Facing Violence – A Global Challenge

Abstract

Violence has been shown lead to a global challenge leading to long lasting social, medical and mental health sequels. In this article we focus on massive social violence affecting groups such as war and civil war. Models developed in Western Europe and North America for understanding trauma related health problems and developing interventions cannot be sufficient to address this global health challenge. Culture is an important aspect of this challenge. Revisions of the APAs Diagnostical and Statistical Manual in DSM V, the discussion of dimensional approaches, new approaches in public mental and community health and closer interdisciplinary collaboration indicate a paradigm shift that reflects the complexity of issues. In displaced populations, the benefit of flight might be unbalanced by further problems due to forced migration. Social suffering and mental health problems related to violence as a global public health problem can only be tackled with a holistic approach that takes cultural, social, legal and economic determinants into account, and might also need a strong focus on human rights. Research that can give a reliable assessment of complex long term outcomes is still largely missing, and can be seen as a major and complex challenge for future research. Key points:• Sequels to violence can, due to their high prevalence and potentially severe long term impact, be seen globally as the potentially largest mental health challenge.• Displacement can add additional challenges for victims and health care systems.• An interdisciplinary approach integrating medical, and psychological but also legal and sociological aspects is required to address understanding, treating and preventing violence.• A stronger focus on subjective, culture based and dimensional factors, as partly reflected in the new DSM V models, needs to be part of any intervention.

Refugees and Mental Health - Hosting, Understand and Treat

“…As sequelas de violência, devido à sua elevada prevalência e ao seu potencial impacto duradoiro, devem ser vistas globalmente como um desafio em termos de saúde mental implicando uma abordagem interdisciplinar não só médica e psicológica mas também social e legal de forma a poderem ser compreendidas, tratadas e prevenidas (Wenzel, Kienzler, & Wollmann, 2015). As populações afetadas por conflitos armados têm uma pior saúde mental.…”

“…Segundo Williams Nester como citado por Wenzel et al (2015) entre 1945 e 1988 rebentaram 269 guerras envolvendo 591 estados. Mais de 85% de todas as guerras entre 1945 e 1976 foram guerras civis e os números parecem tender a aumentar.…”

“…A violência pode ter, e frequentemente tem, um impacto a longo termo sobre a saúde mental incluindo um efeito indireto, que afeta as segundas e terceiras gerações fazendo sentir o seu impacto em termos de indivíduos, grupos e sociedade podendo ser preditor de futura violência. As sequelas de violência são graves e frequentemente resistentes ao tratamento (Wenzel et al, 2015). Além de distúrbios específicos que geralmente resultam de eventos de vida extremos, especialmente a PTSD também, a depressão e outros transtornos de humor e ansiedade são igualmente mais comuns em populações expostas à violência.…”

“…Um fator chave que influência as perturbações psicológicas dos refugiados é a exposição a acontecimentos traumáticos na fase pré-migratória particularmente à tortura (Nickerson et al, 2011). A PSTD é a mais estudada e tem um impacto considerável nos sobreviventes (Wenzel et al, 2015) podendo atingir prevalências da ordem dos 30% como referido por Steel et al (2009) numa meta-análise de 181 estudos levada a cabo em populações afetadas por conflitos armados. Em mulheres e crianças o problema deve ser tratado de uma forma especial pois apresenta nestas pessoas características peculiares (Montgomery, 2011;Roberts & Browne, 2011).…”

Challenges in the early assessment and protection of refugee survivors of torture and extreme violence

“…They will become part of a the so-called "wave" of global forced migration that challenges their coping skills and resources with displacement and cultural differences, but also the existing support and protection mechanisms in host countries. Long-term mental health sequels of war and violence are severe (9)(10)(11)(12)(13)(19)(20)(21)(22)(23), and evidence-based treatment models provided by highly trained experts working in an interdisciplinary team (14)(15)(16)(17) are not available in most countries of origin, are not accessible or too easily overwhelmed by the number of new applicants in host countries (18). The risk of host countries following a group dynamic based tendency to cling to defence mechanisms like nationalism and the withholding of fundamental human rights is to be seen in this context (2).…”