Conference Material > Poster
Al Laham D, Ali E, Moussally K, Nahas N, Alameddine A, et al.
MSF Scientific Days International 2020. 2020 May 13; DOI:10.7490/f1000research.1117937.1
• Since 2011, the conflict in Syria has had a huge impact on its population, many of whom are now displaced
• The Syrian crisis has not only affected the physical health of refugees, but has also had a drastic effect on their mental health
• Wadi Khaled, a rural district in the north of Lebanon, hosts about 36,000 displaced Syrians, and is one of most under-served and marginalized areas of Lebanon
• Médecins Sans Frontières (MSF) has been providing mental health services to Syrian refugees and the Lebanese host population in Akkar, Wadi Khaled since 2016.
• The Syrian crisis has not only affected the physical health of refugees, but has also had a drastic effect on their mental health
• Wadi Khaled, a rural district in the north of Lebanon, hosts about 36,000 displaced Syrians, and is one of most under-served and marginalized areas of Lebanon
• Médecins Sans Frontières (MSF) has been providing mental health services to Syrian refugees and the Lebanese host population in Akkar, Wadi Khaled since 2016.
Protocol
BMJ Open. 2017 February 1; Volume 7 (Issue 2); e014067.; DOI:10.1136/bmjopen-2016-014067
Smith SL, Misago CN, Osrow RA, Franke MF, Iyamuremye JD, et al.
BMJ Open. 2017 February 1; Volume 7 (Issue 2); e014067.; DOI:10.1136/bmjopen-2016-014067
Integrating mental healthcare into primary care can reduce the global burden of mental disorders. Yet data on the effective implementation of real-world task-shared mental health programmes are limited. In 2012, the Rwandan Ministry of Health and the international healthcare organisation Partners in Health collaboratively adapted the Mentoring and Enhanced Supervision at Health Centers (MESH) programme, a successful programme of supported supervision based on task-sharing for HIV/AIDS care, to include care of neuropsychiatric disorders within primary care settings (MESH Mental Health). We propose 1 of the first studies in a rural low-income country to assess the implementation and clinical outcomes of a programme integrating neuropsychiatric care into a public primary care system.
METHODS AND ANALYSIS
A mixed-methods evaluation will be conducted. First, we will conduct a quantitative outcomes evaluation using a pretest and post-test design at 4 purposively selected MESH MH participating health centres. At least 112 consecutive adults with schizophrenia, bipolar disorder, depression or epilepsy will be enrolled. Primary outcomes are symptoms and functioning measured at baseline, 8 weeks and 6 months using clinician-administered scales: the General Health Questionnaire and the brief WHO Disability Assessment Scale. We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members.
ETHICS AND DISSEMINATION
This evaluation was approved by the Rwanda National Ethics Committee (Protocol #736/RNEC/2016) and deemed exempt by the Harvard University Institutional Review Board. Results will be submitted for peer-reviewed journal publication, presented at conferences and disseminated to communities served by the programme.
METHODS AND ANALYSIS
A mixed-methods evaluation will be conducted. First, we will conduct a quantitative outcomes evaluation using a pretest and post-test design at 4 purposively selected MESH MH participating health centres. At least 112 consecutive adults with schizophrenia, bipolar disorder, depression or epilepsy will be enrolled. Primary outcomes are symptoms and functioning measured at baseline, 8 weeks and 6 months using clinician-administered scales: the General Health Questionnaire and the brief WHO Disability Assessment Scale. We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members.
ETHICS AND DISSEMINATION
This evaluation was approved by the Rwanda National Ethics Committee (Protocol #736/RNEC/2016) and deemed exempt by the Harvard University Institutional Review Board. Results will be submitted for peer-reviewed journal publication, presented at conferences and disseminated to communities served by the programme.
Journal Article > ResearchFull Text
Front Public Health. 2016 July 4; Volume 4; 142.; DOI:10.3389/fpubh.2016.00142
Rabelo I, Lee VS, Fallah MP, Massaquoi M, Evlampidou I, et al.
Front Public Health. 2016 July 4; Volume 4; 142.; DOI:10.3389/fpubh.2016.00142
INTRODUCTION
A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community.
METHODS
Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data.
RESULTS
The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients’ isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor’s network were ways to give a meaning to life post-Ebola.
CONCLUSION
Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.
A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community.
METHODS
Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data.
RESULTS
The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients’ isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor’s network were ways to give a meaning to life post-Ebola.
CONCLUSION
Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.
Journal Article > ResearchFull Text
J Clin Psychol. 2003 January 1; Volume 59 (Issue 1); DOI:10.1002/jclp.10118
Mooren TTM, de Jong K, Kleber RJ, Ruvic J
J Clin Psychol. 2003 January 1; Volume 59 (Issue 1); DOI:10.1002/jclp.10118
The efficacy of a community-based psychosocial program in Bosnia-Herzegovina during the war and immediate postwar years (1994-1999) was described in this article. Ten centers provided various kinds of psychological help in the besieged city of Sarajevo and the towns of Zenica, Travnik, and Vitez. Since 1994, an intensive monitoring system has documented data on clients, interventions, and outcomes. This study focused on the systematic evaluation of counseling interventions aimed to alleviate the distress in wartime. The sample consisted of 3,283 and 1,785 inhabitants of Sarajevo, Zenica, Travnik, and Vitez who filled out the GHQ-28 and IES respectively. Pre- and post-assessments were compared throughout consecutive years (1994-1999) and across age groups and both sexes. Outcomes of these scales reflected very high scores, especially among people between 30 and 40 years of age. Furthermore, intake scores increased in time rather than decreased. Differences between pre- and postmeasurements are highly significant--throughout the years. Analyses revealed substantial proportions of clinically recovered or generally improved individual functioning, although some clients revealed no improvement.
Journal Article > ResearchAbstract
J Trop Pediatr. 2011 January 6; Volume 57 (Issue 6); DOI:10.1093/tropej/fmq117
Espie E, Ouss L, Gaboulaud V, Candilis D, Ahmed KA, et al.
J Trop Pediatr. 2011 January 6; Volume 57 (Issue 6); DOI:10.1093/tropej/fmq117
Providing abandoned children the necessary medical and psychological care as possible after their institutionalization may minimize developmental delays. We describe psychomotor development in infants admitted to an orphanage in Khartoum, Sudan, assessed at admission and over an 18-month follow-up. Psychological state and psychomotor quotients were determined using a simplified Neonatal Behavior Assessment Scale (NBAS), the Brunet-Lezine and Alarm distress baby (ADBB) scale. From May-September 2005, 151 children were evaluated 2, 4, 9, 12 and 18 months after inclusion. At admission, ∼15% of children ≤1 month had a regulation impairment according to the NBAS, and 33.8% presented a distress state (ADBB score >5). More than 85% (129/151) recovered normal psychomotor development. The results of the program reinforce the importance of early detection of psychological disorders followed by rapid implementation of psychological case management to improve the development of young children in similar institutions and circumstances.
Journal Article > ResearchFull Text
Int J Methods Psychiatr Res. 2020 September 18; Volume 30 (Issue 1); e1850.; DOI:10.1002/mpr.1850
Llosa AE, Martinez-Viciana C, Carreño C, Evangelidou S, Casas G, et al.
Int J Methods Psychiatr Res. 2020 September 18; Volume 30 (Issue 1); e1850.; DOI:10.1002/mpr.1850
OBJECTIVE
We present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old).
METHODS
We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection.
RESULTS
The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S.
CONCLUSIONS
The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation.
We present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old).
METHODS
We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection.
RESULTS
The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S.
CONCLUSIONS
The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation.
Journal Article > CommentaryFull Text
Lancet. 2000 June 10; Volume 355 (Issue 9220); 2067-2068.; DOI:10.1016/S0140-6736(00)02364-3
de Jong J, Mulhern M, Ford NP, van der Kam S, Kleber RJ
Lancet. 2000 June 10; Volume 355 (Issue 9220); 2067-2068.; DOI:10.1016/S0140-6736(00)02364-3
Other > Journal Blog
BMJ Opinion (blog). 2012 March 5
de Jong K
BMJ Opinion (blog). 2012 March 5
Conference Material > Slide Presentation
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/74t1-zq11
Conference Material > Video (talk)
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 June 10; DOI:10.57740/z68q-6865