Abstract
Compared to psychosocial programs implemented in post-conflict settings those executed in areas of ongoing conflicts may have different effects. Their evidence of efficacy has never been systematically reviewed. We searched PubMed, PsychInfo and the Dutch Tropical Institute Literature Portal from inception to31 January 2013 to identify studies on community-oriented psychosocial and psychiatric/clinical services for adults during ongoing manmade conflict or its direct aftermath. Of 6358 articles screened, 16 met our inclusion criteria. The interventions varied from psycho-educational to psychotropic drugs. The review is presented using outcome indicators such as PTSD, anxiety, depression, physical health, functioning and well being. A substantial improvement of some outcome was found though the small number of studies and their heterogeneity did not justify strong conclusions. PTSD symptoms improved significantly by treatments that included exposure (such as narrative exposure therapy). A number of studies (eight) showed notable improvement of the client’s functioning through counseling interventions. Depression and anxiety both improved considerably using that culturally adapted interventions (two studies), whereas non-culturalized interventions did not. We found a notable lack of studies on the efficacy of medication and on preferred western, evidence-based interventions for PTSD such Eye Movement Desensitization. To measure outcomes only two studies applied locally-developed diagnostic labels and validated instruments. Future research should encourage the use of robust research methods that are culturally valid, including mixed-methods research to combine measurable outputs with qualitative research aimed at improved understanding from the client’s perspective.
Highlights
Interventions to strengthen community and family support systems, often referred to as psychosocial programs, are reported to be effective in improving the mental health status of populations in humanitarian contexts [1]
It has been suggested that daily stressors such as poverty, inadequate medical care, marginalization, and lack of basic resources such as food or shelter rather than war related experiences may explain a substantial part of the variance in mental health symptoms in contexts of ongoing violence [3]
Twelve studies were conducted during ongoing conflicts, one was started during war and finished 3 years post-war [6]; and three were undertaken during the post-conflict period but within the 3-year pre-specified period [7]-[9]
Summary
Interventions to strengthen community and family support systems, often referred to as psychosocial programs, are reported to be effective in improving the mental health status of populations in humanitarian contexts [1]. There is a greater risk to develop mental health and psychosocial problems than in post-conflict situations [2]. It has been suggested that daily stressors such as poverty, inadequate medical care, marginalization, and lack of basic resources such as food or shelter rather than war related experiences may explain a substantial part of the variance in mental health symptoms in contexts of ongoing violence [3]. A study done among Bosnian refugees undertaken more than three years after the conflict [4] found that despite an overall reduction of psychological problems, probably caused by the reduction of conflict and direct related daily stressors, serious mental health pathology persists or even develops for a specific group. We speculate that the effectiveness of typical psychosocial interventions such as counseling may differ because a different set of problems and symptoms is addressed in different stages of the conflict
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