterioration of the migrant’s mental health (MH) since March 2016. In order to understand the MH needs for this stranded population it was essential to explore how, and by what factors, their mental health (MH) has been affected on Lesbos Island due to the EU/Turkey-deal. Methods This was a qualitative study in which eight service providers’ interviews and 12 focus group discussions with male and female Syrian, Afghan and Congolese migrants in two refugee camps on Lesbos Island. Thematic-content analysis was manually applied and triangulation of findings was undertaken to enhance the interpretation of data. Results Three main themes were generated: 1) Institutional abuse, 2) Continuous traumatic stress (CTS) and 3) MH service provision. Institutional abuse was expressed by inhumane living conditions, lack of information in order to make future decisions, humiliation and depersonalization. This led to CTS that was expressed through being in a state of permanent emergency under lack of protective measures. Delays in appointments, lack of psychiatric care and differences in MH perceptions amongst migrants highlighted the provision of MH services. Conclusion The EU/Turkey-deal reduced migrant flows at a very high price. Decongestion of the camps and the elimination of institutional abuse is urgently needed to reduce CTS and improve migrants’ MH.
    • Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines

      Mueller, Y; Cristofani, S; Rodriguez, C; Malaguiok, R; Gil, T; Grais, RF; Souza, R; Epicentre, Paris, France; Médecins Sans Frontières, Geneva, Switzerland; Médecins Sans Frontières, Mindanao, Philippines (2011-03-07)
      ABSTRACT:
    • "Losing the tombola": a case study describing the use of community consultation in designing the study protocol for a randomised controlled trial of a mental health intervention in two conflict-affected regions

      Shanks, L; Moroni, C; Rivera, I C; Price, D; Clementine, S B; Pintaldi, G (BioMed Central, 2015-06-02)
      Community consultation is increasingly recommended, and in some cases, required by ethical review boards for research that involves higher levels of ethical risk such as international research and research with vulnerable populations. In designing a randomised control trial of a mental health intervention using a wait list control, we consulted the community where the research would be undertaken prior to finalising the study protocol. The study sites were two conflict-affected locations: Grozny in the Chechen Republic and Kitchanga in eastern Democratic Republic of Congo.
    • Maternal Perception of Emotional Difficulties of Preschool Children in Rural Niger

      Marquer, C; Grais, RFF; Moro, MR (SAGE Publications We regret that this article is behind a paywall., 2016-05-31)
      Mental health care for infants and young children is often greatly limited in low-resource settings. The purpose of this study was to describe maternal perception of emotional difficulties of preschool children in a rural area of Niger (Maradi). In this context, both mental health awareness and services were scarce. This research was part of a larger cross-cultural validation study of a screening tool for psychological difficulties in children aged 3 to 6 years old. Data collection included group discussion and individual interviews. A total of 10 group interviews and 83 individual interviews were conducted. The results highlight mothers' perceptions concerning their children's psychological difficulties. Sleep difficulties were considered significant by the mothers and were used often as an entry point for further discussion of concerns. Peer and sibling relationships, separation anxiety, and reactions to difficult events were also described. Identification of mothers' perceptions of children's main difficulties through a mixed-method approach shows promise as a way to inform interventions to provide culturally appropriate care for children in need.
    • Medecins Sans Frontieres: mental health in post-tsunami Ache Province, a field report

      de Gryse, B; Laumont, B (2007)
      This article describes a mental health program in Ache Province, a conflict area in Indonesia. The intervention aimed to normalize community life, through activities such as construction of a volleyball field and the organization of a tournament, as well as organizing talking groups to reinforce solidarity and mutual support. On an individual level, offering counselling services supported normalization. The beneficiaries appreciated the communities based group activities the most. As for individual psychological support, counselling proved to be an unknown approach for the majority of the population, and therefore did not always meet their expectations of a fast, practical resolution of their problems.
    • Mental disorders, disability and treatment gap in a protracted refugee setting

      Llosa, A E; Ghantous, Z; Souza, R; Forgione, F; Bastin, P; Jones, A; Antierens, A; Slavuckij, A; Grais, RF; Augusto E. Llosa, PhD, Epicentre, Paris, France; Zeina Ghantous, MPH, Médecins Sans Frontières, Geneva, Switzerland; Renato Souza, MD, Médecins Sans Frontières, Geneva, Switzerland, and Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Fabio Forgione, MSc, Pierre Bastin, MD, Alison Jones, MSc, Annick Antierens, MD, Andrei Slavuckij, MD, Médecins Sans Frontières, Geneva, Switzerland; Rebecca. F. Grais, PhD, Epicentre, Paris, France. (2013-09-12)
      Studies have shown high levels of distress and mental disorder among people living in refugee camps, yet none has confirmed diagnosis through clinical reappraisal.
    • Mental health and deprivation of liberty: experience report as a psychiatrist in a refugee detention center

      Schmid, PC (Centro Brasileiro de Estudos de Saúde, 2019-08-05)
      The experience report refers to the author’s work, for six months, as a psychiatrist for Médecins Sans Frontières (Doctors Without Borders - MSF) in a refugee detention center in Nauru, an island country in Oceania. The report provides descriptions of the field work and theoretical reflections. The author discusses the issue of suicide and the specificity of such issue for the group of refugees and asylum seekers attended, as well as the discovery of a new clinical diagnosis called resignation syndrome. It’s also sought to reflect on the role of mental health professionals in dealing with deprivation of liberty and discusses ethical challenges experienced in the field, regarding Australia’s refugee policy, its economic importance to Nauru and the impact on the refugee population; obstacles encountered until MSF team was expelled by the local government on October 5th, 2018.
    • Mental Health and Trauma in Asylum Seekers Landing in Sicily in 2015: A Descriptive Study of Neglected Invisible Wounds

      Crepet, A; Rita, F; Reid, A; Van den Boogaard, W; Deiana, P; Quaranta, G; Barbieri, A; Bongiorno, F; Di Carlo, S (BioMed Central, 2017-01-13)
      In 2015, Italy was the second most common point of entry for asylum seekers into Europe after Greece. The vast majority embarked from war-torn Libya; 80,000 people claimed asylum that year. Their medical conditions were assessed on arrival but their mental health needs were not addressed in any way, despite the likelihood of serious trauma before and during migration. Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014-15.
    • Mental health care for refugees from Kosovo: the experience of Médecins Sans Frontières.

      de Jong, K; Ford, N; Kleber, R; Médecins Sans Frontières, Amsterdam, The Netherlands. (Elsevier, 1999-05-08)