Integrating Mental Health and Psychosocial Support Into Health Facilities in Conflict Settings: A Retrospective Review From Six African Countries

Andersen, Ida; Rossi, Rita H. de; Yabutu, Mamie Nouria Meniko; Hubloue, Ives

doi:10.3389/fpubh.2020.591369

Cited by 12 publications

(20 citation statements)

References 15 publications

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“…Violence committed by the military or armed groups was a predictor of increased anxiety prior to MHPSS. This is consistent with the findings of a study among victims of violence in health facilities in similar settings [ 8 ] and points to the need to pay attention to the perpetrator profile as a potential vulnerability factor.…”

Section: Discussionsupporting

confidence: 91%

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Mental health and psychosocial support for the war-wounded: A retrospective cohort study from the Democratic Republic of Congo, Mali and Nigeria

et al. 2022

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Background For more than 150 years, war surgery has been at the heart of the humanitarian assistance offered by the International Committee of the Red Cross (ICRC) in conflict zones around the world. Mental health and psychosocial support (MHPSS) is increasingly recognized as an integral part of the medical care offered to this highly vulnerable group of patients. This study seeks to identify patient characteristics associated with high distress prior to MHPSS and predictors of improvement following it. Methods Between October 2018 and April 2020, 2,008 weapon-wounded patients received MHPSS in ICRC-supported hospitals in the Democratic Republic of Congo (DRC), Mali and Nigeria. The 21-item Depression and Anxiety Scale (DASS21), the Impact of Events Scale Revised (IES-R) and the ICRC functionality scale for Africa were administered before and after the MHPSS response. Logistic regression models were used to measure associations between outcome and exposure variables. Data was initially collected for monitoring purposes and analyzed retrospectively for the sake of this study. Results The main reasons for surgery were firearms (65%), other weapons (13%) and mines (5%). Linear trends were found between increasing number of days between violence and first consultation and decreased likelihood of presenting high levels of anxiety (aOR 0.75, p = 0.014), and stress (aOR 0.78, p = 0.032). Violence committed by military/armed group was associated with increased likelihood of reporting high levels of anxiety (aOR 2.47, p = 0.047). On the IES-R, high scores at baseline were more likely to be found among illiterate patients (aOR 0.08, p = 0.042) and having been wounded by firearms considerably increased the likelihood of reporting high levels of PTSD (aOR 21.34, p = 0.035). Following MHPSS, 92.28% of the patients showed a reduction in symptoms on the DASS21, 93.00% showed a reduction in symptoms on the IES-R and 83.04% showed an improvement on the ICRC Africa functioning scale. On the DASS21, factors negatively associated with improved anxiety included lack of social support (aOR 0.17, p = 0.047) and suffering from a chronic medical/physical condition (aOR 0.40, p = 0.013). Patients with reduced IES-R scores were more likely to have a high level of education (aOR 8.95, p = 0.029) and to have received MHPSS that lasted between 22 and 30 days (aOR 8.73, p = 0.008). Predictors of improved functioning included being 35–44 years of age (aOR 3.74, p = 0.004) and suffering from a severe or chronic medical condition (aOR 1.66, p = 0.044). Conclusions Clinical implications of this study include the increased involvement of family and other caregivers in the MHPSS and longer-term follow-up of patients with severe and/or chronic medical conditions. Further research is needed with regard to joint psychological and physical outcomes, the role of the patient’s education level and the personal styles and techniques used by the counsellors.

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Section: Discussionsupporting

confidence: 91%

“…To assess daily functioning, the ICRC functionality scale for Africa was used in the DRC, Mali and Nigeria. For a detailed description of the scales used in ICRC MHPSS programmes, see Andersen et al ., 2020 [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Mental health and psychosocial support for the war-wounded: A retrospective cohort study from the Democratic Republic of Congo, Mali and Nigeria

et al. 2022

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“…To evaluate the pertinence of offering psychological support and prepare an individualized treatment plan, levels of psychological distress were assessed using either the Depression, Anxiety and Stress Scale with 21 items (DASS21) or the Impact of Events Scale Revised (IES-R). In addition, the ICRC functioning scale was used to estimate the level of daily functioning of each beneficiary ( 10 ) ( Figure 2 ).…”

Section: Methodsmentioning

confidence: 99%

Community-Level Mental Health and Psychosocial Support During Armed Conflict: A Cohort Study From the Democratic Republic of the Congo, Mali, and Nigeria

Andersen

Rossi

Hubloue

2022

Front. Public Health

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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.

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“…To evaluate the pertinence of offering psychological support and prepare an individualized treatment plan, levels of psychological distress are assessed using either the Depression, Anxiety and Stress Scale with 21 items (DASS21) or the Impact of Events Scale Revised (IES-R). In addition, the ICRC functioning scale is used to estimate the level of daily functioning of each bene ciary 13 ( gure 2).…”

Section: The Intervention Pre-assessmentmentioning

confidence: 99%

“…As described in a previous publication 14 , a short-term solution-oriented approach is adopted to empower the bene ciary to re ect upon and resolve his or her speci c problems. In addition to offering psychological support, referrals to local service providers are made according to needs and availability.…”

Section: Individual Psychological Supportmentioning

confidence: 99%

Community-level Mental Health and Psychosocial Support During Armed Conflict: A Cohort Study from the Democratic Republic of Congo, Mali and Nigeria

Andersen

Rossi

Hubloue

2021

Preprint

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Introduction: Community-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.Methods: Between December 2018 and June 2020, 6,413 victims of violence received MHPSS through 32 community-level projects in the Democratic Republic of Congo, 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. Results: The most predominant perpetrators were weapon-bearers (76%) and the most common type of violence was rape (46%). Victims of 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; <0.0001). 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 (7 sessions on average) was stronger than individual therapy (4 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 was predicted less improvement of functioning following MHPSS (aOR 0.90; p=0.044). Conclusion: Community-level MHPSS is associated with increased well-being among the vast majority of beneficiaries. To further increase intended health outcomes, it is recommended to increase the number of sessions per beneficiary and address, where relevant, the financial consequences of violence. Also, a longitudinal study is recommended to assess the longer-term changes in symptoms.

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Integrating Mental Health and Psychosocial Support Into Health Facilities in Conflict Settings: A Retrospective Review From Six African Countries

Cited by 12 publications

References 15 publications

Mental health and psychosocial support for the war-wounded: A retrospective cohort study from the Democratic Republic of Congo, Mali and Nigeria

Mental health and psychosocial support for the war-wounded: A retrospective cohort study from the Democratic Republic of Congo, Mali and Nigeria

Community-Level Mental Health and Psychosocial Support During Armed Conflict: A Cohort Study From the Democratic Republic of the Congo, Mali, and Nigeria

Community-level Mental Health and Psychosocial Support During Armed Conflict: A Cohort Study from the Democratic Republic of Congo, Mali and Nigeria

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