Abstract
BackgroundThere is large gap in mental illness treatment globally and potentially especially so in war-affected populations. The study aim was to examine health care utilization patterns for mental, behavioural and emotional problems among the war-affected adult population in the Republic of Georgia.MethodsA cross-sectional household survey was conducted among 3600 adults affected by 1990s and 2008 armed conflicts in Georgia. Service use was measured for the last 12 months for any mental, emotional or behavioural problems. TSQ, PHQ-9 and GAD-7 were used to measure current symptoms of PTSD, depression and anxiety. Descriptive and regression analyses were used.ResultsRespondents were predominantly female (65.0%), 35.8% were unemployed, and 56.0% covered by the government insurance scheme. From the total sample, 30.5% had symptoms of at least one current mental disorder. Among them, 39.0% sought care for mental problems, while 33.1% expressed facing barriers to accessing care and so did not seek care. General practitioners (29%) and neurologists (26%) were consulted by the majority of those with a current mental disorder who accessed services, while use of psychiatric services was far more limited. Pharmacotherapy was the predominant type of care (90%). Female gender (OR 1.50, 95% CI: 1.25, 1.80), middle-age (OR 1.83, 95% CI: 1.48, 2.26) and older-age (OR 1.62, 95% CI: 1.19, 2.21), possession of the state insurance coverage (OR 1.55, 95% CI: 1.30, 1.86), current PTSD symptoms (OR 1.56, 95% CI: 1.29, 1.90) and depression (OR 2.12, 95% CI: 1.70, 2.65) were associated with higher rates of health service utilization, while employed were less likely to use services (OR 0.71, 95% CI: 0.55, 0.89).ConclusionsReducing financial access barriers and increasing awareness and access to local care required to help reduce the burden of mental disorders among conflict-affected persons in Georgia.
Highlights
Health system responses to mental illness are almost always inadequate, with a large gap between those who require mental health care and those who receive effective treatment [1] [2],[3]
Female gender, middle-age and older-age, possession of the state insurance coverage
Reducing financial access barriers and increasing awareness and access to local care required to help reduce the burden of mental disorders among conflict-affected persons in Georgia
Summary
Health system responses to mental illness are almost always inadequate, with a large gap between those who require mental health care and those who receive effective treatment [1] [2],[3]. The gap is potentially wide in war-affected communities, with their high mental disease burden from the trauma and daily stressors of war and their weak health infrastructure [4],[5],[6]. 40% of the IDPs reside in collective centers, with the remaining IDPs living in private accommodation. IDP communities are characterised by poor living conditions, high unemployment, poverty, limited integration with local communities and financial barriers to access health care and medicines [9],[10],[11]. There is large gap in mental illness treatment globally and potentially especially so in war-affected populations. The study aim was to examine health care utilization patterns for mental, behavioural and emotional problems among the war-affected adult population in the Republic of Georgia
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