A controlled trial of problem-solving counseling for war-affected adults in Aceh, Indonesia.

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 non-specific 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.

Evaluation of a brief training on mental health and psychosocial support in emergencies: a pre- and post-assessment in Nepal.

INTRODUCTION: A principal strategy for the integration of mental health and psychosocial support in emergency settings is the training of front-line workers in international consensus-based guidelines. AIM: This paper presents a pilot study evaluating changes in knowledge and understanding as a result of a brief training course in Nepal. METHOD: Evaluation questionnaires were distributed to participants in two-day courses (n = 109) before, directly after, and at two months following completion. RESULTS: The course resulted in a post-training increase in correct answers of 21%, which further increased to 25% at two months. CONCLUSION: A short training course based on widely endorsed guidelines to front-line staff can significantly increase mental health literacy for complex emergencies. While promising, the trend of knowledge gain is modest at most, and suggests a need for more intensive or more targeted training courses.

Mental health and psychosocial support for families of missing persons in Sri Lanka: A retrospective cohort study.

BACKGROUND: The International Committee of the Red Cross (ICRC) has developed its 'Accompaniment model' to address the multi-faceted needs of relatives of people who go missing during armed conflict. In Sri Lanka an Accompaniment Programme was launched in 2015 for the relatives of the more than 16,000 missing persons who remain unaccounted for. METHOD: One thousand seven hundred eighty-three relatives who took part in the mental health and psychosocial support (MHPSS) component of the ICRC's Accompaniment Programme in Sri Lanka between April 2016 and August 2017 were offered eight peer-support group sessions, individual home visits, referrals to local services, and commemoration events to pay tribute to their missing relatives. Symptoms of anxiety and depression (using the HADS scale), somatic difficulties (using the BSI scale) and daily functioning (ICRC scale) were assessed before and after the MHPSS intervention. RESULTS: Prior to receiving support, Tamil and Muslim ethnicity, ≥60 years of age and civilian status were predictors of severe symptoms of anxiety; Tamil ethnicity, ≥50 years of age and being the mother of a missing person were predictors of severe symptoms of depression; and ≥ 50 years of age and severe symptoms of anxiety and depression were predictors of severe somatic difficulties. After receiving support, the vast majority of the relatives of missing persons showed reduced levels of anxiety (81%), depression (79%) and somatic pain (77%), as well as increased functioning (75%). Predictors of improvement following support were severe levels of distress at baseline and Tamil and Muslim ethnicity. In addition, attending at least three group sessions was a predictor of decreased anxiety, age group 51-60 was a predictor of decreased depression, female gender was a predictor of decreased somatic difficulties, and referrals were a predictor of increased functioning. CONCLUSION: The MHPSS component of the ICRC's Accompaniment Programme is a relevant approach to helping families to cope with not knowing the fate and whereabouts of their missing relatives, to reduce distress, to break their social isolation and to resume more functional lives. However, further research is needed, possibly through a controlled trial, to better establish the effectiveness of this approach.

Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors.

The Indonesian population has faced political violence, victimization, and torture throughout the last 70 years. Due to the scarcity of mental health professionals in many low and middle-income countries, counseling programs are increasingly utilizing paraprofessionals to provide support to the affected population as a strategy of task shifting. In this article, we would like to examine the effectiveness of counseling services provided by such trained paraprofessionals. This study was part of program evaluation to determine whether the participants (torture survivors) improved after counseling services provided by trained paraprofessionals in Indonesia. Local communities were invited to join the psychosocial program created and implemented by an NGO in 2005. The 178 participants were recruited from Jakarta, Papua, and Aceh, Indonesia for the program, which aimed to help survivors of violence suffering from "heavy hearts." The intervention lasted three months, and the follow-up intake was conducted after four months. The results indicated the participants' anxiety symptoms, depressive symptoms, somatic symptoms, and functioning improved from the intake to the follow-up. The program appeared to have been effective in reducing the participants' symptoms and impairment in functioning. This indicates that in countries where there is a scarcity of mental health professionals, working with paraprofessionals has the potential to help survivors of torture and violence.

Assessment of the psychosocial and mental health needs, dysfunction and coping mechanisms of violence affected populations in Bireuen Aceh. A qualitative study.

Qualitative research is important due to the shortage of literature in understanding cultural influences on psychosocial and mental health syndromes and their presentation, especially in developing countries. This qualitative study aims to investigate the psychosocial and mental health needs of populations in Aceh, Indonesia affected by over 30 years of conflict, their dysfunction, and their positive coping mechanisms. Results from this qualitative assessment indicate the presence of depression, anxiety and somatic symptoms. The data provide local terminology and ways in which the local population describes their own distress, which is an important addition to the understanding of the mental health consequences of this conflict. The data has been used to develop appropriate intervention strategies and adapt and validate assessment tools to measure psychological distress, dysfunction and coping mechanisms.