A national survey on depressive and anxiety disorders in Afghanistan: A highly traumatized population

Abstract Background This survey attempts to measure at a national level, exposures to major traumas and the prevalence of common mental health disorders in a low-income dangerous country, highly affected by conflicts: Afghanistan. Methods Trans-sectional probability survey in general population by multistage sampling in 8 provinces, represented nationwide: 4445 adults (4433 weighted),15 years or older, 81% participation rate. Face to face interviews used specific scales for measuring lifetime exposure (LEC 5 Life Events Checklist) and Post Traumatic Stress Disorder (PTSD Check List), a diagnostic standardized interview: Composite International Diagnostic Interview (Short Form) for. Major Depressive Episode and Generalized Anxiety Disorder, plus scales for suicidal thoughts and attempts and psychological distress (MH5 and RE from SF36). Results 52.62% of the population is illiterate, 84,61% of the women do not have any source of income; 70.92% of the population lives in rural areas, 60.62% are below 35 years, 80% lives in very dangerous areas. 64.67% of the Afghan population had personally experienced at least one traumatic event; 78.48% had witnessed one such event. 60.77% of the sample experienced collective violence in relation to war and 48.76% reported four or more events; this very much differs across regions and levels of danger; women are less at risk for trauma except sexual violence, 35 years and above are more at risk than younger. 12-month PTSD prevalence reaches a high rate: 5.34% as MDE 11,71%, whereas GAD 2.78%; suicidal thoughts 2.26%, lifetime suicidal attempts 3.50% are close to reported in other countries. Women have more risk for PTSD (0R = 1.93) and suicidal behaviours (attempts OR = 1.92) than men; the number of events increases risk for MDE, PTSD and suicidal attempts, whereas education is protective. Exposure to different war events produced different mental health effects. People suffering from PTSD have higher risk to report 12-months suicidal ideations and lifetime suicidal attempts. Conclusion Our findings highlight the need to map the extent and the types of mental disorders post conflict; this would help maximise the help to be offered in guiding proper choice of interventions, including education.

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The Challenges Facing Mental Health Programs for Post-Conflict and Refugee Communities

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00001539 ◽

2004 ◽

Vol 19 (1) ◽

pp. 90-96 ◽

Cited By ~ 28

Author(s):

Derrick Silove

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Low Income ◽

Traumatic Stress ◽

Health Professionals ◽

Adaptive Systems ◽

Small Scale ◽

Displaced Persons ◽

Stress Reactions ◽

Post Conflict

AbstractThe majority of refugees and communities exposed to warfare and oppression live in low-income countries with few resources or special skills. Yet, epidemiological studies have identified high levels of traumatic stress reactions in such populations. These stress reactions can be intensified by harsh policies aimed at deterring survivors from seeking refuge in technologically advanced societies. The scale of the problem of mass violence and displacement creates formidable challenges for mental health professionals in their efforts to develop practical frameworks for responding to the extensive needs of displaced persons. In this article, a model is proposed for low-income, post-conflict countries, based on a two-tiered formulation. At the eco-social level, mental health professionals can play a supportive, but not a lead, role in facilitating recovery of core adaptive systems that hasten natural recovery from stress for the majority of the population. Where small-scale, community mental health services are established, the emphasis should be on assisting persons and their families who are at greatest survival and adaptive risk. Training and promotion of local workers to assume leadership in such programs are essential. In technologically advanced societies in which refugees are in a minority, torture and trauma services can focus more specifically on traumatic stress reactions, acculturation, and resettlement. In a historical epoch in which displaced persons are facing particularly harsh treatment, there is a pressing need for consensus amongst mental health professionals in advocating for their needs.

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Stillbirth and infant death: mental health among low-income mothers in Mumbai

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03754-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lisa Roberts ◽

Solomon J. Renati ◽

Shreeletha Solomon ◽

Susanne Montgomery

Keyword(s):

Mental Health ◽

At Risk ◽

Low Income ◽

Infant Death ◽

Postnatal Depression ◽

Perinatal Loss ◽

Reproductive Age ◽

Cross Sectional ◽

History Of ◽

Perinatal Grief

Abstract Background India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women’s mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae. Methods We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. Results Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention. Conclusions Understanding factors contributing to women’s suffering related to reproductive challenges in this pronatalist context is critically important for women’s wellbeing.

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Political violence and mental health in Nepal: prospective study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.096222 ◽

2012 ◽

Vol 201 (4) ◽

pp. 268-275 ◽

Cited By ~ 59

Author(s):

Brandon A. Kohrt ◽

Daniel J. Hruschka ◽

Carol M. Worthman ◽

Richard D. Kunz ◽

Jennifer L. Baldwin ◽

...

Keyword(s):

Mental Health ◽

Prospective Study ◽

Political Violence ◽

Low Income ◽

Stressful Life Events ◽

Psychiatric Morbidity ◽

Low Income Countries ◽

Post Traumatic Stress ◽

Post Conflict ◽

Before And After

BackgroundPost-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence.AimsThis prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal.MethodAn adult cohort completed the Beck Depression Inventory and Beck Anxiety Inventory in 2000 prior to conflict violence in their community and in 2007 after the war.ResultsOf the original 316 participants, 298 (94%) participated in the post-conflict assessment. Depression increased from 30.9 to 40.6%. Anxiety increased from 26.2 to 47.7%. Post-conflict post-traumatic stress disorder (PTSD) was 14.1%. Controlling for ageing, the depression increase was not significant. The anxiety increase showed a dose–response association with conflict exposure when controlling for ageing and daily stressors. No demographic group displayed unique vulnerability or resilience to the effects of conflict exposure.ConclusionsConflict exposure should be considered in the context of other types of psychiatric risk factors. Conflict exposure predicted increases in anxiety whereas socioeconomic factors and non-conflict stressful life events were the major predictors of depression. Research and interventions in postconflict settings therefore should consider differential trajectories for depression v. anxiety and the importance of addressing chronic social problems ranging from poverty to gender and ethnic/caste discrimination.

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A high-risk group of pregnant women with elevated levels of conflict-related trauma, intimate partner violence, symptoms of depression and other forms of mental distress in post-conflict Timor-Leste

Translational Psychiatry ◽

10.1038/tp.2015.212 ◽

2016 ◽

Vol 6 (2) ◽

pp. e725-e725 ◽

Cited By ~ 11

Author(s):

S J Rees ◽

W Tol ◽

M Mohammad ◽

A K Tay ◽

N Tam ◽

...

Keyword(s):

Mental Health ◽

Intimate Partner Violence ◽

Physical Abuse ◽

Low Income ◽

Partner Violence ◽

Mental Distress ◽

Intimate Partner ◽

Post Conflict ◽

Timor Leste ◽

Antenatal Clinics

Abstract Women in post-conflict, low-income, post-conflict (LI-PC) countries are at risk of exposure to the traumatic events (TEs) of war and intimate partner violence (IPV), forms of stress that are known to lead to depression and other adverse mental health outcomes. We aimed to assess an index of exposure to these two forms of trauma to identify pregnant women attending antenatal clinics in conflict-affected Timor-Leste at high risk of depression and other forms of stress. A large, cross-sectional study of women in the second trimester of pregnancy was conducted in the four main government antenatal clinics in Dili district of Timor-Leste, between May 2014, and January 2015. The sample consisted of 1672 consecutive women, 3 to 6 months pregnant, with a response rate of 96%. We applied the Edinburgh Postnatal Depression Scale, the Kessler-10 psychological distress scale and the Harvard Trauma Questionnaire. IPV was assessed by the World Health Organisation measure. Composite categories of conflict-related TEs and severity of IPV showed a dose–response relationship with depressive symptoms: for exposure to four or more conflict-related TEs and severe psychological IPV, the adjusted odds ratio (AOR) was 3.95 (95% confidence interval (CI) 2.10–7.40); for four or more TEs and physical abuse, AOR 8.16 (95% CI 3.53–18.85); and for four or more TEs and severe psychological and physical abuse, AOR 9.78 (95% CI 5.31–18.02). For any mental distress, the AOR for four or more TEs and severe psychological abuse was 3.60 (95% CI 2.08–6.23); for four or more TEs and physical abuse 7.03 (95% CI 3.23–15.29); and for four or more TEs and severe psychological and physical abuse the AOR was 10.45 (95% CI 6.06–18.01). Of 184 women (11% of the sample) who reported ⩾4 TEs and either physical abuse alone or in combination with severe psychological abuse, 78 (42%) reached threshold for depressive symptoms and 93 (51%) for any mental distress, a 10-fold increase in depressive and other mental health symptoms. Priority should be directed to providing urgent mental health and social interventions for this group of women. Our findings offer a framework for a tiered approach to detection, guiding prevention and intervention strategies for IPV and associated mental health problems in low-income post-conflict countries.

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Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test

Journal of Medical Internet Research ◽

10.2196/19716 ◽

2020 ◽

Vol 22 (9) ◽

pp. e19716

Author(s):

Merel Marjolein van Herpen ◽

Manon A Boeschoten ◽

Hans te Brake ◽

Niels van der Aa ◽

Miranda Olff

Keyword(s):

Mental Health ◽

Internal Consistency ◽

Psychosocial Functioning ◽

Traumatic Event ◽

Short Form ◽

Model Fit ◽

Positive Outcomes ◽

Divergent Validity ◽

Self Help ◽

Convergent And Divergent Validity

Background Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. Objective The goal of this study was to assess MIRROR’s use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. Methods MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR’s outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale–21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). Results In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range –.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. Conclusions MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.

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NATIONAL-LEVEL DISPARITIES IN INTERNET ACCESS AMONG LOW-INCOME AND BLACK AND HISPANIC YOUTH: CHALLENGES IN REACHING AT RISK GROUPS (Preprint)

Journal of Medical Internet Research ◽

10.2196/27723 ◽

2021 ◽

Author(s):

M. Margaret Dolcini ◽

Jesse A Canchola ◽

Joseph A Catania ◽

Marissa M Song Mayeda ◽

Erin L Dietz ◽

...

Keyword(s):

At Risk ◽

Low Income ◽

National Level ◽

Internet Access ◽

Risk Groups ◽

Hispanic Youth

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COVID-19 Outbreak and Suicides in Nepal: Urgency of Immediate Action (Preprint)

10.2196/preprints.21754 ◽

2020 ◽

Author(s):

Shiva Raj Acharya ◽

Deog Hwan Moon ◽

Yong Chul Shin

Keyword(s):

Mental Health ◽

Low Income ◽

Mental Health Problems ◽

Control Measures ◽

High Rate ◽

Negative Consequences ◽

Mental Health Awareness ◽

Health Authorities ◽

The Government ◽

To Come

UNSTRUCTURED Amid the COVID-19 pandemic, most of the people in the world are experiencing mental health problems. Nationwide lockdown had the negative consequences in many aspects of health of an individual in the community especially in mental health. This paper focuses on the suicides during the COVID-19 outbreak in Nepal. Current situation of COVID-19 pandemic is that cases are increasing in the high rate towards low income developing countries. With 9026 cases & 23 deaths due to COVID-19 in Nepal, suicide cases have shockingly high during corona outbreak. 875 cases of suicide have been reported till May 2020 relatively and will be increase in this COVID-19 pandemic period if no any effective & immediate response from the government and respective authorities. Long-term nationwide lockdown, fear & anxiety, economic crisis, weak corona outbreak control measures considered to be the factor beside the suicide. Mental health awareness program and modification on the nationwide lockdown based on the situation in the respective province should be addressed in order to promote the mental health of the citizens. All the health authorities, government, professionals & media need to come together to tackle suicide upsurge and prevention with effective management.

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238 Adolescent Sleep Variability, Social Jetlag, and Mental Health during COVID-19: Findings from a Large Nationwide Study

SLEEP ◽

10.1093/sleep/zsab072.237 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A95-A95

Author(s):

Patricia Wong ◽

Amy Wolfson ◽

Sarah Honaker ◽

Judith Owens ◽

Kyla Wahlstrom ◽

...

Keyword(s):

Mental Health ◽

High School ◽

At Risk ◽

Online Survey ◽

Short Form ◽

School Level ◽

Depression Symptoms ◽

Social Jetlag ◽

School Schedules ◽

Instructional Formats

Abstract Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted education nationwide, including changes in instructional formats and school schedules. With data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study, we examined whether sleep variability and social jetlag (SJL) during the pandemic associate with mental health. Methods Analyses included online survey data from 4767 students (grades 6-12, 46% female, 36% non-White, 87% high school). For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported bedtimes (BT) and wake times (WT) for each instructional format and for weekends/no school days. Sleep opportunity (SlpOpp) was calculated from BT and WT. Weekday night-to-night SlpOpp variability was calculated with mean square successive differences. SJL was calculated as the difference between the average sleep midpoint on free days (O/A, no school, weekends) versus scheduled days (IP, O/S). Participants also completed the PROMIS Pediatric Anxiety and Depressive Symptoms Short Form. Data were analyzed with hierarchical linear regressions controlling for average SlpOpp, gender, and school-level (middle vs high school). Results Mean reported symptoms of anxiety (60.0 ±9.1; 14%≧70) and depression (63.4 ±10.2; 22%≧70) fell in the at-risk range. Shorter average SlpOpp (mean=8.3±1.2hrs) was correlated with higher anxiety (r=-.10) and depression (r=-.11; p’s<.001) T-scores. Greater SlpOpp variability was associated with higher anxiety (B=.71 [95%CI=.41-1.01, p<.001) and depression (B=.67 [.33-1.00], p<.001) T-scores. Greater SJL (mean=1.8±1.2hrs; 94% showed a delay in midpoint) was associated with higher anxiety (B=.36 [.12-.60], p<.001) and depression (B=.77 [.50-1.03], p<.001) T-scores. Conclusion In the context of system-wide education changes during COVID-19, students on average reported at-risk levels of anxiety and depression symptoms which were associated with greater variability in sleep opportunity across school days and greater social jetlag. Our findings suggest educators and policymakers should consider these sleep-mental health associations when developing instructional formats and school schedules during and post-pandemic. Support (if any) T32MH019927(P.W.)

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Abstract 401: Head to Heart: Mental Health as a Precursor for Heart Disease in San Joaquin Muslim Population

Circulation Research ◽

10.1161/res.127.suppl_1.401 ◽

2020 ◽

Vol 127 (Suppl_1) ◽

Author(s):

Maha Siddiqui

Keyword(s):

Mental Health ◽

Blood Pressure ◽

At Risk ◽

High School Students ◽

Psychological Distress ◽

Low Income ◽

Muslim Community ◽

Muslim Population ◽

Health Concerns ◽

Mental Health Concerns

Introduction: Islamophobia affects the mental health of the large San Joaquin (SJ) Muslim population leading to psychological distress and mental health concerns which can further lead to High Blood Pressure (HBP) and cardiovascular disease (CVD). SJ has a growing rate of Muslim immigrants who may be at risk for psychological distress and CVD. Objectives: Trainees conducted Kessler psychological distress tests, HBP and CVD screenings at mosques to reduce the risk of CVD and spread awareness about mental health, CVD and its implications in the Muslim population due to environmental racism in the most underserved county for health care, SJ. Methods: I trained medically ambitious low-income minority female high school students to conduct weekly Kessler psychological distress tests, blood pressure screenings and serve as a health technology coach. Each student monitored 2 hypertensive and psychological distressed patients of 40 hypertensive, psychological distressed, at risk for CVD and low-income Muslim residents. Kessler psychological distress tests and CVD screenings were conducted at all SJ mosques to spread awareness about mental health and heart health and track psychological distress and HBP in the Muslim community. Findings: -About 58% (304 of 527) of SJ Muslim population are at risk for CVD -About 42% (221 of 527) of SJ Muslim population are Stage 1 hypertensive -About 19% (98 of 527) of SJ Muslim population are Stage 2 hypertensive -About 61% (319 of 527) of SJ Muslim population are hypertensive and psycologically distressed Direct Outcomes: -Youth learned the value of empathy, multiculturalism and service to disadvantaged communities through the program and volunteering -Female empowerment and program students are determined to pursue medicine and address community concerns -Improved patient provider trust -Development of self advocacy for health in the Muslim communityIncreased awareness on CVD, HBP, and mental health among the Muslim communityIncreased participation of youth and females in an otherwise adult and male dominant environments (i.e. mosques) -Awareness, education among Muslim community for better heart and mental health -Better understanding in how to manage and seek referral for mental health concerns

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