Abstract
Introduction: The International Committee of the Red Cross runs an increasing number of mental health and psychosocial programmes integrated into health facilities in conflict settings across Africa. This study looks at changes in symptoms of psychological distress and impaired functioning among patients supported through such programmes.Material and Methods: Between January and December 2019, 5,527 victims of violence received mental health and psychosocial support in 29 health facilities in Burundi, Central African Republic, Democratic Republic of the Congo, Mali, Nigeria and South Sudan. Symptoms of psychological distress (IES-R or DASS21) and daily functioning (ICRC scale) were assessed before and after the intervention. Logistical regression models were used to measure associations between these symptoms and the other variables.Results: Factors associated with high distress prior to receiving support included age (peaking at 45–54 years), intervening within three months, rape, caretaker neglect, internal displacement, secondary education level and referral pathway. Anxiety levels in particular were higher among victims of violence committed by unknown civilians, the military or armed groups. Low functioning was associated with divorce, grief and violence committed by the military or armed groups. Following the intervention, the vast majority of patients reported reduced psychological distress (97.25% for IES-R and 99.11% for DASS21) and improved daily functioning (93.58%). A linear trend was found between number of individual sessions and reduction in symptoms of distress. Financial losses were associated with less reduction in symptoms of depression and stress.Discussion: To further address the mental health and psychosocial needs of victims of violence, intervening quickly and increasing the number of individual sessions per patient is crucial. This requires proximity—being in the right place at the right time—which is challenging when working in stable health structures. Symptoms of depression should not be overlooked, and financial losses must be addressed in order to holistically meet the needs of victims of violence.
Highlights
The International Committee of the Red Cross runs an increasing number of mental health and psychosocial programmes integrated into health facilities in conflict settings across Africa
A cross-sectional study of patients in a hospital run by Doctors Without Borders (MSF) in Central African Republic (CAR), found high prevalence rates of posttraumatic stress disorder (PTSD) (33%), acute stress (17%), insomnia (63%), anxiety (45%), and depression (41%), and identified rape, female gender and high anxiety and depression as the main predictors of stress [2]
International Committee of the Red Cross (ICRC)-supported Mental health and psychosocial support (MHPSS) services were available in 25 primary healthcare facilities (PHC) and four hospitals, namely: eight PHCs in Burundi, one hospital and three PHCs in CAR, eight PHCs in Democratic Republic of the Congo (DRC), two hospitals and four PHCs in Mali, one PHC in Nigeria as well as one hospital and one PHC in South Sudan
Summary
Mental health and psychosocial support (MHPSS) is increasingly recognized as an integral part of humanitarian assistance offered to conflict-affected populations. MHPSS in conflict settings is a rapidly growing area of research as scholars and practitioners seek to identify predictors of psychological distress and evidencebased approaches to treatment. With regards to predictors of distress, a systematic review identified age as an important factor for prevalence of posttraumatic stress disorder (PTSD), with a sharp incline in childhood years—peaking at around 25 years—and a decline after 55 years of age [1]. In terms of efficacy of MHPSS interventions in humanitarian settings, a Cochrane study found substantial evidence for reduction in symptoms of Posttraumatic Stress Disorder (PTSD) and depression in adults, while moderate evidence was found for reduction of anxiety in adults [4]. A recent umbrella review found a relatively large amount of evidence pointing to the benefit of psychosocial interventions on various mental health outcomes in low and middle-income countries, at the same time pointing to the need for more research to enhance the evidence base [5]
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