Showing papers by "Ivan H. Komproe published in 2014"
TL;DR: Findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children, but results suggest the potential benefit of school- based preventive interventions particularly in post-conflict settings.
Abstract: Background: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). Methods: We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. Results: No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes.
127 citations
TL;DR: The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates, and reports are likely to diminish rather than exaggerate the magnitude of suicide rates.
Abstract: Globally, suicide is an important cause of mortality. In low- and middle income settings, it is difficult to find unequivocal data to establish suicide rates. The objective of this review is to synthesize the reporting of suicide incidence in six south Asian countries. We conducted a scoping review combining peer-reviewed studies (PubMed, PsycINFO, EMBASE) with in-country searches for grey literature in Afghanistan, Pakistan, Sri Lanka, India, Nepal and Bangladesh. The review included mapping reported suicide rates, quality appraisals of the studies, use of definitions of suicide and means of committing suicide. In total, 114 studies and reports were included in the review, including 50 peer-reviewed publications. Reported suicide rates varied widely from 0.43/100,000 to 331.0/100,000. The average suicide rate across studies was found to be high compared to the world average, however many studies were of poor quality or not representative. The majority of studies failed to explicitly define suicide (84% of the published articles and 92% of the grey literature documents). Poisoning and hanging were consistently the most common methods of committing suicide on the sub-continent. The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates in South Asia. Reports are likely to diminish rather than exaggerate the magnitude of suicide rates. There is an urgent need to establish new, or evaluate existing, national suicide surveillance systems in the South Asian countries.
81 citations
TL;DR: The DSRS and CPSS showed good utility in detecting depressive disorder and posttraumatic stress disorder in Burundian children, but cut-off points had to be put considerably higher than in western norm populations.
Abstract: In Sub Saharan Africa, there has been limited research on instruments to identify specific mental disorders in children in conflict-affected settings. This study evaluates the psychometric properties of three self-report scales for child mental disorder in order to inform an emerging child mental health programme in post-conflict Burundi. Trained lay interviewers administered local language versions of three self-report scales, the Depression Self-Rating Scale (DSRS), the Child PSTD Symptom Scale (CPSS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED-41), to a sample of 65 primary school children in Burundi. The test scores were compared with an external ‘gold standard’ criterion: the outcomes of a comprehensive semistructured clinical psychiatric interview for children according the DSM-IV criteria (the Schedule for Affective Disorders and Schizophrenia for School-Age Children – K-SADS-PL). The DSRS has an area under the curve (AUC) of 0.85 with a confidence interval (c.i.) of 0.73–0.97. With a cut-off point of 19, the sensitivity was 0.64, and the specificity was 0.88. For the CPSS, with a cut-off point of 26, the AUC was 0.78 (c.i.: 0.62–0.95) with a sensitivity of 0.71 and a specificity of 0.83. The AUC for the SCARED-41, with a cut-off point of 44, was 0.69 (c.i.: 0.54–0.84) with a sensitivity of 0.55 and a specificity of 0.90. The DSRS and CPSS showed good utility in detecting depressive disorder and posttraumatic stress disorder in Burundian children, but cut-off points had to be put considerably higher than in western norm populations. The psychometric properties of the SCARED-41 to identify anxiety disorders were less strong. The DSRS and CPSS have acceptable properties, and they could be used in clinical practice as part of a two-stage screening procedure in public mental health programmes in Burundi and in similar cultural and linguistic settings in the African Great Lakes region.
28 citations
TL;DR: This study explains this variation in rates of mental health outcomes across disaster studies by putting forward 2 methodological problems that are inherent to the effect of a disaster context on mental health screening scores.
Abstract: Many scholars question the immense variation in rates of mental health outcomes across disaster studies. This study explains this variation by putting forward 2 methodological problems that are inherent to the effect of a disaster context on mental health screening scores. The Hopkins Symptom Checklist-25 was administered in a flood-affected group (n = 318) and a nonaffected group (n = 304) in Uttar Pradesh, India. The affected group showed much higher mean scores on subscales of anxiety and depression. However, factor analyses (i.e., confirmatory factor analyses [CFA] and multilevel confirmatory factor analyses [MCFA]; Muthen, 1994) revealed 2 methodological phenomena that account for the differences in scores. First, the outcomes revealed that a large proportion of covariance between observed mental health variables did not refer to the latent concepts of interest (depression and anxiety), but to the context of both groups (disaster affected vs. nonaffected). The shared effect of the disaster on the context explained a large proportion of the covariances between the items and biased outcomes. Second, after dissecting this group variance, the construct validity of the assessments of anxiety and depression was revealed to be poor and unstable across both groups. The subscales of anxiety and depression referred to different concepts in both groups. These 2 methodological problems have not been discussed thus far, but they contribute to the variation in mental health outcomes across disaster studies.
5 citations
TL;DR: Recently additional information on Age available by another variable in the authors' dataset was discovered and changes were made to the procedure, the conclusions, or the merits/essential message of the original article.
1 citations