Showing papers by "Ivan H. Komproe published in 2013"

Conflict and mental health: A cross-sectional epidemiological study in Nepal

Abstract: The aim of this epidemiological study was to identify prevalence rates of mental health problems, factors associated with poor mental health and protective and risk factors in a post-conflict situation in Nepal. This cross-sectional study was conducted among 720 adults in 2008. A three-stage sampling procedure was used following a proportionate stratified random sampling strategy. The outcome measures used in the study were locally validated with Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Post-Traumatic Stress Disorder (PTSD)—Civilian Version (PCL-C) and locally constructed function impairment scale, resources and coping. Of the sample, 27.5 % met threshold for depression, 22.9 % for anxiety, and 9.6 % for PTSD. Prevalence rates were higher among women (depression, OR 2.14 [1.52–3.47]; anxiety, OR 2.30 [1.45–3.17] and PTSD, OR 3.32 [1.87–5.89]) and older age categories (depression, OR 1.02 [1.01–1.04]; anxiety, OR 1.04 [1.03–1.05] and PTSD, OR 1.02 [1.0–1.03]). Respondents who perceived more negative impact of the conflict (e.g., hampered the business/industry; hindered in getting medical treatment, etc.) in their communities were more at risk for depression (OR 1.1 [1.06–1.14]), anxiety (OR 1.05 [1.01–1.09]) and PTSD (OR 1.09 [1.04–1.14]). Other risk factors identified in the study were ethnicity, district of residence and poverty (lack of clothing, medicine and information via radio at home). Overall, the prevalence rates of depression and anxiety in the sample are comparable to, or lower than, other studies conducted with populations affected by conflict and with refugees. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict rural Nepal, especially for marginalized populations.

A controlled evaluation of a brief parenting psychoeducation intervention in Burundi

Abstract: Conduct problems and emotional distress have been identified as key problems among children and adolescents in post-war Burundi. This pilot study aims to evaluate the impact of a brief parenting psychoeducation intervention on children’s mental health. This study employs a controlled pre and post evaluation design. The two-session psychoeducation intervention was offered to groups of parents of children (mean age 12.3 years, 60.8 % female) who had been screened for elevated psychosocial distress. Children in the intervention group (n = 58) were compared to a waitlist control group (n = 62). Outcome indicators included child-reported levels of aggression (using the Aggression Questionnaire), depression symptoms (using the Depression Self Rating Scale) and perceived family social support. The intervention had a beneficial effect on reducing conduct problems compared to the control condition (Cohen d = 0.60), especially among boys, while not showing impact on depression symptoms or family social support. Parents evaluated the intervention positively, with increased awareness of positive parenting strategies and appropriate disciplinary techniques reported as the most common learning points. A brief parenting psychoeducation intervention conducted by lay community counselors is a promising public health strategy in dealing with widespread conduct problems in boys living in violence-affected settings and not so for social and emotional indicators and for girls. An efficacy study is warranted to confirm these preliminary findings.

Implementation of a mental health care package for children in areas of armed conflict: a case study from Burundi, Indonesia, Nepal, Sri Lanka, and Sudan.

Abstract: As one article in an ongoing series on Global Mental Health Practice, Mark Jordans and colleagues describe their work developing and evaluating a community-based psychosocial and mental health care package for children in five conflict affected countries: Burundi, Indonesia, Nepal, Sri Lanka, and Sudan.

Setting priorities for mental health care in Nepal: a formative study

Abstract: There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this. The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one. There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention. The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal.

Promoting Mental Health and Psychosocial Well-Being in Children Affected by Political Violence: Part I–Current Evidence for an Ecological Resilience Approach

Abstract: Research on the mental health and psychosocial well-being of children in areas of political violence has largely focused on investigating the relation between exposure to armed conflict events and posttraumatic stress symptomatology. Comparatively little knowledge is available on protective processes in this population, which may be highly informative in the development of preventive interventions. This chapter reviews findings on resilience in children affected by political violence from a socio-ecological perspective. Despite limitations of current knowledge, the available evidence suggests that strengthening protective processes at the family level may be a fruitful preventive strategy. Furthermore, current knowledge highlights the complexity of sociocultural processes. For example, ideological commitment and religious beliefs may promote mental health but at a larger societal cost, and the promotion of traditional practices may inadvertently be associated with reinforcing stigma or marginalization. We recommend that practitioners interested in building on resilience processes start program development with context-sensitive participative assessments and commit to closely monitoring preventive interventions.

The impact of recurrent disasters on mental health: a study on seasonal floods in northern India

Abstract: Introduction Very little is known on the impact of recurrent disasters on mental health. Aim The present study examines the immediate impact of a recurrent flood on mental health and functioning among an affected population in the rural district of Bahraich, Uttar Pradesh, India, compared with a population in the same region that is not affected by floods. METHODS: The study compared 318 affected respondents with 308 individuals who were not affected by floods. Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25). Psychological and physical functioning was assessed by using the Short Form-12 (SF-12). RESULTS: The affected group showed large to very large differences with the comparison group on symptoms of anxiety (D = .92) and depression (D = 1.22). The affected group scored significantly lower on psychological and physical functioning than the comparison group (respectively D = .33 and D = .80). However, hierarchical linear regressions showed no significant relationship between mental health and the domains of functioning in the affected group, whereas mental health and the domains of functioning were significantly related in the comparison group. CONCLUSION: This study found a large negative impact of the recurrent floods on mental health outcomes and psychological and physical functioning. However, in a context with recurrent floods, disaster mental health status is not a relevant predictor of functioning. The findings suggest that the observed mental health status and impaired functioning in this context are also outcomes of another mechanism: Both outcomes are likely to be related to the erosion of the social and environmental and material context. As such, the findings refer to a need to implement psychosocial context-oriented interventions to address the erosion of the context rather than specific mental health interventions. Wind TR , Joshi PC , Kleber RJ , Komproe IH . The impact of recurrent disasters on mental health: a study on seasonal floods in northern India. Prehosp Disaster Med. 2013;28(3):1-7 . Language: en

Treatment processes of counseling for children in South Sudan: a multiple n=1 design.

Abstract: Studies into treatment processes in low-income settings are grossly lacking, which contributes to the scarcity of evidence-based psychosocial treatment. We conducted multiple n = 1 studies, with quantitative outcome indicators (depression-, PTSD- and anxiety- symptoms, hope) and qualitative process indicators (treatment- perceptions, content and progress) measured before, during and after counseling. We aimed to explore commonalities in treatment processes associated with change profiles within and between cases. The study was conducted in South Sudan with children aged between 10 and 15 years. Change profiles were associated with the quality of the counselor-client relationship (instilling trust and hope through self-disclosure, supportive listening and advice giving), level of client activation, and the ability of the counselor to match treatment strategies to the client’s problem presentation (trauma- and emotional processing, problem solving, cognitive strategies). With limited time, due to restricted resources in low-income settings, training courses can now be better focused on key treatment processes.

Promoting Mental Health and Psychosocial Well-Being in Children Affected by Political Violence: Part II—Expanding the Evidence Base

Abstract: The literature on resilience in children affected by armed conflict is limited by (a) a lack of longitudinal research designs, (b) limited knowledge on transactional processes, (c) sparse findings across diverse sociocultural settings, and (d) poor theoretical development. This chapter describes four recent research projects that were aimed at overcoming some of these limitations. First, we report the findings of a longitudinal study of former child soldiers in Sierra Leone that examined risk and protective processes in psychosocial adjustment and social reintegration. Second, we describe how variables at different ecological levels contributed to outcomes on a measure of positive psychosocial well-being, developed in a participatory way with former child soldiers in Nepal. Third, we highlight the role that single-case studies can play in the development of theory regarding treatment processes, by presenting a study with children affected by armed conflict in Burundi and Sudan. Finally, we describe a study that examined mediators and moderators of intervention effects in a cluster randomized trial of a school-based intervention with children in Indonesia. These examples are meant as an illustration of how advances in longitudinal and multilevel statistics, combined with attention to theory development and a participatory context-sensitive approach, may improve understanding of the complexity of resilience of children in areas of armed conflict.