Medicine, Conflict and Survival最新文献

This study aims to evaluate the effect of a mental health Narrative Community-Based Group Therapy (NCGT) in Afro-Colombian violence survivors. A randomized controlled trial was conducted in Buenaventura and Quibdó, Colombia. Afro-Colombian adults (n=521) were randomly allocated to a NCGT (n₁=175), a wait-control group (n₂=171) or a Common Elements Treatment Approach (CETA, n₃=175). The CETA was described separately given conceptual/methodological differences. Lay psychosocial community workers delivered the NCGT. Symptoms were assessed before and after intervention/wait with culturally adapted mental health symptoms and gender-specific functionality scales. Intent to treat analysis and mean difference of differences were used for comparisons. In Buenaventura, a significant reduction in functional impairment (mean difference: -0.30, 95% Confidence Interval [95% CI]: -0.55, -0.05) and depression (mean difference: -0.24, 95% CI: -0.42, -0.07) were found, with small and moderate effect size, respectively. In Quibdó, functionality improved significantly (mean difference: -0.29, 95% CI: -0.54, -0.04, small effect size). Even though differences in depression and anxiety were not significant, there were reductions in symptoms. The NCGT is effective in improving daily functioning among violence victims in the Colombian Pacific and has the potential to reduce symptoms of depression. Further exploration is required to understand the effects of a narrative group therapy for mental health in Afro-Colombian populations.Trial Registration: ClinicalTrials.gov number: NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

Conflict-related sexual violence (CRSV) is one of the most severe and stigmatizing human rights violations. The recognition of men and boys as targets of sexual violence is a rather recent development. In the present study data on experiences of sexual violence as well as mental health outcomes were analysed in recently arrived male refugees (N = 392) in Germany. More than one third of the men interviewed (n = 128; 36.6%) reported having experienced sexual violence. Compared to male refugees without experiences of sexual violence, male refugee survivors showed higher prevalence rates of PTSD. Moreover, some differences were found between the subgroups on the single symptoms level, indicating higher severity in those affected by sexual violence, including negative alterations in cognition/mood, suicidal ideation, and nervousness or shakiness inside. The findings provide initial data on prevalence of sexual violence and related mental health outcomes in male refugees newly arrived in Germany and emphasize the significance of sexual violence as a risk factor for different mental health outcomes. This provides clear implications for health care professionals that could aid them in better identifying those affected. Finally, further research is urgently needed that takes a closer, more differentiated look at sexual violence in male refugee populations.

Suicide is the third-leading cause of death globally, predominantly among youth. We aimed at reviewing the available published literature and some reports about suicide, in an attempt to unveil aspects of this mental health problem in Iraq. Articles about suicide in Arab/Middle Eastern countries were also included to compare those populations of a similar race and religion. The estimated suicide rate in Iraq is 1.7/100000 population (mostly among youth), which is still lower than in western countries. However, underreporting is the reason actual numbers are not known and many who attempt suicide do not report it and so hide their intent to die. The most common method of suicide is self-hanging, followed by firearms, self-burning, and self-poisoning. Suicide and suicidality in Iraq are on the increase even though it is believed to be underreported. Many socio-demographic, psychological and environmental factors predispose to ideation, attempts, and completed suicides despite the religious and social taboos. Young females are more represented in suicide attempts and ideation using potentially lethal methods like self-burning as a consequence of higher rates of depression, community and domestic violence. A key component in suicide prevention is improving the accessibility and quality of mental and social health care services.

Introduction: Societies marked by armed conflict face huge challenges in mental health care provision due to lowered resources and destruction of infrastructure along with an increased need for care. This especially affects the vulnerable groups already facing bigger challenges in terms of higher disease burden and limited access to care.

Aim: To examine how the association between conflict-related trauma and mental health is affected by different factors affecting the individual's vulnerability, and to address the provision of and barriers in access to mental health services in conflict and post-conflict contexts.

Materials and methods: Scoping literature review based on a focused literature search in PubMed and DIGNITY Documentation Centre and Library.

Results: Population mental health may be affected by violence and by general hardship by (1) causing new mental health conditions, predominantly PTSD, depression and anxiety, and (2) exacerbating pre-existing mental health conditions. Violence, stigmatization, social and physical capital, gender and access to health care were identified as the main vulnerability factors affecting the association between conflict and mental health conditions.

Discussion and conclusion: The associations between violence, vulnerability and mental health might be overlapping and multi-directed. Vulnerability is considered an effect-modifier on the associations between conflict/trauma and mental health.