Violence and social capital in post-conflict Guatemala.

OBJECTIVE: Violence in post-conflict Guatemala has serious public health consequences for the population. The objective of this study was to assess the relationship between violence and social capital. METHODS: Data from a cross-sectional victimization survey conducted in 2008 - 2010 in Guatemala were analyzed. Two-stage proportionate sampling was used in the survey. Households (n = 1 300) were randomly sampled within a random sample of communities (n = 118) in five administrative departments. The survey collected information on the six-month violence exposure of 6 335 individuals. Social capital was measured at the household level using the short version of the Adapted Social Capital Tool (SASCAT). The odds ratio for household violence exposure was estimated using multiple logistic regression. Community-level data from the latest national census were included as explanatory factors at the community level. Income, ethnicity, and social capital were included at the household level. Data were analyzed using SPSS 18.0. RESULTS: In total, 2.7% of individuals and 11.7% of households had been exposed to violence within the past six months. The multivariate analysis showed that 1) structural social capital (in this case, the level of participation in social networks and civil society) was a risk factor for violence and 2) cognitive social capital (measured as trust, norms, and sense of belonging) was a protective factor for violence. CONCLUSIONS: The opposite direction of the association between violence and structural and cognitive social capital challenges the use of social capital as a unified concept. If this finding is corroborated by other studies, structural and cognitive social capital will have to be treated as two distinctly different concepts.

Towards an integrated model for supervision for mental health and psychosocial support in humanitarian emergencies: A qualitative study.

BACKGROUND: Despite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies. METHODS: Semi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group. RESULTS: Results reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees' wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision. CONCLUSION: An integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process.

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings.

BACKGROUND: Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. METHODS: The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. RESULTS: The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols. CONCLUSION: The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.

Caring for the mental health of humanitarian volunteers in traumatic contexts: the importance of organisational support.

Background: Humanitarian workers operate in traumatic contexts, putting them at an increased risk of adverse mental health outcomes. The quality of the support they receive from their organization, their supervisor, and team members are proposed as determinants of mental illness and well-being, via the stress-appraisal process. Objective: Grounded in organizational support theory, we sought to understand the relationship between organizational factors, including perceived organizational support, supervisor support, and team support, and indicators of both adverse mental health and mental well-being among humanitarian volunteers. This relationship is hypothesized to be mediated by the perceived psychological stress. Methods: A sample of 409 humanitarian volunteers from the Sudanese Red Crescent Society completed an online, anonymous, survey comprised of the Perceived Supervision, Perceived Organizational Support, Team Support, and Perceived Psychological Stress scales, as well as the Generalized Anxiety Disorder and Patient Health Questionnaire scales, (GAD-7 and PHQ- 8), and the Warwick-Edinburgh Mental Well-being Scale. Study objectives were tested using structural equation modelling (SEM) procedures. Results: Perceived helplessness (PH) and perceived self-efficacy (PSE), as measures of psychological stress, were both found to fully mediate the relationship between perceived organizational support and mental health outcomes. Perceived organizational support was associated with PSE and inversely with PH. PH was associated with adverse mental health and inversely related to mental well-being. PSE was only associated with mental well-being. Perceived supervision was negatively associated with PSE. Conclusions: Perceived organizational support is a key determinant of the mental health of humanitarian volunteers, with greater perceived support associated with lower distress symptomology and greater mental well-being. Humanitarian agencies should take actions to improve their internal organization support systems to mitigate the stress associated with working in traumatic contexts. Specifically, more attention should be paid to the organizational support of the volunteers as front-line workers in humanitarian settings.

Antecedentes: Los trabajadores humanitarios operan en contextos traumáticos, lo que los pone en un mayor riesgo de resultados adversos para la salud mental. La calidad del apoyo que reciben de su organización, su supervisor, y los miembros del equipo han sido propuestos como determinantes importantes de las enfermedades mentales y el bienestar, a través del proceso de evaluación del estrés.Objetivo: Basados en la teoría del apoyo organizacional, buscamos comprender la relación entre los factores organizacionales, incluyendo el apoyo organizacional percibido, el apoyo del supervisor, y el apoyo del equipo, y los indicadores de salud mental adversa y bienestar mental entre los voluntarios humanitarios. La hipótesis es que esta relación está mediada por el estrés psicológico percibido.Métodos: Una muestra de 409 voluntarios humanitarios de la Sociedad de la Media Luna Roja Sudanesa completó una encuesta en línea, anónima, compuesta por las escalas de Supervisión Percibida, Apoyo Organizacional Percibido, Apoyo del Equipo, y Estrés Psicológico Percibido, así como las escalas de Trastorno de Ansiedad Generalizada y el Cuestionario de Salud del Paciente, (GAD-7 y PHQ-8 en sus siglas en inglés) y la Escala de Bienestar Mental Warwick-Edinburgh. Los objetivos del estudio se probaron utilizando procedimientos de modelo de ecuaciones estructurales (SEM en su sigla en inglés).Resultados: Se encontró que la desesperanza percibida (DP) y la autoeficacia percibida (AP), como medidas de estrés psicológico, mediaron completamente la relación entre el apoyo organizacional percibido y los resultados de salud mental. El apoyo organizacional percibido se asoció con la DP (b = −0.60) y la AP (b = 0.56). La DP se asoció con salud mental adversa (b = 0.88) y se relacionó inversamente con el bienestar mental (b = −0.43). La AP solo se asoció con el bienestar mental (b = 0.41). La supervisión percibida se asoció negativamente con la AP (b = −0.33).Conclusiones: El apoyo organizacional percibido es un determinante clave de la salud mental de los voluntarios humanitarios, con mayor apoyo percibido asociado con menor sintomatología de angustia y mayor bienestar mental. Las agencias humanitarias deberían tomar medidas para mejorar los sistemas de apoyo de su organización interna para mitigar el estrés asociado con el trabajo en contextos traumáticos. Específicamente, se debe prestar más atención al apoyo organizacional de los voluntarios como trabajadores de primera línea en entornos humanitarios.

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT).

In this paper we present a description of the Horizon2020, Marie Sklodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology.

En este artículo presentamos una descripción de un nuevo programa de investigación y formación, Horizon2020, con fondos de Marie Sklodowska-Curie Action, llamado CONTEXT o 'Red coordinadora para la formación y la excelencia en psicotraumatología'. Se presentan los tres objetivos del programa y cada uno de los cuales hace referencia a un componente clave del programa CONTEXT. Primero, resumimos los doce proyectos individuales de investigación que se llevarán a cabo en tres poblaciones prioritarias: (i) refugiados y solicitantes de asilo, (ii) personal de respuesta en emergencias y (iii) perpetradores y sobrevivientes de violencia infantil y de género. En segundo lugar, detallamos el programa de tutoría y formación, eje central de CONTEXT. Finalmente, describimos cómo la investigación, junto con la formación, contribuirá a una mejor política, directrices y práctica en el campo de la psicoterapia.

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries.

The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.

La crisis en Siria ha dado lugar a un gran número de refugiados que buscan asilo en países vecinos a Siria, así como en Europa. Los refugiados corren un riesgo considerable de desarrollar trastornos mentales comunes, como depresión, ansiedad y trastorno por estrés postraumático (TEPT). La mayoría de los refugiados no tienen acceso a servicios de salud mental para estos problemas debido a las múltiples barreras existentes en los sistemas de salud nacionales y específicos para refugiados, incluida una limitada disponibilidad de profesionales de salud mental. Para contrarrestar algunos de los retos derivados de la limitada capacidad del sistema de salud mental, la Organización Mundial de la Salud (OMS) ha desarrollado una gama de intervenciones psicológicas escalables dirigidas a reducir la angustia psicológica y mejorar el funcionamiento de las personas afectadas por la adversidad. Estas intervenciones, que incluyen Problem Management Plus (Gestión de problemas plus, PM+) y sus variantes, están pensadas para ser aplicadas en formatos cara a cara o mediante teléfonos inteligentes a individuos o grupos por personas no profesionales que no han recibido formación especializada en salud mental,Proporcionamos una justificación basada en la evidencia para el uso de programas escalables orientados a la PM+ que están siendo adaptados para refugiados sirios y proporcionamos información sobre el programa STRENGTHS recientemente lanzado para adaptar, probar y ampliar la PM+ en diversas modalidades, tanto en los países vecinos como en los europeos que reciben refugiados de Siria.

Inequality in self-rated health among immigrants, their descendants and ethnic Danes: examining the role of socioeconomic position.

OBJECTIVES: We investigated inequalities in self-rated health between immigrants, their descendants, and ethnic Danes and explored mediation by socioeconomic position and interactions between country of origin and socioeconomic position. METHODS: Cross-sectional survey data on self-rated health from 4,985 individuals aged 18-66 years including immigrants from seven non-Western countries, their descendants, and ethnic Danes was linked to registry-based data on education, employment status, and income as indicators of socioeconomic position. Using multiple logistic regression analysis, we estimated the association between country of origin and self-rated health. RESULTS: Immigrants reported poorer health compared with ethnic Danes [age-adjusted odds ratio (OR) = 2.0-7.3 for men; 2.1-10.5 for women, dependent on country of origin] as well as their descendants (OR = 1.6-3.8 for men; 1.5-2.0 for women). Adjustment for socioeconomic position attenuated this association. Stratified analysis indicated that the effect of socioeconomic position on self-rated health varied across the groups. CONCLUSION: Policies addressing inequalities in health between immigrants, their descendants, and ethnic Danes should target underlying socioeconomic inequalities. Further research of the effects of socioeconomic position on health among immigrants and descendants is needed.

Violence and social capital in post-conflict Guatemala / Violencia y capital social en la Guatemala posterior al conflicto

OBJECTIVE: Violence in post-conflict Guatemala has serious public health consequences for the population. The objective of this study was to assess the relationship between violence and social capital. METHODS: Data from a cross-sectional victimization survey conducted in 2008 - 2010 in Guatemala were analyzed. Two-stage proportionate sampling was used in the survey. Households (n = 1 300) were randomly sampled within a random sample of communities (n = 118) in five administrative departments. The survey collected information on the six-month violence exposure of 6 335 individuals. Social capital was measured at the household level using the short version of the Adapted Social Capital Tool (SASCAT). The odds ratio for household violence exposure was estimated using multiple logistic regression. Community-level data from the latest national census were included as explanatory factors at the community level. Income, ethnicity, and social capital were included at the household level. Data were analyzed using SPSS 18.0. RESULTS: In total, 2.7% of individuals and 11.7% of households had been exposed to violence within the past six months. The multivariate analysis showed that 1) structural social capital (in this case, the level of participation in social networks and civil society) was a risk factor for violence and 2) cognitive social capital (measured as trust, norms, and sense of belonging) was a protective factor for violence. CONCLUSIONS: The opposite direction of the association between violence and structural and cognitive social capital challenges the use of social capital as a unified concept. If this finding is corroborated by other studies, structural and cognitive social capital will have to be treated as two distinctly different concepts.

OBJETIVO: La violencia en la Guatemala posterior al conflicto tiene graves consecuencias para la salud pública de la población. El objetivo de este estudio fue evaluar la relación entre la violencia y el capital social. MÉTODOS: Se analizaron los datos de una encuesta transversal sobre victimización realizada del 2008 al 2010 en Guatemala. Se empleó el muestreo proporcional en dos etapas. Se obtuvo una muestra aleatoria de hogares (n = 1 300) seleccionados de una muestra aleatoria de comunidades (n = 118) de cinco departamentos administrativos. La encuesta recopiló información sobre la exposición de 6 335 personas a la violencia durante seis meses. El capital social se midió a escala doméstica mediante la versión abreviada de la Herramienta Adaptada de Evaluación del Capital Social (SASCAT, por sus siglas en inglés). Se calculó la razón de posibilidades de exposición a la violencia doméstica mediante regresión logística múltiple. Se incluyeron los datos a escala comunitaria del último censo nacional como factores comunitarios explicativos. A escala doméstica, se incluyeron el nivel de ingresos, el grupo étnico y el capital social. Los datos se analizaron mediante el SPSS 18.0. RESULTADOS: En total, 2,7% de las personas y 11,7% de los hogares se habían visto expuestos a la violencia en los seis últimos meses. El análisis multifactorial mostró que 1) el capital social estructural (en este caso, el nivel de participación en las redes de relaciones sociales y la sociedad civil) constituía un factor de riesgo de violencia; y 2) el capital social cognitivo (medido como la confianza, las normas y el sentido de pertenencia) constituía un factor protector frente a la violencia. CONCLUSIONES: La dirección opuesta de la asociación entre la violencia y el capital social estructural y el cognitivo cuestiona el empleo del capital social como un concepto unificado. Si este hallazgo se corrobora en otros estudios, el capital social estructural y el cognitivo deberán considerarse como dos conceptos marcadamente diferentes.