scholarly journals Brief materials and programmes for children and families who have experienced conflict and displacement

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Calam ◽  
A El-Khani

Abstract This presentation will provide an overview of a set of materials and programmes designed for families who are living through or have escaped conflict and displacement. Delivery formats include i) brief leaflets giving parenting advice for caregivers; ii) a more extensive booklet and format for a Conversation Group, and iii) a programme designed to address post-traumatic stress in children, Teaching Recovery Techniques (TRT), to which a caregiver and parenting skills module was added, to form TRT+Parenting. Each intervention has been tested or trialled with families living in challenged contexts. The leaflet was distributed to 3000 families via bakeries in conflict zones in Syria. The Conversation Group was trialled for feasibility in Palestine. TRT+Parenting was piloted with Syrian families living on the Turkey-Syria border, and then trialled with 120 families in Lebanon, with teachers and social care workers trained as facilitators. In Syria, 59.5% of 3000 parents returned questionnaires and reported satisfaction with the leaflet despite the study being conducted in a conflict zone and in the context of humanitarian intervention. The Conversation Group proved feasible and acceptable, and caregivers in Palestine gave positive feedback. Children and caregivers showed significant improvements across measures of trauma and mental health, with higher levels of improvement seen in the TRT+Parenting group compared to TRT alone or waitlist. Caregivers who took part in the Plus Parenting component also reported improvement in their own mental health. The results demonstrated valuable improvements across all interventions, and indicate that brief programs can and should be widely used as components of preventive strategies.

2021 ◽  
pp. 070674372110252
Author(s):  
Marie-Michèle Dufour ◽  
Nicolas Bergeron ◽  
Axelle Rabasa ◽  
Stéphane Guay ◽  
Steve Geoffrion

Objectives: Health-care workers (HCW) exposed to COVID-19 are at risk of experiencing psychological distress. Although several cross-sectional studies have been carried out, a longitudinal perspective is needed to better understand the evolution of psychological distress indicators within this population. The objectives of this study were to assess the evolution of psychological distress and to identify psychological distress trajectories of Canadian HCW during and after the first wave of COVID-19. Method: This prospective cohort study was conducted from May 8 to September 4, 2020, and includes a volunteer sample of 373 HCW. Symptoms of post-traumatic disorder, anxiety, and depression were assessed using the Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders fifth edition (PCL-5), the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9. Descriptive statistics were used to illustrate the evolution of psychological distress indicators, whereas latent class analysis was carried out to identify trajectories. Results: During and after the first wave of COVID-19, the rates of clinical mental health symptoms among our sample varied between 6.2% and 22.2% for post-traumatic stress, 10.1% and 29.9% for depression, and 7.3% and 26.9% for anxiety. Finally, 4 trajectories were identified: recovered (18.77%), resilient (65.95%), subchronic (7.24%), and delayed (8.04%). Conclusion: The longitudinal nature of our study and the scarcity of our data are unique among existing studies on psychological distress of HCW in COVID-19 context and allow us to contextualize prior transversal data on the topic. Although our data illustrated an optimistic picture in showing that the majority of HCW follow a resilience trajectory, it is still important to focus our attention on those who present psychological distress. Implementing preventive mental health interventions in our health-care institutions that may prevent chronic distress is imperative. Further studies need to be done to identify predictors that may help to characterize these trajectories.


2021 ◽  
pp. 175114372098318
Author(s):  
Natasha Dykes ◽  
Oliver Johnson ◽  
Peter Bamford

Background COVID-19 has presented a unique set of psychological stressors for healthcare professionals. There is currently a dearth of literature establishing the impact amongst intensive care workers, who may be at the greatest risk. This study aimed to establish the prevalence of anxiety, depression and post-traumatic stress disorder amongst a cohort of intensive care workers within the United Kingdom. Methods A questionnaire was designed to incorporate validated screening tools for depression (Patient Health Questionnaire, PHQ-9) anxiety (Generalised Anxiety Disorder Scale, GAD-7), and post-traumatic stress disorder (Impact of Event Scale–Revised, IES-R). All intensive care workers at the Countess of Chester Hospital (UK) were eligible. Data was collected between 17th June and 8th July 2020. Results The majority of the 131 respondents were nurses (52.7% [69/131]) or doctors (32.8% [43/141]). Almost one-third (29.8% [39/131]) reported a significant or extreme impact of COVID-19 on their mental health. In total, 16%(21/131) had symptoms of moderate depression, 11.5%(15/131) moderately severe depression and 6.1%(8/131) severe depression. Females had significantly higher mean PHQ-9 scores than males (8.8 and 5.7 respectively, p = 0.009). Furthermore, 18.3% (24/131) had moderate anxiety with 14.5% (19/131) having severe anxiety. Mean GAD-7 scores were higher amongst females than males (8.7 and 6.3 respectively, p = 0.028). Additionally, 28.2% (37/131) reported symptoms consistent with a diagnosis of PTSD (IES-R ≥ 33). Despite these findings, only 3.1% (4/131) of staff accessed trust mental health support. Conclusion The impact of COVID-19 on intensive care workers is significant and warrants specific focus and attention in order to preserve this key sector of the workforce.


2021 ◽  
Vol 12 ◽  
Author(s):  
Ali Sahebi ◽  
Atefeh Yousefi ◽  
Kamel Abdi ◽  
Yousef Jamshidbeigi ◽  
Siamak Moayedi ◽  
...  

Introduction: Frontline health care workers (HCWs) have had an increased risk of developing health problems during the COVID-19 pandemic. In addition to physical illness, they have experienced mental health challenges, including post-traumatic stress disorder (PTSD). The aim of this study is to investigate the prevalence of PTSD among HCWs during the COVID-19 pandemic via an umbrella review and meta-analysis.Methods: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to perform a systematic literature search using various medical databases (Web of science, PubMed, Scopus, Cochrane, ProQuest, Science Direct, Embase, and Google scholar). The search included all articles published through the first of January 2020 the end of March 2021. The systematic review and meta-analysis studies that reported the prevalence of PTSD among health care workers were included in the study, and studies that reported the prevalence of PTSD in normal people or other epidemics were excluded. The random effects model was used to perform a meta-analysis, and the I2 index was used to evaluate heterogeneity among studies. Publication bias was assessed using the Egger test. Data was analyzed using STATA (version 14) software.Results: The initial literature search yielded 145 studies. After excluding duplicates and assessing the quality of the studies, 7 studies were selected for meta-analysis. The results showed that the overall prevalence of PTSD among HCWs during the COVID-19 pandemic was 13.52% (95% CI: 9.06–17.98, I2 = 65.5%, p = 0.008).Conclusion: There is a high prevalence of PTSD among frontline HCWs during the COVID-19 pandemic. It is important to invest in efforts to screen HCWs for mental health disorders such as PTSD and provide them with mental health support.


2021 ◽  
Vol 12 ◽  
Author(s):  
Igor Portoghese ◽  
Maura Galletta ◽  
Federico Meloni ◽  
Ilenia Piras ◽  
Gabriele Finco ◽  
...  

Introduction: The COVID-19 pandemic is asking health care workers (HCWs) to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements (ERs) arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms.Purpose: The aim of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19.Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs (physicians and nurses) participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model.Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant.Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher.


2021 ◽  
pp. 000486742098141
Author(s):  
Jessica C Bird ◽  
Emma C Fergusson ◽  
Miriam Kirkham ◽  
Christina Shearn ◽  
Ashley-Louise Teale ◽  
...  

Objective: Paranoia may be particularly prevalent during adolescence, building on the heightened social vulnerabilities at this age. Excessive mistrust may be corrosive for adolescent social relationships, especially in the context of mental health disorders. We set out to examine the prevalence, symptom associations, and persistence of paranoia in a cohort of young people attending child and adolescent mental health services. Method: A total of 301 patients (11–17 years old) completed measures of paranoia, affect, peer difficulties and behavioural problems. Clinicians also rated each participant’s psychiatric symptoms. Patterns of association were examined using linear regressions and network analyses. In total, 105 patients repeated the measures several months later. Results: Most of the adolescents had affective disorders ( n = 195), self-harm/suicidality ( n = 82), or neurodevelopmental conditions ( n = 125). Few had suspected psychosis ( n = 7). Rates of paranoia were approximately double compared with previous reports from the general population. In this patient sample, 35% had at least elevated paranoia, 15% had at least moderate paranoia, and 6% had high paranoia. Paranoia had moderate associations with clinician-rated peer difficulties, self-harm, and trauma, and small associations with clinician-rated social anxiety, depression, generalised anxiety, and educational problems. Network analyses showed paranoia had the strongest unique relationship with peer difficulties. Paths from peer difficulties to anxiety, self-harm, post-traumatic stress disorder symptoms, and behavioural problems were all via paranoia. Both self-harm and post-traumatic stress disorder were solely associated with paranoia in the network. Paranoia remained persistent for three-quarters and was associated with greater psychological problems over time. Conclusion: Paranoia is relatively common and persistent across a range of clinical presentations in youth. When paranoia occurs alongside emotional problems, important peer interactions may be adversely affected. Wider consideration of paranoia in adolescent patients is needed.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
T. Dolev ◽  
S. Zubedat ◽  
Z. Brand ◽  
B. Bloch ◽  
E. Mader ◽  
...  

AbstractLack of established knowledge and treatment strategies, and change in work environment, may altogether critically affect the mental health and functioning of physicians treating COVID-19 patients. Thus, we examined whether treating COVID-19 patients affect the physicians’ mental health differently compared with physicians treating non-COVID-19 patients. In this cohort study, an association was blindly computed between physiologically measured anxiety and attention vigilance (collected from 1 May 2014 to 31 May 31 2016) and self-reports of anxiety, mental health aspects, and sleep quality (collected from 20 April to 30 June 2020, and analyzed from 1 July to 1 September 2020), of 91 physicians treating COVID-19 or non-COVID-19 patients. As a priori hypothesized, physicians treating COVID-19 patients showed a relative elevation in both physiological measures of anxiety (95% CI: 2317.69–2453.44 versus 1982.32–2068.46; P < 0.001) and attention vigilance (95% CI: 29.85–34.97 versus 22.84–26.61; P < 0.001), compared with their colleagues treating non-COVID-19 patients. At least 3 months into the pandemic, physicians treating COVID-19 patients reported high anxiety and low quality of sleep. Machine learning showed clustering to the COVID-19 and non-COVID-19 subgroups with a high correlation mainly between physiological and self-reported anxiety, and between physiologically measured anxiety and sleep duration. To conclude, the pattern of attention vigilance, heightened anxiety, and reduced sleep quality findings point the need for mental intervention aimed at those physicians susceptible to develop post-traumatic stress symptoms, owing to the consequences of fighting at the forefront of the COVID-19 pandemic.


2020 ◽  
pp. bmjmilitary-2020-001622 ◽  
Author(s):  
Dominic Murphy ◽  
C Williamson ◽  
J Baumann ◽  
W Busuttil ◽  
N T Fear

IntroductionData are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic.MethodsData were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions—Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity.ResultsIt was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties.ConclusionsOur findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.


Author(s):  
Anna Renner ◽  
David Jäckle ◽  
Michaela Nagl ◽  
Anna Plexnies ◽  
Susanne Röhr ◽  
...  

Refugees from war zones often have missing significant others. A loss without confirmation is described as an ambiguous loss. This physical absence with simultaneous mental persistence can be accompanied by economic, social or legal problems, boundary ambiguity (i.e., uncertainty about who belongs to the family system), and can have a negative impact on mental health. The aim of this study was to identify sociodemographic and loss-related predictors for prolonged grief, anxiety, depression, post-traumatic stress disorder (PTSD) and somatization in treatment-seeking Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. For the present study, data were based on the treatment-seeking baseline sample of the “Sanadak” randomized-controlled trial, analyzing a subsample of 47 Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. Sociodemographic and loss-related questions were applied, along with standardized instruments for symptoms of prolonged grief (ICG), anxiety (GAD-7), depression (PHQ-9), PTSD (PDS-5) and somatization (PHQ-15). Linear regression models were used to predict mental health outcomes. Having lost a close family member and higher boundary ambiguity showed a statistically significant association with higher severity in prolonged grief. The overall model for somatization reached statistical significance, while no predictor independently did. Boundary ambiguity showed a statistically significant positive association with depression, while the overall model showed no statistically significant associations. Boundary ambiguity and missing family members seemed to be important predictors for prolonged grief. These findings support the importance of reunification programs and suggest an inclusion of the topic into psychosocial support structures, e.g., including psychoeducational elements on boundary ambiguity in support groups for traumatized individuals and families experiencing ambiguous loss. Further research is needed for a more detailed understanding of the impact of ambiguous loss on refugee populations.


2021 ◽  
Vol 11 (1) ◽  
pp. 7
Author(s):  
Carol S. North ◽  
Alina M. Surís ◽  
David E. Pollio

The coronavirus disease of 2019 (COVID-19) pandemic rapidly spread around the world, resulting in massive medical morbidity and mortality and substantial mental health consequences. Post-traumatic stress disorder (PTSD) is an important psychiatric disorder associated with disasters, and many published scientific articles have reported post-traumatic stress syndromes in populations studied for COVID-19 mental health outcomes. American diagnostic criteria for PTSD have evolved across editions of the manual, and the current definition excludes naturally occurring medical illness (such as viral illness) as a qualifying trauma, ruling out this viral pandemic as the basis for a diagnosis of PTSD. This article provides an in-depth nosological consideration of the diagnosis of PTSD and critically examines three essential elements (trauma, exposure, and symptomatic response) of this diagnosis, specifically applying these concepts to the mental health outcomes of the COVID-19 pandemic. The current criteria for PTSD are unsatisfying for guiding the response to mental health consequences associated with this pandemic, and suggestions are made for addressing the conceptual diagnostic problems and designing research to resolve diagnostic uncertainties empirically. Options might be to revise the diagnostic criteria or consider categorization of COVID-19-related psychiatric syndromes as non-traumatic stressor-related syndromes or other psychiatric disorders.


2021 ◽  
pp. 152483802110484
Author(s):  
Aino Suomi ◽  
Annalese Bolton ◽  
Dave Pasalich

Background Birth parents of children in the statutory child protection system have disproportionally high rates of trauma exposure and mental health problems, however, little is known about the extent to which this population display symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex PTSD. This study provides a systematic review and meta-analysis of the PTSD rates in parent samples involved in the child protection services. Method Articles were identified by searching PSYCINFO, Medline, CINAHL, and PILOTS. The search included terminology pertaining to parents, trauma, and child protective services and we included all peer-reviewed articles that reported a valid measure of PTSD and child protection service involvement. Results Fifteen studies were included in the review with a combined prevalence estimate for PTSD based on 11 studies ( n = 4871) was 26.0% (95% CI 20.0–32.0%) for mothers, and estimate based on three studies ( n = 2606) was 13.0% (95% CI 7.0%–18.0%) for fathers and 23.0% (95% CI 17.0–29.0) for all parents based on 7848 responses. Four studies that did not report prevalence rates, reported sample mean scores for PTSD that were consistently higher than in general population. Factors associated with parents’ PTSD symptoms included mental health co-morbidities, victimization of physical and sexual violence, and perpetration of child abuse. Conclusion There are high rates of PTSD in parents involved in the protective system, thus more targeted efforts are needed to identify and adequately address trauma symptoms of parents as part of child protection interventions.


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