Mental health and psychosocial support in conflict: children’s protection concerns and intervention outcomes in Syria

Child protection and mental health during conflict intersects with a variety of adverse conflict-related factors, and intervention outcomes in the field are often difficult to predict. Using the casefiles of 376 school children registered in a Mental Health and Psychosocial Support (MHPSS) project in the Northwest governorate of Idleb in Syria, this study aimed to determine (i) the rates of various protection concerns (potential mental health conditions, psychosocial deprivation issues, and social, behavioural and emotional issues) for students enrolled in this project, (ii) whether the rates of any of the protection concerns varied between children and adolescents, or between boys and girls, and (iii) which of the identified demographic and protection sector factors predicted the presence of potential mental health conditions and MHPSS intervention outcomes. MHPSS interventions (including individual MHPSS sessions tailored for children in conflict, resilience building activities, tutoring, peer building activities, community awareness, and other tailored services) were implemented at schools operated by the UK-based organization, Syria Relief. The variables tested included demographic variables of age group (208 children, aged 4–9 years; 168 adolescents, aged 10–14 years) and gender (211 males, 165 females), and 23 protection sector variables including 11 potential mental health problems (anxiety, attention deficit hyperactivity disorder, conduct disorder, autism, epilepsy, motor tics, depression, post-traumatic-stress disorder, social phobia, specific phobia, learning disability), 7 psychosocial deprivation (PSD) variables (war injury, child labour, loss of caregiver, neglect, domestic abuse, displacement, poverty), and 5 social, behavioural and emotional (SBE) variables (low/abnormal socialization, emotional issue, peer issues/being bullied, peer issues/being aggressive, educational decline). Within the sample, 73.7% were found with a probable mental health problem, with 30.6% showing signs of anxiety, 36.2% of depression and 26.6% showing signs of post-traumatic-stress disorder. Additionally, 74.5% of the sample had at least one form of PSD present (42.6% were displaced, 39.6% suffered from abject poverty), and 64.9% had a reported SBE concern. Children were more likely to have a potential mental health concern, especially autism and PTSD, and poor socialization; while adolescents were more likely to engage in child labour, experience abject poverty, exhibit aggressive behaviour, and educational decline. Male gender was associated with child labour and aggressive behaviour while female gender was associated with the presence of potential mental health problems, especially depression, and loss of caregiver, and poor socialisation. Odds ratios (ORs) indicated significant negative impact of the presence of SBE concerns (any), 4.45 (95% CI: 1.68–12.7), emotional issue, 11.02 (95% CI: 2.76–74.49), low/abnormal socialization, 8.37 (95% CI, 2–57.71), and displacement, 2.91 (95% CI, 1.21–7.48) on the child’s mental health. MHPSS intervention outcomes were categorized as case improvement, decline, or incomplete/limited information available; with case improvement noted for 63.6% of the sample, decline noted for 14.4%, and incomplete treatment/limited follow-up noted for 22.1% of the sample. Additional analysis of predictors of treatment success found that child labour was significantly associated with a lack of treatment success, OR 0.24 (95% CI, 0.07–0.92). These findings provide important insights into the complex tailoring needs that protection and MHPSS field projects require.

When is a justice campaign over? Transitional justice, ‘overing’ and Bloody Sunday

This article explores the political, strategic and emotional issue of victim groups deciding to continue or discontinue central components of a justice campaign in the aftermath of receiving ‘truth’. Drawing on in-depth interviews, the article focuses on relatives and other stakeholders’ varying positions on (dis)continuing the annual Bloody Sunday commemoration march after the publication of the Report of the Bloody Sunday Inquiry and the UK Prime Minister’s apology for the massacre. I demonstrate that there has emerged an, at times, acrimonious schism between those who feel the apology and report were sufficient to stop the march and those who believe them to be insufficient. Thus, while much of the literature on political apology evaluates its effects on the dyadic relationship between victim and perpetrator, this article develops Sara Ahmed’s concept of ‘overing’ to demonstrate that the ostensible moment of truth can create unanticipated and deleterious intra-victim tensions. The article concludes by suggesting practical measures emerging from the findings that other justice campaigns may consider.

The Alans between a Scholarly Paradigm and Ethnocentrism: the “Memory Wars” and Their Background

A social (historic) memory and an alternative history are discussed with respect to the hot and very emotional issue dealing with the claims of certain North Caucasian peoples for the Alan ancestors. One should make a difference between academic approaches, on the one hand, and pseudo-scholarly, often highly politicized motives of the alternative history authors, on the other hand. Yet, even scholars who have dual loyalty have to make an uneasy choice between the scholarly paradigm and ethnocentric constructions which serve ethno-national interests. The author argues that a scholarly approach demands for, firstly, a nuanced treatment of the name of the “Alans” which had different meanings in the different historic periods, and secondly, a careful analysis of such names which initially could serve social or political goals rather than ethnic ones.

Describing the objective and subjective mental health care needs of minor refugees in Germany

Background Half of the estimated 70.8 million forcibly displaced people are under the age of 18. Clinical studies assessing prevalence of mental illness, commonly depict them as a particularly vulnerable group. However, screening instruments are not enough when establishing the need for mental health care. By supplementing them with subjective measures, we aim to provide insight into the mental health care needs of otherwise overlooked groups. Methods Data were collected between February and November 2019 in German schools and refugee accommodations via tablet based self-assessment. Adolescents between 12 and 18 years of age coming from Syria, Afghanistan, and Iraq were invited to participate. The Hopkins Symptom Checklist-37 (HSCL) was used to measure internalizing and externalizing symptoms (i.e. objective need; cut-off score = 69). A single item was used to assess the subjective need for mental health care: “Do you think that you have emotional difficulties for which you need help?” Results A total of 259 participants completed the questionnaire. While 22.4% reported an emotional issue for which they need help (missing values=22.4%), the HSCL (α=.90) identified 10.4% of participants to be at risk for a mental health disorder (missing values=18.5%). Most participants (62.5%) reported neither objective nor subjective care need. However, 23.7% (n = 36) of those not identified as at risk said they have emotional difficulties, while 5.9% (n = 9) of those at risk stated they do not have an emotional issue. Conclusions Our sample showed lower levels of mental health issues as measured by the HSCL, when compared to samples of refugee minors in Germany (33.7%) and Norway (17.2%). Especially vulnerable groups are those who report problems, but are not identified by the screening measure as at risk and those identified as at risk, but do not perceive to have mental health difficulties. Public health interventions need to develop tailored strategies to reach these groups. Key messages Screening instruments are not enough when establishing the need for mental health care of vulnerable populations. Subjective and objective need should be considered when establishing who gets mental health care.

The role of emergency medicine for postgraduate year one undifferentiated physician: a qualitative analysis of trainees' perspective

Background PGY1 program was initiated in 2003 for undifferentiated physicians in Taiwan, the program aimed to improve the general competency gap exposed during the SARS epidemic breakout in physicians. Many published studies discussed the effectiveness of the program. We were interested in the learning impacts gained from the physicians' perspectives during EM rotation in the PGY1 program, and little was known regarding this subject. Methods This retrospective study used grounded theory data analysis methods. 201 PGY1 physicians rotated in the emergency department from August 2014 to July 2017 answered three open-ended post-rotation survey questions and resulted in a dataset of 603 comments. A three-member team for code development reviewed all comments and established the code themes with the consensus of the team members. A four-member coding team coded applicable comments accordingly. Results We coded 563 (96%) comments and sorted 32 themes essential to characterize the clinical experiences into two categories. Twenty-six codes were relevant to professional development; 6 were related to the emotional issue. In the professional development category, patient care (33%) was the most frequently coded domains in the sub-level of six core competencies, followed by system-based practice (25%) and interpersonal and communication skills (19%). Senses of growth and improvement were the most frequently coded theme in the emotional issue category, followed by pressure at the workplace and on-the-spot-feedback. The top 3 lessons learned by physicians' perception were decision-making, team and patient communication, and prioritize tasks. Conclusions EM rotation had a productive role in professional development for undifferentiated physicians before receiving specialty discipline training. Gaining experiences on clinical judgment and communication were the strengths of the EM PGY1 program. This model of analysis might be used as a novel way of assessment on the achievement of learning objectives from the trainee's perspective. However, a prospective standardized study protocol is needed for a further affirmative conclusion.

Incidence of Vaccine Preventable Diseases in Pediatric Population of Latvia

Childhood and adolescent immunizations are one of the most effective means of preventing such serious diseases as diphtheria, pertussis, rubella etc. These infectious diseases are termed as vaccine preventable diseases because vaccination continues to be the most effective strategy to reduce morbidity and mortality from these diseases. Despite this, immunization is an emotional issue for many parents. As vaccine preventable diseases become less common and parents have little familiarity with the devastating effects of vaccine preventable illnesses, the benefits of immunization may seem less important than the potential adverse effects.

Border Security: Defining it is the Real Challenge

The idea of border security is a notion that the US has pursued in earnest since September 11, 2001 and continues to be a focus for many Americans. This topic is assuredly going to rise once again as we near our 2016 national elections and the complex, often emotional issue, will take center stage as a heavily discoursed issue. Although there have been significant gains in how we enforce our international borders, there is wide disagreement on the success we have had with our border security efforts. Performance measures for border security are not always clear but there is a mosaic listing of outputs that suggest that border enforcement efforts have been successful. Unfortunately, we have failed to clearly delineate what successful border security efforts look like and before the nation, once again, makes a significant investment in resources we should start with the notion of defining successful border security.

Perilymph Fistula: Fifty Years of Controversy

Perilymph fistula (PLF) is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semi circular canal from cholesteatoma and the superior canal dehiscence syndrome. It was first recognized in the early days of stapedectomy as causing disequilibrium and balance problems before sealing of the stapedectomy with natural tissue became routine. It then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause of PLF. Descriptions of “spontaneous” PLF with no trauma history followed. A large literature on PLF from all causes accumulated. It became an almost emotional issue in Otolaryngology with “believers” and “nonbelievers.” The main criticisms are a lack of reliable symptoms and diagnostic tests and operative traps in reliably distinguishing a perilymph leak from local anaesthetic. There are extensive reviews on the whole topic, invariably conveying the authors' own experiences and their confirmed views on various aspects. However, a close examination reveals a disparity of definitions and assumptions on symptoms, particularly, vestibular. This is an intentionally provocative paper with suggestions on where some progress might be made.

Jews at Home

The questions at the heart of this book are: what things make a home ‘Jewish’, and what is it that makes Jews feel ‘at home’ in their environment? The material dimensions are explored through a study of the symbolic and ritual objects that convey Jewishness and a consideration of other items that may be used to express Jewish identity in the home. The discussion is geographically and ethnically wide-ranging, and the transformation of meaning attached to different objects in different environments is contextualized. For diasporic Jewish culture, the question of feeling at home is an emotional issue that frequently emerges in literature, folklore, and the visual and performing arts. The phrase ‘at-homeness in exile’ aptly expresses the tension between the different heritages with which Jews identify, including that between the biblical promised land and the cultural locations from which Jewish migration emanated. The chapters take a closer look at the way in which ideas about feeling at home as a Jew are expressed in literature originating in Brazil, Argentina, and the United States, and also at the political ramifications of these emotions. The question is further explored in a series of exchanges on the future of Jews feeling ‘at home’ in Australia, Germany, Israel, and the United States. The book examines the theme of the Jewish home materially and emotionally from a variety of disciplinary perspectives. It uses the theme of home and the concept of domestication to revise understanding of the lived (and built) past, and to open new analytical possibilities for the future.