Betancourt T.S.,Harvard University |
Betancourt T.S.,Francois Xavier Bagnoud Center for Health and Human Rights |
Newnham E.A.,Francois Xavier Bagnoud Center for Health and Human Rights |
Newnham E.A.,University of Western Australia |
And 5 more authors.
Journal of Adolescent Health | Year: 2012
Purpose: As we build the evidence base of interventions for depression among war-affected youth, it is critical to understand factors moderating treatment outcomes. The current study investigated how gender and history of abduction by Lord's Resistance Army rebels moderated treatment outcomes for war-affected youth. Methods: The study - a three-armed, randomized, controlled trial - was conducted with internally displaced war-affected adolescents in northern Uganda. Participants with significant depression symptoms (N = 304; 57% female; 14-17 years of age) were randomly assigned to an interpersonal psychotherapy group (IPT-G), a creative play/recreation group, or a wait-list control condition. Secondary analyses were conducted on data from this randomized controlled trial. Results: A history of abduction by Lord's Resistance Army rebels was reported by 42% of the sample. Gender and abduction history interacted to moderate the effectiveness of IPT-G for the treatment of depression. In the IPT-G intervention arm, treatment effectiveness was greatest among female subjects without an abduction history, with effect size = 1.06. IPT-G was effective for the treatment of depression for both male and female subjects with a history of abduction (effect size =.92 and.50, respectively). Male subjects with no abduction history in IPT-G showed no significant improvement compared with those in the control conditions. Conclusions: Abduction history and gender are potentially important moderators of treatment effects, suggesting that these factors need to be considered when providing interventions for war-affected youth. IPT-G may be an effective intervention for female subjects without an abduction history, as well as for both male and female former child soldiers, but less so for male subjects without an abduction history. © 2012 Society for Adolescent Health and Medicine.
Betancourt T.S.,Harvard University |
Yang F.,Harvard University |
Yang F.,Georgia Regents University |
Bolton P.,Center for Refugee and Disaster Response
International Journal of Methods in Psychiatric Research | Year: 2014
This study aimed to refine a dimensional scale for measuring psychosocial adjustment in African youth using item response theory (IRT). A 60-item scale derived from qualitative data was administered to 667 war-affected adolescents (55% female). Exploratory factor analysis (EFA) determined the dimensionality of items based on goodness-of-fit indices. Items with loadings less than 0.4 were dropped. Confirmatory factor analysis (CFA) was used to confirm the scale's dimensionality found under the EFA. Item discrimination and difficulty were estimated using a graded response model for each subscale using weighted least squares means and variances. Predictive validity was examined through correlations between IRT scores (θ) for each subscale and ratings of functional impairment. All models were assessed using goodness-of-fit and comparative fit indices. Fisher's Information curves examined item precision at different underlying ranges of each trait. Original scale items were optimized and reconfigured into an empirically-robust 41-item scale, the African Youth Psychosocial Assessment (AYPA). Refined subscales assess internalizing and externalizing problems, prosocial attitudes/behaviors and somatic complaints without medical cause. The AYPA is a refined dimensional assessment of emotional and behavioral problems in African youth with good psychometric properties. Validation studies in other cultures are recommended. © 2014 John Wiley & Sons, Ltd.
Tierney D.,St John Of God Frankston Rehabilitation Hospital |
Bolton P.,Center for Refugee and Disaster Response |
Matanu B.,Buka Hospital |
Garasu L.,Nazareth Treatment Center |
And 2 more authors.
International Journal of Mental Health Systems | Year: 2016
Background: The Bougainville Crisis (1988-1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis. Methods: A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues. Results: The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues. Conclusions: The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs. © 2016 Tierney et al.
PubMed | University of Washington, University of Cape Town, Center for Refugee and Disaster Response, Iraq Ministry of Health and 2 more.
Type: Journal Article | Journal: Injury | Year: 2016
Falls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad.A two-stage, cluster randomised, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.Nine hundred households totaling 5148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. 65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged <15 years (49% of unintentional injuries) and 77 were respondents aged 15-64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30-8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family members fall (52; 46%).Falls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life-limiting disabilities. In turn, households shouldered much of the burden after fall injury due to loss of income and/or medical expenditure, often resulting in food insecurity. Given ongoing conflict, civilian injury control initiatives, trauma care strengthening efforts and support for households of the injured is urgently needed.
PubMed | University of Washington, Lakehead University, Kwame Nkrumah University Of Science And Technology, Center for Refugee and Disaster Response and 2 more.
Type: Journal Article | Journal: Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention | Year: 2016
Around 50 million people are killed or left disabled on the worlds roads each year; most are in middle-income cities. In addition to this background risk, Baghdad has been plagued by decades of insecurity that undermine injury prevention strategies. This study aimed to determine death and disability and household consequences of road traffic injuries (RTIs) in postinvasion Baghdad.A two-stage, cluster-randomised, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding crash specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.Nine hundred households, totalling 5148 individuals, were interviewed. There were 86 RTIs (16% of all reported injuries) that resulted in 8 deaths (9% of RTIs). Serious RTIs increased in the decade postinvasion and were estimated to be 26341 in 2013 (350 per 100000 persons). 53% of RTIs involved pedestrians, motorcyclists or bicyclists. 51% of families directly affected by a RTI reported a significant decline in household income or suffered food insecurity.RTIs were extremely common and have increased in Baghdad. Young adults, pedestrians, motorcyclists and bicyclists were the most frequently injured or killed by RTCs. There is a large burden of road injury, and the families of road injury victims suffered considerably from lost wages, often resulting in household food insecurity. Ongoing conflict may worsen RTI risk and undermine efforts to reduce road traffic death and disability.
Strong J.,Center for Refugee and Disaster Response |
Varady C.,Caritas Lebanon Migrant Center |
Chahda N.,Caritas Lebanon Migrant Center |
Doocy S.,Center for Refugee and Disaster Response |
Burnham G.,Center for Refugee and Disaster Response
Conflict and Health | Year: 2015
Background: The flight of Syrian and Palestinian families into Lebanon from Syria included a number of older refugees. This study sought to characterize the physical and emotional conditions, dietary habits, coping practices, and living conditions of this elderly population arriving in Lebanon between March 2011 and March 2013. Methods: A systematic selection of 210 older refugees from Syria was drawn from a listing of 1800 refugees over age 60 receiving assistance from the Caritas Lebanon Migrant Center (CLMC) or the Palestinian Women's Humanitarian Organization (PALWHO). CLMC and PALWHO social workers collected qualitative and quantitative information during 2013. Results: Two-thirds of older refugees described their health status as poor or very poor. Most reported at least one non-communicable disease, with 60% having hypertension, 47% reporting diabetes, and 30% indicating some form of heart disease. Difficulties in affording medicines were reported by 87%. Physicial limitations were common: 47% reported difficulty walking and 24% reported vision loss. About 10% were physically unable to leave their homes and 4% were bedridden. Most required medical aids such as walking canes and eyeglasses. Diet was inadequate with older refugees reporting regularly reducing portion sizes, skipping meals, and limiting intake of fruits, vegetables, and meats. Often this was done to provide more food to younger family members. Some 61% of refugees reported feeling anxious, and significant proportions of older persons reported feelings of depression, loneliness, and believing they were a burden to their families. 74% of older refugees indicated varying degrees of dependency on humanitarian assistance. Conclusion: The study concluded older refugees from Syria are a highly vulnerable population needing health surveillance and targeted assistance. Programs assisting vulnerable populations may concentrate services on women and children leaving the elderly overlooked. © 2015 Strong et al.
Bass J.,Applied Mental Health Research Group |
Poudyal B.,Rehabilitation Action for Torture Victims in Aceh RATA |
Tol W.,Yale University |
Murray L.,Applied Mental Health Research Group |
And 2 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2012
Purpose War and conflict have consequences on the mental health of individuals and entire communities and the communities in Aceh, Indonesia, having experienced more than 30 years of armed conflict, are no exception. This study presents results from an evaluation of a nonspecific mental health group counseling program among adults affected by conflict. Interventions such as these need to be evaluated to further the limited empirical evidence base for efficacious community-based treatments for improving the mental health and psychosocial problems in humanitarian settings. Methods A total of 589 adults were screened using a locally validated measure of mental health and functioning. Of all, 420 (71%) met the study inclusion criteria of elevated symptom levels and functional impairment: 214 and 206 in three intervention and three control villages, respectively. Intervention participants met weekly for eight sessions in groups of eight to ten adults. Following completion of treatment, 175 (85%) controls and 158 (74%) intervention participants were re-assessed. Regression analyses compared pre- and post-intervention scale scores. Results We did not find an intervention effect for reducing the burden of depression and anxiety symptoms when compared with the control sample. Impact on functioning was mixed and there was an increase in use of positive coping strategies. Conclusions The lack of mental health impact may be because the mental health problems and dysfunction were not due to disorder, but were normal responses to struggles of daily living experienced by this community and not addressed by the intervention. © Springer-Verlag 2011.
Morton M.,Johns Hopkins University |
Morton M.,Center for Refugee and Disaster Response |
Levy J.L.,Johns Hopkins University |
Levy J.L.,Center for Refugee and Disaster Response
Prehospital and Disaster Medicine | Year: 2011
Gathering essential health data to provide rapid and effective medical relief to populations devastated by the effects of a disaster-producing event involves challenges. These challenges include response to environmental hazards, security of personnel and resources, political and economic issues, cultural barriers, and difficulties in communication, particularly between aid agencies. These barriers often impede the timely collection of key health data such as morbidity and mortality, rapid health and sheltering needs assessments, key infrastructure assessments, and nutritional needs assessments. Examples of these challenges following three recent events: (1) the Indian Ocean tsunami; (2) Hurricane Katrina; and (3) the 2010 earthquake in Haiti are reviewed. Some of the innovative and cutting-edge approaches for surmounting many of these challenges include: (1) the establishment of geographical information systems (GIS) mapping disaster databases; (2) establishing internet surveillance networks and data repositories; (3) utilization of personal digital assistant-based platforms for data collection; (4) involving key community stakeholders in the data collection process; (5) use of pre-established, local, collaborative networks to coordinate disaster efforts; and (6) exploring potential civil-military collaborative efforts. The application of these and other innovative techniques shows promise for surmounting formidable challenges to disaster data collection. © Copyright Morton © 2011 World Association for Disaster and Emergency Medicine.
PubMed | University of Washington, Kwame Nkrumah University Of Science And Technology, Johns Hopkins University, Center for Refugee and Disaster Response and 4 more.
Type: Journal Article | Journal: Burns : journal of the International Society for Burn Injuries | Year: 2016
We aimed to describe the burden of fires in displaced persons settlements and identify interventions/innovations that might address gaps in current humanitarian guidelines.We performed a systematic review of: (i) academic and non-academic literature databases; and (ii) guidelines from leading humanitarian agencies/initiatives regarding fire prevention/control.Of the 1521 records retrieved, 131 reports described settlement fires in 31 hosting countries since 1990. These incidents resulted in 487 deaths, 790 burn injuries, displacement of 382,486 individuals and destruction of 50,509 shelters. There was a 25-fold increase in the rate of settlement fires from 1990 to 2015 (0.002-0.051 per 100,000 refugees, respectively). Only 4 of the 15 leading humanitarian agencies provided recommendations about fire prevention/control strategies. Potentially useful interventions/innovations included safer stoves (e.g. solar cookers) and fire retardant shelter materials.The large and increasing number of fires in displaced persons settlements highlights the need to redress gaps in humanitarian fire prevention/control guidelines. The way forward includes: (i) developing consensus among aid agencies regarding fire prevention/control strategies; (ii) evaluating the impact of interventions/innovations on the burden of fires; and (iii) engaging agencies in a broader discussion about protecting camp residents from armed groups.
Gorokhovich Y.,City University of New York |
Doocy S.,Center for Refugee and Disaster Response |
Walyawula F.,Makerere University |
Muwanga A.,Makerere University |
Nardi F.,University of Rome La Sapienza
Landslide Science and Practice: Global Environmental Change | Year: 2013
Severe rains at the beginning of March in eastern Uganda caused fatal landslide in village Nametsi, district Bududa. On March 1st 300 people were missing or dead as the result of this event. More than 8,000 people from nearby villages were evacuated in UN funded temporary camp in Bulucheke. Results of preliminary assessment of the landslide situation showed development of new scarp within 300 m from the head of the Nametsi landslide. Absence of drainage systems, steep slopes and changes of the land cover exacerbate the potential for new landslides and will lead to new disasters in the future. Bududa area is known for Arabica coffee plantations that provide cash and jobs to local residents. Establishment of a simple monitoring system and education of local population regarding mitigation measures will reduce the risk of future disasters and provide better and safe environment for the coffee production. This will also lead to the reduction of poverty in the area and creating a potential for the future economic growth. © Springer-Verlag Berlin Heidelberg 2013.