Posttraumatic Disorder Research Articles

Psychometric properties of the Specific Phobia Dimensional Scale in an Australian adult community sample

ABSTRACT Objective The Specific Phobia Dimensional Scale (SP-D) is a 10-item scale developed by the Diagnostic and Statistical Manual (Fifth Edition) Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic and Dissociative Disorder work group to supplement current categorical approaches to Specific Phobia (SP) assessment. The aim of the current study was to examine the psychometric properties of the SP-D in an Australian community sample. Method A total of 285 participants (74% female) aged 18–76 years (M = 28.15; SD = 12.01) completed the study. A smaller subsample (n = 18) completed the measures of interest a second time to examine test–retest reliability. Results Confirmatory factor analysis indicated a unidimensional factor structure of the SP-D (root mean square error of approximation [RMSE] = 0.13; comparative fit index [CFI] = 0.94). Internal consistency and test–retest reliability was high (a = 0.95 and Intraclass Correlation Coefficient [ICC] = 0.95, respectively). The measure demonstrated adequate convergent validity with the Specific Phobia Questionnaire (SPQ; r s = 0.54), and unsatisfactory divergent validity with the Fear Questionnaire – Agoraphobia subscale (FQ-Ag; r s = 0.45). Conclusions Overall, the findings suggest that the SP-D can reliably and briefly measure SP symptoms within an Australian community sample. Further research is required to investigate divergent validity. Replication of the test–retest results are required due to small sample size. Overall, this study is limited in its female-biased convenience sample and recruitment methodologies.

Potential Role of Soundscape and Music Interventions in post-Intensive Care Rehabilitation

Background Post Intensive Care Unit (ICU) survivors face physical, psychological, and cognitive impairments during their recovery phase, adversely affecting their quality of life. Given the scarcity and barriers to access to post-ICU care worldwide, patient-centered adjuncts are worth exploring. Although music interventions have gained recognition as non-pharmacological approaches in the acute phase of critical illness; exploration of their potential benefits in the post-ICU is scarce. Objective This paper examines the potential of sound and music interventions as an adjunct therapeutic modality to improve the well-being of adults post-ICU patients, through a narrative overview of published research evidence regarding post-ICU recovery and other relevant post-acute conditions, such as post-traumatic disorder and anxiety. Results The effectiveness of sound/ music interventions on several key outcomes including reduced anxiety, stress, pain, and PTSD, improved sleep, and enhanced mood and emotional well-being have been studied. Research indicates that music-based approaches to physical and psychological well-being reduce emotional distress, foster connectedness, and improve overall well-being. The importance of tailoring sound and music interventions to the individual needs and preferences of post-ICU patients is emphasized. Conclusion The potential benefits of sound and music interventions, both in terms of physiological and psychological well-being, encourage further investigation into their potential application and implementation into post-ICU care and rehabilitation. Ultimately, this therapeutic approach could contribute to enhancing the overall quality of life and empowerment of post-ICU patients on their path to recovery.

Effectiveness of Drama and music therapies as health communication interventions for reducing anxiety and posttraumatic disorders among children-victims of flood

This study examined the usefulness of drama and music therapies as communication strategies for reducing symptoms of post-traumatic stress disorder (PTSD) and generalised anxiety disorder (GAD) among school children (aged 10-16) who were victims of the 2022 floods in Nigeria. The researchers randomly assigned the children to control (n=122) drama therapy (n=120) and music therapy (n=120) groups. The result of the study revealed that after the intervention, school children in the drama and music therapies (unlike those in the control group) reported a significant reduction in their PTSD and GAD symptoms; the reduction achieved statistical significance (p=0.001, ηp2 =.48). Further results revealed a significant interactive effect of gender (p=0.001) with boys reporting a significant reduction more than girls. The results showed that drama therapy contributed more to reducing PTSD symptoms, while music therapy contributed more to reducing GAD symptoms. The difference did not achieve statistical significance (p=0.23). The researchers conclude that both drama and music therapies were associated with reduced symptoms, indicating the interventions may be beneficial therapies.

Chronic pain over time among Syrian refugees resettled in Norway

Abstract Background Chronic pain disproportionately impacts vulnerable groups such as migrants and refugees. This study investigates the long-term changes in chronic pain experienced by Syrian refugees in Norway and explores the factors influencing these changes. Methods This prospective cohort study used data from the CHART and Integration for Health studies, with data collection at three points: in Lebanon (Wave-1), one year (Wave-2), and four years post-arrival in Norway (Wave-3). All participants who completed surveys at these timepoints were included (n = 132). Chronic pain was measured by asking about pain lasting at least six months. Mixed-effects logistic regression was used to examine changes in prevalence and assess how age, gender, educational level (categorized as low, ≤9 years, and high, >9 years), and mental health symptoms (anxiety, depression, and post-traumatic disorders) affect these changes. Results Between Wave-1 and Wave-3, the proportion of participants reporting chronic pain increased from 31% to 53%, with an odds ratio of 3.6 (95% CI 2.2 - 5.8). There was an interaction between changes in chronic pain over time and participants’ educational level, where the increase in pain prevalence over time was more pronounced among participants with lower educational levels than higher levels. No modification with the other factors were detected. Conclusions The study observed an increase in the number of participants reporting chronic pain over time. Low educational level at baseline emerged as a useful indicator for identifying those at higher risk of chronic pain. Understanding this correlation can be crucial for guiding preventive strategies and optimizing resource allocation to assist those most vulnerable. Key messages • Chronic pain disproportionately impacts vulnerable groups such as refugees. • Refugees with lower education levels at baseline were more likely to experience chronic pain over time.

Paying attention to uncertainty: A stochastic multimodal transformers for post-traumatic stress disorder detection using video

Background and Objectives:Post-traumatic stress disorder is a debilitating psychological condition that can manifest following exposure to traumatic events. It affects individuals from diverse backgrounds and is associated with various symptoms, including intrusive thoughts, nightmares, hyperarousal, and avoidance behaviors. Methods:To address this challenge this study proposes a decision support system powered by a novel multimodal deep learning approach, based on a stochastic Transformer and video data. This Transformer has the ability to take advantage of its stochastic activation function and layers that allow it to learn sparse representations of the inputs. The method leverages a combination of low-level features extracted using three modalities, including Mel-frequency cepstral coefficients extracted from audio recordings, Facial Action Units captured from facial expressions, and textual data obtained from the audio transcription. By considering these modalities, our proposed model captures a comprehensive range of information related to post-traumatic stress disorder symptoms, including vocal cues, facial expressions, and linguistic content. Results:The deep learning model was trained and evaluated on the eDAIC dataset, which consists of clinical interviews with individuals with and without post-traumatic disorder. The model achieved state-of-the-art results, demonstrating its effectiveness in accurately detecting PTSD, showing an impressive Root Mean Square Error of 1.98, and a Concordance Correlation Coefficient of 0.722, signifying the model’s superior performance compared to existing approaches. Conclusion:This work introduces a new method for post-traumatic stress disorder detection from videos by utilizing a multimodal stochastic Transformer model. The model makes use of a variety of modalities, such as text, audio, and visual data, to gather comprehensive and varied information in order to make the detection.

Posttraumatic stress disorder increases thrombosis risk: Evidence from a biobank data set.

Depression and anxiety are linked to deep venous thrombosis (DVT) and posttraumatic disorder (PTSD) increases risk of venous thromboembolism in women. However, the mechanisms underlying this relationship remain unknown. We hypothesized that PTSD would associate with increased DVT risk, that neuroimmune mechanisms would mediate the PTSD-DVT link, and that these associations would be stronger in women. This cohort study included N = 106 427 participants from a large biobank. PTSD and DVT were defined using ICD-10 codes. A subset (N = 1520) underwent imaging, from which we assessed stress-associated neural activity (SNA). High-sensitivity C-reactive protein (hs-CRP) levels and heart rate variability (HRV) were used as indicators of systemic inflammation and autonomic activity, respectively. Linear, logistic, and Cox regressions and mediation analyses were used to test our hypotheses. Of 106 427 participants, 4192 (3.9%) developed DVT. PTSD associated with increased DVT risk (HR [95% CI]: 1.66 [1.34, 2.07], p < .001), and this finding remained significant after adjustment for age, sex, and traditional DVT risk factors. When analyzed separately by sex, PTSD was significantly associated with DVT risk in women but not men. Further, heightened SNA and lower HRV mediated the effect of PTSD on DVT risk. Results suggest that individuals with PTSD are at increased risk for DVT, and that risk is higher in women. This relationship was partially driven by alterations in stress-associated neural activity and autonomic function, suggesting potential targets for preventive therapies. Future studies are needed to investigate whether intervening on PTSD-DVT mechanisms has downstream beneficial effects on DVT, especially among women.

Post-traumatic cognitive disorders: the cholinergic therapy options

Traumatic brain injury (TBI) is one of the most common causes of neurological disability in young and middle-aged people. Cognitive impairment is the most persistent and universal brain injury syndrome in cases of TBI and, moreover, the best indicator of TBI severity to predict its outcome. Cognitive impairment can persist persistently even after mild TBI, which accounts for 70–90 % of the total number of trauma patients. This may be due to the fact that in cases of mild TBI, the most fragile functions of integrative structures of the frontal and temporal lobes are slowly and not always completely recovered and the dominant clinical manifestation become complex neuropsychological disorders. Individuals with repeated mild TBI are characterized by development of chronic post-traumatic encephalopathy, that is a kind of neurodegenerative disease manifested by slowly increasing cognitive impairment, parkinsonism and a number of other neurological syndromes. Early detection and adequate correction of the cognitive impairments may improve the outcome of injury of diverging severity. Due to the fact that the pathogenesis of TBI is based on disorder of cholinergic system, the patients have predominance of regulatory disorders in the neuropsychological profile, as well as a combination of cognitive and affective disorders. Administration of acetylcholine precursors leads to rapid increase of free choline levels in plasma that penetrates the blood-brain barrier well and enhances cholinergic activity by increasing acetylcholine synthesis and release. The article considers the possibilities of using acetylcholine precursors in connection with their potential to block the progressive impairment of cognitive functions induced by trauma as well as to reduce severity of behavioral and affective disorders.

Treatment of post-traumatic cognitive disorders and asthenia: results of an observational study

Treatment of post-traumatic cognitive disorders and asthenia: results of an observational study

The "Double Victim Phenomenon"-Results From a National Pilot Survey on Second Victims in German Family Caregivers (SeViD-VI Study).

Second-victim phenomena may lead to severe reactions like depression or posttraumatic disorder, as well as dysfunction and absenteeism. Medical error as a cause for second victims is not limited to professionals, as family caregivers care for millions of patients at home. It remains unclear whether these are first, second, or double victims in case of error. This explorative study investigated whether second victim effects and signs of moral injury are detectable in family caregivers and whether existing instruments are applicable in lay persons. In an open convenience sampling online survey, we recruited 66 German family caregivers. Propensity score matching was conducted to obtain a balanced sample of family caregivers and qualified nurses who took part in the previous study by adjusting for age and sex. The groups were compared regarding the German Version of the Second Victim Experience and Support Tool-Revised and the German version of the Moral Injury Symptom and Support Scale for Health Professionals. Sixty-six caregivers participated, of whom 31 completed the survey. Of all, 58% experienced a second victim-like effect, 35% experienced a prolonged effect, and 45% reported to still suffer from it. In a matched sample (22 family caregivers and 22 nurses), no significant differences were observed between the groups. Regarding the limitations of this pilot study, demanding for resampling in larger populations, we could show that second victim effects and moral injury are detectable in family caregivers by validated instruments and are not inferior to professionals' experiences. Concerning the demand for further studies, we confirmed the applicability of the testing instruments but with need for item reduction to lower response burden.

ТИПОЛОГИЯ СУБЪЕКТИВНОГО ВОСПРИЯТИЯ ПСИХОЛОГИЧЕСКОГО НАСИЛИЯ В СТАРШЕМ ПОДРОСТКОВОМ ВОЗРАСТЕ

The present article discusses the results of the study of subjective perception of psychological violence by different characterological types. The application of the results of this study allows to increase the level of safety of the educational environment, to build psychological and peda-gogical work in the field of psychological education of parents, as well as to teach teachers con-structive forms of interaction with children, taking into account their subjective perception of psychological violence depending on the characterological type. In modern psychological sci-ence, the study of psychological violence and personal traumatization is a cutting-edge direction in the field of providing a safe environment for both students and educators. Psychological vio-lence represents various forms of behavior, consciously or unconsciously aimed at causing psy-chological pain using verbal or nonverbal communication. Under the forms of psychological vio-lence we understand threats, insults, manipulation, ignoring and so on. Such forms of psycholog-ical violence have an extremely destructive effect on a person, contributing to the development of borderline conditions and such mental disorders as depression, complex post-traumatic disor-der, etc. Understanding the peculiarities of perception of psychological violence will allow educational psychologist to significantly improve the quality of counseling work with both parents and teachers, which increases the chances of building the safest educational environment. Further research in the direction of studying the peculiarities of subjective perception of psychological violence will allow scientists to study in more detail the issues of traumatization and correction in connection with the peculiarities of characterological types.

항공사 객실승무원의 직장 내 괴롭힘, 소진, 외상 후 울분장애(PTED) 간의 영향 관계

Cabin crews work in high-stress and high-pressure environments, yet the issue of workplace harassment they face has not been adequately addressed. Workplace harassment causes psychological distress and anxiety, which not only undermine cabin crews' job satisfaction and productivity but also compromise the safety and well-being of both cabin crews and passengers. However, the majority of existing studies on workplace harassment have primarily adopted an organizational perspective, thereby neglecting the individual experiences of cabin crews. This study seeks to address this gap by examining the structural relationships between workplace harassment and its effects on burnout and post-traumatic embitterment disorder (PTED) among cabin crews in both full-service and low-cost carriers in Korea. Survey data were collected from 399 respondents. The results indicate that workplace harassment significantly exacerbates the emotional exhaustion and depersonalization dimensions of burnout, although it does not significantly reduce personal accomplishment. Moreover, both workplace harassment and burnout substantially contribute to PTED, with an average PTED score among participants being 1.746, which indicates a significant level of long-term embitterment. These findings provide foundational data needed in developing intervention programs to enhance the mental health and quality of life of cabin crews and in creating healthier work environments at the corporate level, considering organizational dynamics and service performance.

Morally injurious events and posttraumatic embitterment disorder in U.K. health and social care professionals during COVID-19: A longitudinal web survey.

To longitudinally estimate the prevalence and predictors of potentially morally injurious events (PMIEs) and posttraumatic embitterment disorder (PTED) and in U.K. health and social care workers (HSCWs) during the COVID-19 pandemic. Additionally, to investigate the mechanism by which PMIEs increase embitterment by lowering personal belief in procedural justice, that is, the belief that they experience fair processes. An online longitudinal survey was hosted on Qualtrics between September-October 2020 and September-November 2021. Using Prolific, 400 HSCWs aged 18 or above and working in the United Kingdom during the pandemic were recruited. PMIEs were assessed using the Moral Injury Events Scale, and PTED was assessed using the PTED self-rating scale. Potential predictors were measured using surveys of exposure to occupational stressors, optimism, pessimism, self-esteem, resilient coping style, consideration of future consequences, and personal just world beliefs. Seventy-one percent of participants experienced at least one COVID-related PMIE and 20% displayed clinically relevant signs of PTED at Time 2 in 2021. Exposure to occupational stressors increased the risk of experiencing PMIEs and PTED, whereas personal belief in a procedurally just world protected against transgressions by others and betrayal PMIEs. Self-esteem was protective, and a resilient coping style was a risk for experiencing betrayal. PMIEs increased embitterment by lowering personal belief in procedural justice over a 12-month period. PMIEs and PTED are being experienced by U.K. HSCWs in 2020 and 2021, particularly in those exposed to work-related stressors. Exposure to PMIEs increases the risk of embitterment by lowering belief in procedural justice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Morally Injurious Events and Posttraumatic Embitterment Disorder in U.K. Health and Social Care Professionals During COVID-19: A Longitudinal Web Survey

Supplemental Material for Morally Injurious Events and Posttraumatic Embitterment Disorder in U.K. Health and Social Care Professionals During COVID-19: A Longitudinal Web Survey

Medial anterior prefrontal cortex stimulation downregulates implicit reactions to threats and prevents the return of fear.

Downregulating emotional overreactions toward threats is fundamental for developing treatments for anxiety and post-traumatic disorders. The prefrontal cortex (PFC) is critical for top-down modulatory processes, and despite previous studies adopting repetitive transcranial magnetic stimulation (rTMS) over this region provided encouraging results in enhancing extinction, no studies have hitherto explored the effects of stimulating the medial anterior PFC (aPFC, encompassing the Brodmann area 10) on threat memory and generalization. Here we showed that rTMS over the aPFC applied before threat memory retrieval immediately decreases implicit reactions to learned and novel stimuli in humans. These effects enduringly persisted 1 week later in the absence of rTMS. No effects were detected on explicit recognition. Critically, rTMS over the aPFC resulted in a more pronounced reduction of defensive responses compared to rTMS targeting the dorsolateral PFC. These findings reveal a previously unexplored prefrontal region, the modulation of which can efficiently and durably inhibit implicit reactions to learned threats. This represents a significant advancement toward the long-term deactivation of exaggerated responses to threats.

Suicidality Among Bereaved Families After the Sewol Ferry Disaster: A Longitudinal Study

This study aimed to investigate the relationship between suicidality and various mental health problems using longitudinal follow-up data in bereaved families after the Sewol ferry disaster. Data from 226 participants gathered over 7 years (2015–2021) were used. Suicidal risk was measured and mental health variables including depression, insomnia, post-traumatic embitterment disorders(PTED), complicated grief were gathered. A series of Generalized Estimating Equation models were developed to identify the factors associated with potential suicide risk among the bereaved family members of the Sewol ferry disaster. Participants with depression, clinically significant PTED, and complicated grief were associated with suicidal ideation, suicide plan, and having suicide preventive factors. Participants with prolonged PTED were also associated with suicide plan and having suicide preventive factors. The probability of having suicide ideation (from the fourth to the seventh year) and suicide preventive factors (in the fifth year) was significantly decreased compared to the first year since the disaster occurred. This study provided evidence by illuminating the long-term prognosis of suicide risk in disaster-affected families and its correlation with mental health factors. It offered a valuable insight that interventions addressing depression, PTED, and complicated grief are necessary in the long term to reduce their suicide risk.

Connectivity of EEG and fMRI network in the resting state in healthy people and patients with post-traumatic disorder of consciousness

Recovery of consciousness in patients with post-comatose unconscious states after severe traumatic brain injury and the search for their objective markers are among the urgent medical and social problems. To clarify the information content and the degree of consistency of changes in hemodynamic and bioelectrical parameters, in this work we carried out comparative studies of fMRI networks and EEG connectivity at rest in healthy subjects, as well as in patients with post-traumatic disorders of consciousness before and after therapeutic rhythmic transcranial magnetic stimulation (rTMS). It was shown that the characteristics of the functional connectivity of fMRI and EEG at rest are among the informative markers of neuroplasticity during depression of consciousness. A certain topographic correspondence between the fMRI networks and the EEG integral connectivity pattern at rest was established, regardless of the modification of the latter assessment: in the continuous recording mode or pseudo-EP. At the same time, the method of independent fMRI components more clearly reveals the features of the state of individual neural networks, and the indicators of EEG functional connectivity (range 1–15 Hz) are more informative in assessing the integral neural network characteristics and their changes during treatment.

Association of type 2 diabetes with family history of diabetes, diabetes biomarkers, mental and physical disorders in a Kenyan setting

This study aimed to determine the degree of family relations and associated socio-demographics characteristics, clinical/physical and mental disorders in type 2 diabetes mellitus in a Kenyan diabetes clinic. This study was part of a large multicentre study whose protocol and results had been published. It took place at the outpatient diabetes clinic at a County Teaching and Referral Hospital in South East Kenya involving 182 participants. We used a socio-demographic questionnaire, the Hamilton Depression (HAM-D) and PHQ-9 rating scales for depression, the MINI International Neuropsychiatric Interview (MINI; V5 or V6) for DSM-5 diagnoses, the WHO-5 Well-being scale and Problem Areas in Diabetes Scale (PAID). We extracted from the notes all physical conditions. We enquired about similar conditions in 1st and 2nd degree relatives. Descriptive, Chi-square test, Fisher’s exact test, one way ANOVA, and Multinomial logistic regression analysis were conducted to test achievements of our specific aims. Of the 182 patients who participated in the study, 45.1% (82/182) reported a family history of diabetes. Conditions significantly (p < 0.05) associated with a degree of family history of diabetes were retinopathy, duration of diabetes (years), hypertension, and depressive disorder. On average 11.5% (21/182) scored severe depression (≥ 10) on PHQ-9 and 85.2% (115/182) scored good well-being (≥ 13 points). All DSM-5 psychiatric conditions were found in the 182 patients in varying prevalence regardless of relations. In addition, amongst the 182 patients, the highest prevalence was poor well-being on the WHO quality of life tool. This was followed by post-traumatic disorders (current), suicidality, and psychotic lifetime on DSM-5. The least prevalent on DSM-5 was eating disorders. Some type 2 diabetes mellitus physical disorders and depression have increased incidence in closely related patients. Overall, for all the patients, the prevalence of all DSM-5 diagnoses varied from 0.5 to 9.9%.

The gut microbiota and post-traumatic major depression disorder: insights from bidirectional two-sample Mendelian randomization.

Exposure to trauma is often associated with an increased incidence of Major Depressive Disorder (MDD), yet the mechanisms underlying MDD development post-trauma remain elusive. The microbiota-gut-brain axis has been implicated in neuropsychiatric disorders, suggesting its potential role in post-traumatic MDD (PTMDD) development. Our study aimed to assess the significance of the gut microbiome-brain interaction in PTMDD. We conducted a bidirectional two-sample Mendelian Randomization (MR) analysis to investigate the causal relationship between the gut microbiota and both PTMDD and trauma exposure in MDD. Genome-wide association study (GWAS) summary datasets for PTMDD and trauma exposure in MDD, both derived from the UK Biobank. The PTMDD dataset included 24,090 individuals (13,393 cases and 10,701 controls), while the dataset for trauma exposure in MDD comprised 22,880 participants (13,393 cases and 9,487 controls). Additionally, gut microbiota data from the MiBioGen consortium included 14,306 European individuals across 18 diverse cohorts. Our research identified a significant negative association between the phylum Verrucomicrobia (odds ratio (OR) [95% confidence interval (CI)] =0.799 [0.684-0.933], P=0.005) and the risk of developing PTMDD, suggesting a protective role for Verrucomicrobia against PTMDD. Conversely, our findings indicate no causal effects of the gut microbiota on trauma exposure in MDD. However, reverse analysis revealed that both PTMDD and MDD influence certain bacterial traits, affecting 5 and 9 bacterial traits, respectively. Moreover, Verrucomicrobia (OR [95% CI] = 1.166 [1.051 - 1.294], P=0.004) was found to be positively impacted by trauma exposure in MDD. Our findings provide a cause-and-effect relationship between the gut microbiota and PTMDD, contributing to our understanding of the microbiota-gut-brain axis and its role in neuropsychiatric disorder development after trauma. This information provides an opportunity for new treatment and prevention methods which are aimed at the gut-brain interaction.

Tics Temporally Associated with Mild Traumatic Brain Injury in Pediatric Patients: A Sui Generis Case Series

Traumatic brain injury (TBI) is a major public health concern in Canada, with falls, blows to the head, car accidents, and sports-related injuries being the leading causes. Post-traumatic movement disorders, such as tics, can occur after a TBI, but their association with mild TBIs has been less explored. This manuscript presents two pediatric cases of de novo tics following mild TBIs, shedding light on this unique phenomenon. Possible mechanisms linking mild TBI and tics, such as genetic predisposition and stress-induced activation of the hypothalamic-pituitary-adrenal axis, are discussed. This paper emphasizes the importance of recognizing tics as a potential consequence of mild TBIs in children, and underscores the need for further research to shed light on the mechanism involved.

Practical challenges for mental health services among Rohingya refugee in Bangladesh

Rohingya Muslims have been forcefully displaced from their mother land, Rakhaine State, Myanmar to Bangladesh, a country with about 170 million population with a treatment gap of more than 90% for standard mental health care. Due to the experienced trauma and displacement, high prevalence of depression, anxiety and post-traumatic tress disorders has been identified among Rohingya refugees in addition to the enduring mental health burden of Bangladesh. Very little has been known regarding the practical challenges of mental health services among Rohingya refugees in Bangladesh. In this commentary, we aimed to highlight the practical challenges for mental health services in Rohingya camps in Bangladesh along with our speculative ways forward based on available evidence, work experience, and informal communications. We highlighted the available mental health services, several major challenges including awareness, perception and belief towards mental health, language and cultural barriers, dearth of skilled service providers, inadequate services for severe mental illness, dearth of mental health services for children, inadequate provision of supervision and ‘Care for Caregivers’ program, and privacy and confidentiality of the clients. Although significant improvements have been made in the mental health field in the emergency crisis sector in Cox's Bazar over the past years, concentrated efforts are urgently required to actualize proposed solutions in this paper.