The Ukraine crisis: Mental health resources for clinicians and researchers.

The mental health consequences of the war in Ukraine will be enormous. Mental health professionals who are providing care for people in Ukraine, or those resettled elsewhere, may require access to standardized and validated assessment tools. We have developed a repository of mental health measures that are available in Ukrainian, Russian, and English and can be accessed at http://www.traumameasuresglobal.com/ukraine.

Changes in Mental Health Needs during COVID-19 in the Republic of Georgia: A Longitudinal Follow-up Study.

Background: To examine changes in COVID-19 stressors and symptoms of mental disorders in the Republic of Georgia. Methods: A longitudinal design was used. Following on from our study of May-June 2020, this follow-up study in January-March 2021 was conducted at: (i)an individual level with the same respondents involved in the May-June 2020 study (repeat responders/cohort); and (ii) at a population-wide level, using non-probabilistic sampling. Questionnaire sections covered: (i)demographic, socio-economic characteristics; (ii)level of burden caused by COVID-19-related stressors/concern; and (iii)symptoms of anxiety(GAD-7), depression(PHQ-9), PTSD(ITQ), adjustment disorder(ADNM8). Descriptive and multivariable regression analyses were conducted. Results: Among population-level survey respondents(N=1195), the probability of reporting mental ill health symptoms increased in 2021 compared to 2020 for PTSD(OR1.82), depression(OR1.40), adjustment disorder(OR 1.80), and marginally for anxiety(OR1.17). For the individual repeat respondents(N=455), the probability increased for depression(OR1.88) and adjustment disorder(OR2.56). The perceived burden of pandemic concern worsened in 2021 compared to 2020 for almost all stressors, particularly around access to health care, infecting others, and conflict in the home. PTSD was associated with an increased concern score from 2020 to 2021. Conclusion: Our study highlights the need to strengthen response strategies to address the elevated mental health needs related to COVID-19 in Georgia. It recommends increasing accessibility of early interventions and the need to modernise mental health services to strengthen access to care. It also calls for monitoring patterns of mental health disorders for better understanding and responses to mental health needs in Georgia.

The influence of concern about COVID-19 on mental health in the Republic of Georgia: a cross-sectional study.

BACKGROUND: Early evidence indicates increased mental health burden arising from COVID-19 and related control measures. The study aim was to examine concern about COVID-19 and its association with symptoms of mental disorders in the Republic of Georgia. A cross-sectional internet-based survey of adults in Georgia using non-probabilistic sampling was used. Questionnaire topics were: (i) demographic and socio-economic characteristics; (ii) level of burden caused by common causes of COVID-19 related concerns; (iii) strategies used in response to concerns about COVID-19; and (iv) symptoms of mental disorders of anxiety (GAD-7), depression (PHQ-9), PTSD (ITQ) and adjustment disorder (ADNM8). Descriptive and multivariate analyses were conducted. RESULTS: There were 2088 respondents. High levels of symptoms for mental disorders were observed for anxiety (23.9% women, 21.0% men), depression (30.3% women, 25.27% men), PTSD (11.8% women, and 12.5% men), and adjustment disorder (40.7% women, 31.0% men). Factors significantly associated with increased COVID-19 concern included bad/very bad household economic situation, larger household size, current NCD, symptoms of anxiety, adjustment disorder and PTSD. Response strategies significantly associated with reduced mental disorder symptoms included meditation and relaxation exercises, physical exercise, positive thinking, planning for the future, TV/radio, housework/DIY, and working. Drinking alcohol was associated with a greater probability of increased mental disorder symptoms. CONCLUSIONS: High levels of mental disorders were recorded, and they were strongly associated with increased concern about COVID-19. A number of response strategies were identified which may help protect against worse mental health and these could be supported by innovations in mental health care in Georgia.

Alcohol use among conflict-affected persons in Ukraine: risk factors, coping and access to mental health services.

BACKGROUND: There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours. METHODS: A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours. RESULTS: Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours. CONCLUSIONS: AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.

Patterns of somatic distress among internally displaced persons in Ukraine: analysis of a cross-sectional survey.

PURPOSE: There are often high rates of mental disorders in low- and middle-income countries during humanitarian crises, but the prevalence of somatic distress (SD) is underreported in the existing health service research. We aim to examine the patterns of SD among internally displaced persons (IDPs) in Ukraine, who were forcibly displaced due to the ongoing conflict in the country's eastern region. METHODS: The study design was a cross-sectional survey of 2203 adult IDPs throughout Ukraine. The survey collected data on sociodemographic characteristics, traumatic life events (Life Events Checklist), utilisation of mental health care services, and self-reported outcomes of SD (Patient Health Questionnaire 15), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), and post-traumatic stress (PTSD Checklist). Descriptive and multivariate regression analyses were used. RESULTS: Over half of respondents (n = 1142, 55%) were identified as being at risk of SD (PHQ-15 score ≥ 6), and the prevalence of moderate (n = 377, 18%) and high severity SD risk (n = 275, 13%) was substantial. There were significant associations (p < 0.05) between SD and age, female gender, economic status, self-reported depression and post-traumatic stress, and multiple trauma exposures. Being at risk of SD was also significantly associated with increased functional disability. Use of mental health care services was low across this population and only high SD risk seemed to be a reliable predictor of care-seeking behaviour. CONCLUSIONS: There is a significant risk of SD among IDPs in Ukraine. Our results illustrate the need for targeted health service research and regional programs to ensure that mental health needs are appropriately met.

Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study.

BACKGROUND: There is a paucity of evidence on access to services for mental health and psychosocial support for conflict-affected populations in low- and middle-income countries. In the Republic of Georgia, rates of utilization of mental health services among internally displaced people with mental disorders are low. We set out to identify the health system barriers leading to this treatment gap. METHODS: We used rapid appraisal methods (collection and triangulation of multiple data sources) to investigate barriers to accessing mental health care services among adult IDPs in Georgia. Data collection included review of existing policy documents and other published data, as well as semi-structured interviews with 29 key informants including policy makers, NGO staff, health professionals and patients. RESULTS: The following factors emerged as important barriers affecting access to mental health care services among IDPs in Georgia: inadequate insurance coverage of mental disorders and poor identification and referral systems, underfunding, shortage of human resources, poor information systems, patient out-of-pocket payments and stigmatization. CONCLUSION: While rapid appraisal methods cannot control for potential biases or achieve representativeness, triangulation supports internal validity and reliability of the data collected, allowing data to be used to inform health care interventions. The appropriateness and potential effectiveness of policy interventions such as insurance coverage of a wider range of mental disorders, integration of services for these at the primary health care level, and community-based approaches in this context should be explored.

Mental disorders and their association with disability among internally displaced persons and returnees in Georgia.

There remains limited evidence on comorbidity of mental disorders among conflict-affected civilians, particularly internally displaced persons (IDPs) and former IDPs who have returned to their home areas (returnees). The study aim was to compare patterns of mental disorders and their influence on disability between IDPs and returnees in the Republic of Georgia. A cross-sectional household survey was conducted with adult IDPs from the conflicts in the 1990s, the 2008 conflict, and returnees. Posttraumatic stress disorder (PTSD), depression, anxiety, and disability were measured using cut scores on Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and the WHO Disability Assessment Schedule 2.0. Among the 3,025 respondents, the probable prevalence of PTSD, depression, anxiety, and comorbidity (>1 condition) was 23.3%, 14.0%, 10.4%, 12.4%, respectively. Pearson correlation coefficients (p < .001) were .40 (PTSD with depression), .38 (PTSD with anxiety), and .52 (depression with anxiety). Characteristics associated with mental disorders in regression analyses included displacement (particularly longer-term), cumulative trauma exposure, female gender, older age, poor community conditions, and bad household economic situation; coefficients ranged from 1.50 to 3.79. PTSD, depression, anxiety, and comorbidity were associated with increases in disability of 6.4%, 9.7%, 6.3%, and 15.9%, respectively. A high burden of psychiatric symptoms and disability persist among conflict-affected persons in Georgia.

Cultural psychological factors in posttraumatic symptom development and expression: a study protocol.

Introduction: Cultural factors were shown to be particularly relevant for the development and expression of posttraumatic stress. Recently, the concept of cultural scripts of trauma has been introduced, which proposes that trauma sequelae elements may be sequentially linked and specifically associated with cultural factors. Furthermore, a cascade model is proposed, including trauma exposure, demographic characteristics, cultural affiliation, and trauma-related value orientations as influencing factors of posttraumatic development. The purpose of this Network Project is to investigate cultural psychological factors that contribute to the expression of posttraumatic stress.Methods: The present Network Project implements a mixed methods approach and will be conducted in 5 different study sites, including Switzerland, Israel, Georgia, China, and East Africa. In sub-study I, the cultural scripts of traumatic stress inventories (CSTIs) will be developed. These scales provide a pool of trauma sequelae elements for each cultural group. For this purpose, focus groups with trauma survivors and trauma experts will be conducted and analysed using qualitative research methods. Sub-study II implements a validation analysis of the CSTIs and the empirical investigation of a cultural cascade model. This quantitative approach will include a larger sample of individuals who experienced traumatic life events.Discussion: This contribution is timely and enriches the knowledge of trauma and culture. Future publications of this Network Project will address trauma sequelae from a cultural perspective and provide diagnostic and psychotherapeutic implications.

This paper presents a Network Project that investigates cultural factors in posttraumatic sequelae.The Network Project encompasses an innovative research design with both qualitative and quantitative methods.New developments in the field of cultural clinical psychology are introduced, including cultural scripts of trauma and a cascade model of cultural factors in posttraumatic symptom expression.

Providing immediate digital mental health interventions and psychotrauma support during political crises.

We describe the development and provision of a digital mental health intervention and trauma support platform for victims of political and social repression in Belarus. The Samopomoch platform provides secure and effective support tailored to the needs of such victims, and individuals are provided with access to the service via a modern, encrypted, and protected communication platform. The service involves personal health tracking (e-mental health self-screening), targeted and untargeted client communication (psychoeducation and self-help information), and psychological counselling sessions. The Samopomoch platform is also collecting evidence to show the effectiveness of the service and proposes a model for replication in similar settings. To our knowledge, this is the first immediate digital mental health-care response to a political crisis, and the high needs and increasing demand for this service within the targeted population indicate the necessity for its continuation and scaling-up. We urge policy makers to provide immediate responses for establishing digital mental health interventions and psychological trauma support.

The Ukraine crisis: Mental health resources for clinicians and researchers.

The mental health consequences of the war in Ukraine will be enormous. Mental health professionals who are providing care for people in Ukraine, or those resettled elsewhere, may require access to standardized and validated assessment tools. We have developed a repository of mental health measures that are available in Ukrainian, Russian and English and can be accessed at www.traumameasuresglobal.com/ukraine.

A transdiagnostic psychosocial prevention-intervention service for young people in the Republic of Georgia: early results of the effectiveness study.

Background: The decade between the ages of 14 and 25 is a particularly vulnerable period for the development of mental health problems, especially of common mental disorders. Mental health and psychosocial prevention and support services for young people in the Republic of Georgia have been extremely limited, leaving a wide treatment and care gap. Club Synergy was designed as an innovative, pragmatic solution that is responsive to the needs of young people and incorporates all necessary levels of care required (prevention, early identification & intervention, and treatment) into a single, trauma-informed service that uses a transdiagnostic approach. This paper presents preliminary findings from the pilot phase of establishing and running the service. Aim: To examine the characteristics of young people presenting to Club Synergy and the effectiveness of contact with the service. Methods: Quantitative evaluation of a consecutive series of young people seen by Club Synergy between November 2019 and July 2020. Demographic information was analysed using descriptive statistics. Pre-post outcomes for anxiety (GAD-7), depression (PHQ-9) and health-related quality of life (EQ-5D-5L) were analysed using the Wilcoxon signed-rank test. Results: Hundred and seventy-four young people were included. The majority (68.9%) self-referred, with referral from The Ministry of Justice due to conflict with law (23%) accounting for most of the other young people seen. Emotional disturbance (73.6%), anxiety (60.3%), problems in interpersonal relationships (57.5%) and low mood (49.4%) were the commonest presenting symptoms. Seventy-three per cent reported 4 or more adverse childhood experiences. After engaging in transdiagnostic modules, median baseline scores for depression and anxiety reduced by 40% and 45%, respectively, and self-rated health improved by 14%. Conclusions: Preliminary analysis indicates that Club Synergy's trauma-informed model of care, based on a transdiagnostic approach, has the potential to provide an effective service to young people in Georgia at risk of developing and with mental health problems. HIGHLIGHTS: This pragmatic study of a newly established mental health service for young people in Georgia suggests that a trauma-informed approach, using transdiagnostic modules, has the potential to effectively prevent and treat common mental health presentations.

Understanding the health needs of internally displaced persons: A scoping review.

We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDP health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.

Stressors, coping and symptoms of adjustment disorder in the course of the COVID-19 pandemic - study protocol of the European Society for Traumatic Stress Studies (ESTSS) pan-European study.

BACKGROUND: During the current COVID-19 pandemic, the people in Europe are exposed to self-isolation, quarantine, job loss, risk of contracting COVID-19, or grief of loved ones. Such a complex array of stressors may lead to symptoms of adjustment disorder or posttraumatic stress disorder. This research protocol describes a study launched by the European Society of Traumatic Stress Studies (ESTSS) to investigate the impact of the COVID-19 pandemic on symptoms of adjustment disorder across European countries. OBJECTIVE: The longitudinal online cohort study aims (1) to explore psychosocial reactions to the COVID-19 pandemic across ten European countries; (2) to examine the relationships between risk and resilience factors, stressors and symptoms of adjustment disorder during the pandemic; and (3) to investigate whether these relationships are moderated by coping behaviours. METHOD: In ten countries (Austria, Croatia, Georgia, Germany, Italy, Lithuania, Netherlands, Poland, Portugal, and Sweden), between 1,000 and 2,000 participants will be recruited, depending on the size of the country. Participants will be assessed at two timepoints with a six-month interval. Following a conceptual framework based on the WHO's social framework of health, an assessment of risk and resilience factors, COVID-19 related stressors and pandemic-specific coping behaviours will be measured to estimate their contribution to symptoms of adjustment disorder. The Adjustment Disorder New Module 8 (ADNM-8) will be used to assess symptoms of adjustment disorder. As a secondary measure, symptoms of posttraumatic stress disorder will be measure using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). DATA ANALYSIS: The relative contribution of risk factors, resilience factors, and stressors on symptoms of adjustment disorder or symptoms of posttraumatic stress disorder will be estimated using multilevel analysis. To determine the moderating effects of different types of coping behaviours on these relationships, a multilevel mediation analysis will be carried out.

Antecedentes: Durante la actual pandemia de COVID-19, las personas en Europa están expuestas a autoaislamiento, cuarentena, pérdida de empleo, riesgo de contraer COVID-19 o duelo de sus seres queridos. Un conjunto tan complejo de factores estresantes puede provocar síntomas de trastorno de adaptación o trastorno de estrés postraumático. Este protocolo de investigación describe un estudio lanzado por la Sociedad Europea de Estudios de Estrés Traumático (ESTSS) para investigar el impacto de la pandemia COVID-19 en los síntomas del trastorno de adaptación en países europeos.Objetivo: El estudio longitudinal de cohorte en línea tiene como objetivo (1) explorar las reacciones psicosociales a la pandemia de COVID-19 en diez países europeos; (2) examinar las relaciones entre los factores de riesgo y resiliencia, estresores y síntomas de trastorno de adaptación durante la pandemia; e (3) investigar si estas relaciones son moderadas por comportamientos de afrontamiento.Método: En diez países (Austria, Croacia, Georgia, Alemania, Italia, Lituania, Países Bajos, Polonia, Portugal y Suecia) serán reclutados entre 1,000 y 2,000 participantes, dependiendo del tamaño del país. Los participantes serán evaluados en dos momentos con un intervalo de seis meses. Siguiendo un marco conceptual basado en el marco social de salud de la OMS, una evaluación de los factores de riesgo y resiliencia, factores estresantes relacionados con COVID-19 y el comportamiento de afrontamiento específico de la pandemia serán medidos para estimar su contribución a los síntomas de trastorno de adaptación. El nuevo módulo de trastorno de adaptación 8 (ADNM-8) se utilizará para medir los síntomas del trastorno de adaptación. Como medida secundaria, se evaluarán síntomas de trastorno de estrés postraumático usando el cribaje de TEPT en atención primaria para DSM-5 (PC-PTSD-5).Análisis de datos: La contribución relativa de los factores de riesgo, factores de resiliencia y los estresores sobre los síntomas de trastorno de adaptación o síntomas de trastorno de estrés postraumático se estimará mediante análisis multinivel. Para determinar los efectos moderadores de diferentes tipos de conductas de afrontamiento en estas relaciones, se llevará a cabo un análisis de mediación multinivel.

Trauma and trauma care in Europe.

The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the state-of-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.

Los países Europeos tienen una larga historia de exposición a traumas de larga escala. A principios de la década de 1990, la creciente conciencia de las consecuencias del trauma dentro de la comunidad de salud mental condujo a la fundación de las sociedades locales para la psicotraumatología en Europa y la Sociedad Europea de Estudios de Estrés Traumático (ESTSS), la cual celebra en el 2018 su 25° aniversario. El enfoque de este artículo es describir el estado actual de la atención de los sobrevivientes de traumas en los 15 países Europeos, donde las sociedades miembros de la ESTSS se han establecido. Las descripciones breves sobre la carga histórica de trauma en cada país son seguidas por una descripción general del sistema de atención para sobrevivientes de trauma en el país, el estado de la técnica de las intervenciones, los desafíos actuales en el cuidado de sobrevivientes y los temas que necesitan ser abordados con mayor urgencia en el futuro. Los reportes de los diferentes países demuestran los pasos importantes que se han dado en Europa en la entrega de atención para los sobrevivientes de trauma. Dada la diversidad cultural y económica del continente, hay también diferencias entre los países Europeos, por ejemplo en relación al uso de tratamientos basados en la evidencia. Las estrategias para resolver estas diferencias, como el nuevo curriculum de entrenamiento de la ESTSS para los proveedores de atención a lo largo de Europa son discutidas brevemente.

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Our flesh is here but our soul stayed there: A qualitative study on resource loss due to war and displacement among internally-displaced women in the Republic of Georgia.

Losses experienced by conflict-affected civilians in low and middle income countries is a relatively unexplored area. The aim of our paper is to explore the concept of resource loss in the accounts of internally displaced women in Georgia. We use Hobfoll's Conservation of Resources (COR) theory to guide our approach by examining the loss of objects, personal characteristics, conditions, and energies. Semi-structured interviews were conducted on 42 purposively-selected Georgian women residing in internally displaced persons settlements during fieldwork in Georgia from December 2012 to February 2013. Line-by-line open-coding was conducted on translated and transcribed interviews using Nvivo. The conservation of resources theory was utilised to guide the 'mapping' of the relationships between losses which occurred in the post-conflict period. War-related trauma led to the loss of property, which caused the loss of livelihood and subsequent loss of social networks and mental and physical health. The mental and physical health losses, along with the loss of livelihood, constituted a loss spiral in which losses in one area perpetuated on-going losses in the other areas. Interventions at supporting livelihoods are needed in order to address the cascade of losses resulting from war.

Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study.

BACKGROUND: There is large gap in mental illness treatment globally and potentially especially so in war-affected populations. The study aim was to examine health care utilization patterns for mental, behavioural and emotional problems among the war-affected adult population in the Republic of Georgia. METHODS: A cross-sectional household survey was conducted among 3600 adults affected by 1990s and 2008 armed conflicts in Georgia. Service use was measured for the last 12 months for any mental, emotional or behavioural problems. TSQ, PHQ-9 and GAD-7 were used to measure current symptoms of PTSD, depression and anxiety. Descriptive and regression analyses were used. RESULTS: Respondents were predominantly female (65.0%), 35.8% were unemployed, and 56.0% covered by the government insurance scheme. From the total sample, 30.5% had symptoms of at least one current mental disorder. Among them, 39.0% sought care for mental problems, while 33.1% expressed facing barriers to accessing care and so did not seek care. General practitioners (29%) and neurologists (26%) were consulted by the majority of those with a current mental disorder who accessed services, while use of psychiatric services was far more limited. Pharmacotherapy was the predominant type of care (90%). Female gender (OR 1.50, 95% CI: 1.25, 1.80), middle-age (OR 1.83, 95% CI: 1.48, 2.26) and older-age (OR 1.62, 95% CI: 1.19, 2.21), possession of the state insurance coverage (OR 1.55, 95% CI: 1.30, 1.86), current PTSD symptoms (OR 1.56, 95% CI: 1.29, 1.90) and depression (OR 2.12, 95% CI: 1.70, 2.65) were associated with higher rates of health service utilization, while employed were less likely to use services (OR 0.71, 95% CI: 0.55, 0.89). CONCLUSIONS: Reducing financial access barriers and increasing awareness and access to local care required to help reduce the burden of mental disorders among conflict-affected persons in Georgia.

Patterns of somatic distress among conflict-affected persons in the Republic of Georgia.

BACKGROUND: There are substantial risk factors for somatic distress (SD) among civilian populations affected by armed conflict in low and middle income countries. However, the evidence is very limited. Our aim was to examine patterns of SD among conflict-affected persons in the Republic of Georgia, which has over 200,000 internally displaced persons (IDPs) from the wars over separatists regions in the 1990s and with Russia in 2008. METHODS: A cross-sectional household survey was conducted with 3600 randomly selected IDPs and former IDPs (returnees). SD was measured using the Patient Health Questionnaire (PHQ-15). Post-traumatic stress disorder (PTSD), depression, anxiety, and disability were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and WHO Disability Assessment Schedule 2.0, respectively. Descriptive, tetrachoric and multivariate regression analyses were used. RESULTS: Forty-two percent of respondents (29% men; 48% women) were recorded as at risk of SD (PHQ-15 score >5). In tetrachoric analysis, SD scores were highly correlated with depression (r = 0.60; p < 0.001), PTSD (r = 0.54; p < 0.001), and anxiety (r = 0.49; p < 0.001). Factors significantly associated with SD in the multivariate regression analysis were depression, PTSD, anxiety, individual trauma event exposure, cumulative trauma exposure, female gender, older age, bad household economic status, and being a returnee compared to an IDP. SD was also associated with increased levels of functional disability (b = 6.73; p < 0.001). CONCLUSIONS: The high levels of SD among IDPs and returnees in Georgia indicate significant suffering. The findings have implications for both mental and physical health services in Georgia.

Reversing hard won victories in the name of human rights: a critique of the General Comment on Article 12 of the UN Convention on the Rights of Persons with Disabilities.

The UN Convention on the Rights of Persons with Disabilities (CRPD) is a major milestone in safeguarding the rights of persons with disabilities. However, the General Comment on Article 12 of the CRPD threatens to undermine critical rights for persons with mental disabilities, including the enjoyment of the highest attainable standard of health, access to justice, the right to liberty, and the right to life. Stigma and discrimination might also increase. Much hinges on the Committee on the Rights of Persons with Disabilities' view that all persons have legal capacity at all times irrespective of mental status, and hence involuntary admission and treatment, substitute decision-making, and diversion from the criminal justice system are deemed indefensible. The General Comment requires urgent consideration with the full participation of practitioners and a broad range of user and family groups.