Vulnerability and mental health in Afghanistan: Looking beyond war exposure

Abstract

This study examined the prevalence of mental distress among groups in Afghanistan considered to be at risk. Data were drawn from a representative cross-sectional disability survey carried out in Afghanistan including 5,130 households in 171 clusters throughout the 34 provinces of the country. The sample included 838 nondisabled control participants aged above 14, and 675 disabled participants. Results showed that various vulnerable groups (disabled people, the unemployed, the elderly, minority ethnic groups, as well as widowed, divorced or separated women) were at higher risk of experiencing mild to severe mental health problems. The adjusted odds ratio for war-related disability compared to nondisabled was 4.09 (95% confidence interval 2.09 to 7.99) for mild mental distress disorders, and 7.10 (3.45-14.5) and 14.14 (3.38-59.00) for moderate or severe mental distress disorders, respectively. Women with disabilities (whatever the cause of impairment) when compared with nondisabled men, as well as poorer segments of society compared to the richest, had a higher prevalence of mental health problems. Women with non-war-related disabilities compared with nondisabled men were respectively 3.35 (1.27-8.81) and 8.57 (3.03-24.1) times more likely to experience mild or moderate mental distress disorders. People who experience multiple vulnerabilities are more at risk of deteriorating mental health in conflict zones. The study shows that mental health, in times of war, is influenced by a combination of demographic and socioeconomic characteristics linked to social exclusion mechanisms that were in place before the conflict began and that are redefined in relation to the changing social, cultural, and economic contexts. Mental health policies and programmes must prioritise the most vulnerable segments of Afghan society.

War experiences, daily stressors and mental health five years on

“…We heard from numerous colleagues that the paper expressed long held concerns they had had about: (1) the lack of explanatory power of the trauma focused or ' direct exposure' model and its overly narrow focus on treating war related PTSD; (2) the unrecognised and powerful in£uence of daily stressors on the mental health of war a¡ected populations; and (3) the need for multi-level or ecological interventions that address daily stressors, as well as enduring posttraumatic stress reactions. Trani and Bakhshi's (2013) research found that mental health in Afghanistan was linked to increased social exclusion present before war, driving home the importance of examining the maintenance and exacerbation of pre war stressors in conceptualising daily stressors. We reiterate that we were hardly the ¢rst nor only researchers to consider the importance of environmental stressors a¡ecting civilians in con£ict zones.…”

Trauma exposure and posttraumatic symptoms in Iraqi police recruits

“…As promoted by the World Health Organization and the World Organization of Family Doctors, integration of mental health care into primary health care services may be the most effective way to provide access to mental health care that is otherwise unavailable in most parts of the world (WHO & Wonca, 2008). This approach may be viable in Iraq; a systematic program to integrate mental health into 1200 primary care centers across Iraq was begun in 2008 (Sadik, Abdulrahman, Bradley, & Jenkins, 2011).…”

Mapeamento dos estudos sobre vulnerabilidade em saúde: uma revisão de escopo

“…O cenário onde se desenvolveram os estudos, em geral, corresponde aos três níveis de atenção à saúde. Notaram-se diferentes espaços onde o conceito foi discutido, desde o ambiente domiciliar (Trani & Bakhshi, 2013;Tah et al, 2015;Zanatta et al, 2018a;Amancio et al, 2019), até cenários como o local de trabalho (Fatini et al, 2014;Takahashi et al, 2014;Smith et al, 2015;Santos et al, 2015) , a escola (Anjos et al, 2012;Atanázio et al, 2013;Jesus & Monteiro, 2016;Marushima et al, 2018) e a universidade (Meneghel et al, 2003;Mussi et al, 2012;Olveira et al, 2013;Carrillo et al, 2014;Zanatta & Motta, 2015;D'Arco et al, 2016;Sequeira et al, 2017;Soares et al, 2018), traduzindo um pouco a aproximação à promoção da intersetorialidade a que o conceito se propôs nos seus quadros conceituais originários.…”