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.

Introduction: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. Purpose: To describe and evaluate a manualized cognitive behavioral therapy for traumatized refugees incorporating exposure therapy, mindfulness and acceptance, and commitment therapy. Material and methods: 85 patients received six months’ treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient was monitored in detail. The changes in mental state and the treatment components associated with change in state were analyzed statistically. Results: Despite the low level of functioning and high co-morbidity of patients, 42% received highly structured CBT, which was positively associated with all treatment outcomes. The more methods used and the more time each method was used, the better the outcome. The majority of patients were able to make homework assignments and this was associated with better treatment outcome. Correlation analysis showed no association between severity of symptoms at baseline and the observed change. Conclusion: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must be adapted to the special needs of refugees and trauma exposure should be further investigated.

IntroductionCommunity-level mental health and psychosocial support (MHPSS) was the first type of MHPSS program launched by the International Committee of the Red Cross (ICRC) back in 2004. Standardized beneficiary-level monitoring was put in place in late 2018. This is the first study to explore whether this type of program correlates, as intended, with reduced psychological distress and increased daily functioning.MethodsBetween December 2018 and June 2020, 6,413 victims of violence received MHPSS through 32 community-level projects in the Democratic Republic of the Congo (DRC), Mali and Nigeria. Symptoms of psychological distress (IES-R or DASS21) and daily functioning (ICRC scale) were assessed before and after the intervention and logistical regression models were used to identify predictors of these symptoms.FindingsVictims of the violence committed by weapon bearers were more likely to show high levels of anxiety prior to MHPSS (aOR 3.51; p < 0.0001). Also, victims of physical violence were more likely to show high levels of stress (aOR 1.49; p < 0.0001), whereas victims who had witnessed physical violence were more like to report high levels of depression (aOR 2.54; p < 0.0001). The most common perpetrators were weapon bearers (76%) and the most common type of violence was rape (46%). Lack of social support stood out as a predictor of both high anxiety (aOR 2.10; p < 0.0001) and post-traumatic stress (aOR 2.04; p < 0.0001) prior to MHPSS. Following MHPSS, the vast majority of beneficiaries reported a reduction in distress on the DASS21 (96.58%) and the IES-R scales (92.70%) as well as an increase of functioning (82.26%). Adherence to group therapy (seven sessions on average) was stronger than adherence to individual therapy (four sessions on average). A linear trend was found between length of treatment and likelihood of reporting reduced symptoms of depression. Having suffered destruction or loss of property or income predicted less improvement of functioning following MHPSS (aOR 0.90; p = 0.044).ConclusionReceiving community-level MHPSS is associated with increased wellbeing among the vast majority of beneficiaries. To further enhance the intended health outcomes, it is recommended to increase the length of treatment per beneficiary (30 days minimum) and address, where relevant, the financial consequences of violence. Also, a longitudinal study is recommended to assess longer-term changes in MHPSS symptoms.