A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants.

BACKGROUND: Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. METHODS: English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). RESULTS: Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. CONCLUSION: Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.

Posttraumatic stress disorder correlates among internally displaced Yazidi population following Islamic state of Iraq and Syria attacks in Iraq.

BACKGROUND: In 2014, the so-called Islamic State of Iraq and Syria (ISIS) took over one-third of Iraq. This study measured the rate of posttraumatic stress disorder (PTSD) among Iraqi Yazidi internally displaced persons (IDPs) and examined associated demographic and traumatic risk factors. METHODS: A cross-sectional survey was carried out in April-June 2015 at the Khanke camp, northern Iraq. Trauma exposure and PTSD were measured by the Harvard Trauma Questionnaire (Iraqi version). RESULTS: Of 814 adult Yazidi IDPs, 34% screened positive for PTSD. Avoidance and intrusion symptoms had the highest means (M = 3.16, SD = 0.86 and M = 2.63, SD = 0.59 respectively). Associated factors of PTSD included exposure to a high number of traumatic events, unmet basic needs and having witnessed the destruction of residential or religious areas (OR = 1.39, 95% CI: 1.02-1.9 and OR = 1.25, 95% CI: 1.01-1.53 respectively). Being a widow was the only linked demographic factor (OR = 15.39, 95% CI: 3.02-78.39). CONCLUSIONS: High traumatic exposure, specifically unmet basic needs and having witnessed destruction, was an important predictor of PTSD among Yazidi IDPs. These findings are important for mental health planning for IDPs in camps.

Resilience and Hope Among Yazidi Women Released From ISIS Enslavement.

ABSTRACT: This study aimed to explore the levels of resilience and hope among Yazidi women who survived captivity by Islamic State of Iraq and Syria (ISIS) and to examine its relationship with posttraumatic stress disorder (PTSD), generalized anxiety, and depressive symptoms. In this cross-sectional study, 139 formerly enslaved Yazidi women were assessed. The mean scores of resilience and hope were below the suggested cutoff means (M = 2.47, SD = 0.48, R = 1-5) and (M = 31.6, SD = 11.7, R = 8-64), respectively. Sociodemographic variables were not related to resilience and hope, other than those women who stayed in captivity for more than a 3-year period who reported significantly lower levels of hope (M = 28.36, SD = 11.69). Formerly enslaved Yazidi women who display higher levels of PTSD, generalized anxiety, and depression exhibit significantly lower levels of resilience and hope. Resilience and hope are therefore important concepts to explore in traumatized populations.

Evaluation of effect of brief-intensive cognitive behavior therapy on symptoms severity in relation with catastrophic cognition in patients with panic disorder: a randomized controlled trial.

INTRODUCTION: Due to a dearth of evidence, we examined the effectiveness of brief-intensive CBT on symptom severity and catastrophic cognition in patients with panic disorder (PD). MATERIALS AND METHODS: In this randomized controlled trial, 155 patients were assigned to either the experimental group (2 successive days of brief-intensive CBT-3 h per day) or the control group (regular pharmacotherapy only). After excluding ineligible participants, 20 patients in the brief intensive CBT group and 18 patients in the control group completed the study and were included in the final analysis. The primary outcome was symptom severity, and the secondary outcome was catastrophic cognition, assessed by the Panic Disorder Severity Scale (PDSS) for symptoms severity and the Agoraphobic Cognition Scale (ACS) for cognitive assessment, respectively. RESULTS: The study showed that after one month of treatment, the PDSS (1.70 vs. 4.78; p = 0.0172) in the brief-intensive CBT group was significantly lower compared to the control group in contrast with the ACS (5.10 vs. 5.44; p = 0.8533). The mean score of PDSS and ACS significantly decreased from 21.60 to 1.7 (p < 0.0001) and from 22.55 to 5.10 (p < 0.0001) in the brief CBT group and from 19.44 to 4.78 (p < 0.0001) and 20.00 to 5.44 (p < 0.0001) in the control group, respectively. After treatment, the mean scores of PDSS and ACS significantly decreased in the brief intensive CBT and control groups. Both higher ACS and lower education levels contributed to higher PDSS in the brief intensive CBT group. However, only the PDSS correlated to the ACS in the control group. CONCLUSIONS: The study showed that brief-intensive CBT is an effective technique for reducing the severity of symptoms among PD patients. But, it was not effective to improve the cognitive level in PD patients at one month.

Home Quarantine Induced Health Anxiety During the Beginning of the COVID-19 Pandemic - Evidence From Iraq.

OBJECTIVE: This study aimed to assess the compliance to voluntary home quarantine and to examine the prevalence and associated factors of health anxiety among the voluntary home quarantined population during the onset of the coronavirus disease (COVID-19) pandemic. METHODS: An online survey questionnaire, including the health anxiety questionnaire, was administered to 1578 eligible adults from the general population of 19 governorates of Iraq. RESULTS: Self-reported compliance with home confinement was reported by a majority of respondents (83%) and was followed to a larger extent by young adults (62.2%), females (53.9%), unmarried individuals (56.7%), university graduates (54.5%), unemployed individuals (48.6%), and inhabitants of the northern provinces (50.2%). Compliance was significantly correlated to the level of personal knowledge on COVID-19. The quarantined individuals experienced greater health anxieties and preoccupations and exhibited increased reassurance-seeking behavior. Higher knowledge of COVID-19 was a protective factor against health anxiety. CONCLUSIONS: A significant mental health burden is discovered among Iraqis during the quarantine period. Based on the insights gleaned from this study, psychological education and interventions should be prioritized to diminish the psychological impact of the quarantine experience, especially among the high-risk groups. Improvement in compliance to quarantine can be approached by providing better information regarding the novel infection.

Gender Differences in Traumatic Experiences, PTSD, and Relevant Symptoms among the Iraqi Internally Displaced Persons.

Conflict in Iraq has led to a large number of internally displaced Iraqis, with a great impact on their mental health. A few previous studies investigated the gender differences of mental disorders in Iraqi internally displaced persons (IDPs). The aim of this study was to assess gender differences among Iraqi IDPs after the 2014 terrorist attacks in terms of types of traumatic experiences, prevalence of post-traumatic stress disorder (PTSD), and other symptoms of common mental disorders (depression, anxiety, and somatization symptoms). A cross-sectional survey was conducted in April-June 2015 among 358 female and 464 male adult IDPs living in IDP camps in Duhok, Iraq. The Harvard Trauma Questionnaire (HTQ), General Health Questionnaire (GHQ-28), and Self-Reporting Questionnaire (SRQ-20) were applied by local interviewers. Comparison of scores of these measures between the two genders was performed using independent sample t-tests. Logistic regression analysis was carried out to identify predictors for PTSD. Although the types of traumatic events experienced by female and male IDPs were nearly similar, males reported higher exposure to combat situation, torture, oppressions, and destruction of personal properties (t = 3.718 and 4.758, respectively, p < 0.001). Overall, males experienced more events than females (p < 0.001). The probable PTSD prevalence rates (29.1% among females and 31.9% among males) did not differ significantly (p = 0.212). Female IDPs reported more somatic (p < 0.001) and depressive/anxious (p < 0.001) symptoms than males. The demographic factors and duration of camp stay were not associated significantly with PTSD diagnosis. Probable PTSD rates among male and female IDPs in Iraq are substantial. Although no gender differences were found in probable PTSD rates between female and male Iraqi IDPs, the mean score of common mental disorders cases was higher among females and they presented with higher levels of somatic and depressive/anxious symptoms. Further studies are needed to clarify the underlying mechanisms contributing to gender differences in PTSD.

Measures of depression, generalized anxiety, and posttraumatic stress disorders amongst Yazidi female survivors of ISIS slavery and violence.

BACKGROUND: In 2014 the Islamic State of Iraq and Syria (ISIS) undertook a systematic and deliberate campaign against minority groups and non-Sunni Muslim communities. Amongst some of the greatest atrocities were those targeted towards Yazidi communities and in particular their women. The mental health outcomes of those women held in captivity requires investigation. This study sought to examine and compare levels of general psychological distress, depression, generalized anxiety, posttraumatic stress disorder (PTSD) and self-reported suicidal thoughts and behaviors amongst Yazidi women held in captivity compared with those without such experiences. METHOD: Between January to May 2019, a total 348 Yazidi women located in internal displaced person (IDP) camps were interviewed. Of these 348, 139 females were survivors of ISIS captivity. Measures used included Kessler Psychological Distress Scale (K10), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Harvard Trauma Questionnaire part IV (HTQ part IV). RESULTS: Formerly enslaved Yazidi females showed a significantly higher prevalence of severe mental distress (97.1%; P < 0.001), more severe levels of depression (36.7%; P < 0.001) and general anxiety symptoms (37.4%; P < 0.001), greater rates of PTSD (90.6%; P < 0.001) and higher reported rates of suicidal ideation (38.1%; P < 0.001). Logistic regression analysis undertaken to examine the role of sociodemographic factors as predictors of the assessed mental health conditions. Amongst the formerly enslaved group, no such significance was found, however amongst the non-enslaved group, unemployment was found to statistically determine depression, generalized anxiety and PTSD. Specifically, women from the non-enslaved group who were unemployed were 2.5 times more likely to have depression, 3 times more likely to have generalized anxiety and 3.3 times more likely to have PTSD. Finally, amongst the non-enslaved group, those women with between 5 to 8 siblings were significantly less likely to have depression than those with fewer siblings. CONCLUSION: Rates of distress and trauma related symptomology were significantly higher amongst those with history of enslavement. Sociodemographic factors and duration of enslavement do not seem to predict mental disorders among enslaved females.