Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study.

Background: Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods: A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results: The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion: This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.

Factors associated with depression among war-affected population in Northeast, Ethiopia.

BACKGROUND: Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia. METHOD: A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULT: The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression. CONCLUSION: This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.

Social determinants, symptoms and mental problems in adults internally displaced by armed conflict. Soacha, Colombia, 2019.

OBJECTIVE: To characterise social determinants of health, mental health problems and potentially problematic symptoms in the adult population displaced by internal armed conflict in Colombia. METHODS: Cross-sectional descriptive study with a random sample of 98 adults forcefully displaced to Soacha, Colombia, due to internal armed conflict. The Self Report Questionnaire to detect potentially problematic mental health problems and symptoms, and a structured questionnaire on social determinants of health were applied. RESULTS: The median age was 38 [interquartile range, 28-46] years, and women predominated (69.39%). The median time since displacement was 36 [16-48] months, and time since settlement in Soacha, 48 [5-48] months. 86.32% survived on less than the minimum wage per month and 93.87% did not have an employment contract. 42.86% and 7.14% reported being owners of their homes before and after displacement, respectively. Upon arriving in Soacha, 79.60% went to primary support networks and 3% to institutions. Before displacement, 16.33% lacked health insurance and 27.55% afterwards. Regarding mental health problems; there were possible depressive or anxious disorders in 57.29%; possible psychosis in 36.73%; and potentially problematic symptoms in 91.66%, being more prevalent and serious in women (p = 0.0025). CONCLUSIONS: A deterioration in living conditions and a higher prevalence of potentially problematic mental health problems and symptoms was reported in displaced adult populations settled in Soacha compared to other regions of the country. Analyses with complementary perspectives are required to evaluate these differences.

Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria.

BACKGROUND: Armed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. METHODS: We conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017-2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decision-making, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED. RESULTS: Exposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict-affected men were more likely to support a delay in girls' childbearing. CONCLUSION: Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

Health and well-being of young mothers displaced by conflict: Experiences from South Sudan and the Kurdistan Region of Iraq.

Giving birth during adolescence is linked to a variety of negative outcomes, including poor health and well-being. Girls who have been displaced by conflict are at increased risk for becoming young mothers. While prevalence rates and health outcomes have been documented, rarely have the complex personal narratives of early motherhood been examined from the perspectives of mothers themselves, particularly in the Global South. This study relies on in-depth, inductive, narrative analysis of qualitative interviews with 67 young mothers and 10 relatives in South Sudan and the Kurdistan Region of Iraq (KRI) who had been displaced by conflict. This study provides deep insights into the contributing circumstances and consequences of young motherhood from sexual and reproductive health and well-being perspectives, with additional insights on mothering in humanitarian crisis.

Cognitive and Relational Processes Associated to Mental Health in Italian High School Students during COVID-19 and Russian-Ukrainian War Outbreaks.

The negative impact of the COVID-19 pandemic on mental health has been widely demonstrated; however, few studies have investigated the psychological processes involved in this impact, including core beliefs violation, meaning-making disruption, interpersonal support, or one's relational functioning. This study explored the mental health of 215 Italian adolescents during the COVID-19 pandemic and the subsequent outbreak of the Russian-Ukrainian war. By administering a set of questionnaires, several cognitive and emotional variables were investigated, including core belief violation, meaning attribution to the pandemic and war, attachment, and emotion regulation, social media addiction, and relationships with significant others and teachers. We conducted some descriptive, mean difference, correlational, and predictive analyses that revealed a significant association between core belief violation caused by war and pandemic, ability to integrate war and pandemic within personal meaning universe, the relational support received, and mental health. The relationship with teachers during these challenging periods improved significantly according to the respondents' opinion, becoming both more authoritative and empathic. This study offers insights into what cognitive and relational processes are useful to intervene on to reduce the distress of adolescents who are facing significant moments of crisis due to events that challenge their cognitive and emotional balance.

Mental health consequences among Sudanese due to the armed conflicts and civil unrest of 2023: a cross-sectional study.

AIM: To investigate depression, anxiety, PTSD, and insomnia levels among Sudanese citizens during the 2023 Armed Forces conflict in Sudan. METHODS: An online survey was distributed. It is composed of five parts, covering the following areas: (a) sociodemographic data; (b) depression assessment; (c) generalized anxiety disorder assessment; (d) post-traumatic stress disorder assessment; and (e) insomnia assessment.Statistical Package for Social Sciences version 27 was used for data analysis; frequency and percentage were used to describe the qualitative variables. The Pearson correlation coefficient and Chi-square test were used for correlation and association analysis; a p-value equal to or less than .05 was considered statistically significant. RESULTS: The study included 221 participants, whose ages were 35.02 ± 11.83 years. Among the participants, 57.5% were female. The length of stay in the war zone was 39.29 ± 31.71 days. The sound of gunfire, bombs, or explosions was the most frequent war violence personally experienced by participants or their family members, friends, or acquaintances, in 203 (91.8%) and 221 (100%), respectively. Moderate-severe and severe depression were present in 25.3% and 62.0%, respectively. Moderate and severe anxiety were present in 36.2% and 52.9%, respectively. 58.8% had PTSD. Sub-threshold insomnia was present in 57.5%. There was a negative correlation between sex (female) and depression (correlation coefficient = -.183, p-value = .006), which indicates that depression is more likely to be in females. For PTSD, there was a negative correlation between age and PTSD (correlation coefficient = -.150, p-value = 0.026), which indicates that younger age groups were more likely to experience PTSD. Additionally, there was a negative correlation between marital status (married) and PTSD (correlation coefficient = -.175, p-value = .009), which indicates that married participants were more likely to experience PTSD. CONCLUSIONS: Exposure to war-related trauma can also lead to mental health issues. These findings emphasize the urgent need for proper mental health support and interventions in war-affected areas to address the prevalent mental disorders.

The Experiences of People From Arab Countries in Coping with Trauma Resulting From War and Conflict in the Middle East: A Systematic Review and Meta-synthesis of Qualitative Studies.

The Middle East region has been an area of war and political conflict for several decades. There is currently limited research on the experiences of war and conflict among the individuals from Arab countries in the Middle East. The aim of this review was to systematically review and meta-synthesize qualitative literature on the experiences of individuals from Arab countries in the Middle East of going through and coping with war and political conflict. We systematically searched for relevant literature through MEDLINE, PsycINFO, CINAHL, Google Scholar, EThOS, OpenGrey, and The Arab Journal of Psychiatry. Studies selected needed to have a qualitative design reporting on the war and conflict experiences of participants aged 18 years or older from Arab countries in the Middle East. The review protocol was preregistered with PROSPERO (Ref: CRD42022314108). We identified 27 studies to be included in the final review. Four overarching themes were included in the meta-synthesis: War and conflict as life-defining experiences, experiences of hardship, coping with war and conflict, and positives out of a painful experience. Participants in the included studies reported significant distress and losing their sense of self, as well as resilience and positive growth. This review and meta-synthesis revealed the particular culturally informed experiences of individuals from Arab countries in the Middle East in processing their conflict experiences. These experiences highlight the need for culturally sensitive interventions for a population that has been under significant war-related stressors.

Experiences of grief and moral sentiments in survivors of the armed conflict in Medellín, Colombia.

The objective of the study is to understand the experience of grief and moral sentiments in survivors of the armed conflict in the city of Medellín, Colombia, through qualitative research. In total, 32 people affected by different victimising acts in the context of the armed conflict participated. There is a direct relationship between moral sentiments and the processes of handling and processing loss. Moral sentiments frame the experience of emotions in the victim, after the events have occurred, which influence the way in which the pain experienced is processed. These sentiments permeate the processes of dealing with the incident in survivors, the ways in which they perceive themselves and the perpetrators, and the social stances they adopt to face life. We conclude that moral factors play a role in the emotional recovery of victims and are indicative the possibility or difficulty of processing the events that occurred.

Child growth and armed conflict.

BACKGROUND: During armed conflict, the non-combative population, and particularly children, are susceptible to the effects of conflict from a variety of perspectives; psychological stress, loss of food and resources, loss of accommodation, occupation, income, death of family members, etc. The Lancet recently published a special issue entitled 'Maternal and child health and armed conflict' concluding that the ways in which health can be affected by conflict are protean but systematic evidence is sparse, whatever evidence exists is localised and of low to moderate quality, and that data on adolescents are sparse to non-existent. Whilst this may be true of the challenging environments of conflicts in developing countries, historically recent conflicts in Europe provide an alternative viewpoint that is frequently aired in the Auxological literature but is virtually unknown and/or unrecognised in health settings. METHODS: The current paper summarises three previously published studies based on repeated cross-sectional child growth surveys in London, Oslo, and Stuttgart covering the years of the Second World War. Taken together these studies provide extensive evidence of the response of children to armed conflict in the context of secular tends in growth of children living in industrialised nations during the twentieth century. CONCLUSIONS: The conclusions to all three studies may be summarised, with regard to children in industrialised nations, as: (1) armed conflict adversely affects human growth and health, (2) armed conflict affects all age groups but adolescents more so, (3) all age groups recover from poor growth as conditions improve in relation to post-war health and welfare programmes, (4) pre-war differences in size between SES groups diminish during post-war recovery when accompanied by nutritional, welfare and reconstruction programmes.

Transcultural pathways to the will to fight.

In 2022, the "Will to Fight Act" was referred to the US Congress urging attention to measuring and assessing will to fight. That Bill was not enacted, and evaluation efforts within the political and military establishment remain contentious, fragmented, and meager. This likely will persist, along with attendant policy failures and grievous costs, without awareness of research that the social and psychological sciences reveal on the will to fight [S. Atran, Science 373, 1063 (2021)]. We illustrate such research using converging data from a multimethod and multicultural approach, including field and online studies from the Middle East, North Africa, and Europe. These studies reveal specific psychosocial pathways, within a general causal framework, that predict willingness to make costly sacrifices, including to cooperate, fight, and die in war and sustained conflict. From the continuing strife in Iraq to embattled Ukraine, 31 studies were conducted in 9 countries with nearly 12,000 participants. These include people in longstanding conflicts, refugees, imprisoned jihadists and gangs, US military, studies in Ukraine before and during the current war, and rolling studies with a European ally of Ukraine. Results provide evidence for a mediation model of transcultural pathways to the will to fight. Building on our previous behavioral and brain research, on the battlefield in Iraq, with violent extremists, and with US military, the linear mediation yielding the will to fight involves identity fusion, perceived spiritual formidability, and trust. The model, a variation on "The Devoted Actor Framework," applies to primary reference groups, core cultural values, and leaders.

Armed conflict exposure and mental health: examining the role of imperceptible violence.

Armed conflict exposure is associated with multiple mental health problems. However, more needs to be known about the differential effects of particular modalities of armed conflict violence and war methods on mental health. This study a) examined the modalities of violence employed in the Colombian armed conflict and b) assessed their association with mental health problems in armed conflict survivors. Using armed conflict data from the Colombian Armed Conflict Events Information System, we identified three violence modalities: armed confrontations, indiscriminate attacks, and selective violence. Descriptive statistics showed that selective violence generated most (86%) of the 333,219 victims of the Colombian armed conflict between 1996 and 2016. A subsample of armed conflict survivors (n = 551) from the 2015 Colombian Mental Health Survey was used to assess the association of each modality of violence with depression and anxiety, Post Traumatic Stress Disorder (PTSD), and substance abuse. Adjusted Odds Ratios (aOR) (p < .05, 95% CI) showed that survivors of selective violence crimes such as forced disappearance of loved ones, kidnapping, sexual violence, and massacres were at increased risk of experiencing Common Mental Health Disorders, PTSD symptoms, and hazardous drinking. Identifying those at elevated risk for developing mental health problems and substance misuse among survivors of armed conflict may help to use limited resources more effectively.

One-year outcomes of two community-based mental health interventions for Afro-Colombian survivors of the armed conflict and displacement.

The objective of the study is to assess the middle-term effects (1 year after intervention) of two community-based mental health interventions, Common Elements Treatment Approach intervention, CETA, and Narrative Community Group Therapy intervention, NCGT, in two cities of the Colombian Pacific region (Buenaventura and Quibdó). A follow-up study was conducted on a cohort of trial participants. In this trial, the positive effects of two mental health interventions were evaluated; assessment was carried out in separate groups (CETA arm, NCGT arm and a control group) of the reduction of symptoms of anxiety, depression, post-traumatic stress and function impaired mentality. The participants were Afro-Colombian survivors of the armed conflict and displacement living in Buenaventura and Quibdó. They were surveyed using the same instrument used in the original trial. Intent-to-treat analyses were performed, and longitudinal mixed-effects regression models with random effects were used to analyse the middle-term effects of the interventions. At 1-year post-intervention, participants in Buenaventura who received the CETA intervention experienced a decrease in depression (-0.23; p = 0.02), post-traumatic stress symptoms (-0.23; p = 0.02) and total mental health symptoms (-0.14; p = 0.048). In Quibdó, the NCGT intervention significantly improved function impairment (-0.30; p = 0.005). CETA and NCGT interventions have the potential to maintain a reduction of mental health symptoms in participants from the Colombian Pacific region.

The Mental Health Costs of Armed Conflicts-A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones.

AIMS: Armed conflicts produce a wide series of distressing consequences, including death, all of which impact negatively on the lives of survivors. This paper focuses specifically on the mental health consequences of war on adults and child/adolescent refugees or those living in war zones through a review of all systematic reviews and/or meta-analyses published from 2005 up until the current time. RESULTS: Fifteen systematic reviews and/or meta-analyses conducted in adult populations, and seven relating to children and adolescents, were selected for the purpose of this review. Prevalence rates of anxiety, depression and post-traumatic stress disorder (PTSD) were two- to three-fold higher amongst people exposed to armed conflict compared to those who had not been exposed, with women and children being the most vulnerable to the outcome of armed conflicts. A series of war-related, migratory and post-migratory stressors contribute to short- and long-term mental health issues in the internally displaced, asylum seekers and refugees. CONCLUSION: It should be a required social responsibility for all psychiatrists and psychiatric associations to commit to raising awareness amongst political decision-makers as to the mental health consequences caused by armed conflicts, as part of their duty of care for people experiencing the consequences of war.

Traumatismo e violência: a criança em meio à guerra urbana brasileira / Trauma y violencia: el niño en medio de la guerra urbana brasileña / Traumatism and violence: the child in the middle of the Brazilian urban combat / Traumatisme et violence: l'enfant dans milieu de la guerre urbaine brésilienne

O cotidiano de muitas crianças no Brasil tem sido atravessado por situações violentas extremas, evidenciando um estado de abandono social. Sendo assim, o presente artigo visa compreender, a partir da história de Sandro Barbosa do Nascimento e da psicanálise, a natureza do traumatismo e sua relação ao trauma na experiência da criança que vivencia cenas violentas em seu cotidiano. Compreendemos que o traumatismo se constitui na dimensão singular de cada criança, a partir do modo como lidam com o encontro com o trauma que as cenas violentas comportam, bem como com o gozo que irrompe da proximidade do Outro totalitário. Estes modos podem se constituir do recurso simbólico de cada sujeito, mas também da experiência com o não-sentido

La vida cotidiana de muchos niños en Brasil ha estado atravesada por situaciones de extrema violencia, evidenciando un estado de abandono social. Así, este artículo pretende comprender, a partir del relato de Sandro Barbosa do Nascimento y del psicoanálisis, la naturaleza del traumatismo y su relación con el trauma en la experiencia de los niños que viven escenas violentas en su vida cotidiana. Entendemos que el traumatismo se constituye en la dimensión singular de cada niño, a partir de la forma en que se enfrenta al encuentro con el trauma que suponen las escenas violentas, así como con el goce que brota de la proximidad del Otro totalitario. Estos modos pueden constituirse a partir del recurso simbólico de cada sujeto, pero también de la experiencia con el sinsentido

The daily life of many children in Brazil has been crossed by extreme violent situations, evidencing a state of social abandonment. Thus, this article aims to understand, from the story of Sandro Barbosa do Nascimento and of psychoanalysis, the nature of traumatism and its relation to trauma in the experience of children who experience violent scenes in their daily lives. We understand that traumatism is constituted in the singular dimension of each child, from the way they deal with the encounter with the trauma that can be found at violent scenes, as well as with the jouissance that erupts from the proximity of the totalitarian Other. These ways may be constituted from the symbolic resource of each subject, but also from the experience with non-sense

La vie quotidienne de nombreux enfants au Brésil est traversée par des situations de violence extrême, et témoigne d'un état d'abandon social. Cet article vise à comprendre, à partir de l'histoire de Sandro Barbosa do Nascimento et de la psychanalyse, la nature du traumatisme et sa relation au trauma dans l'expérience des enfants qui vivent des scènes de violence dans leur vie quotidienne. Nous comprenons que le traumatisme se constitue dans la dimension singulière de chaque enfant, à partir de la manière dont il gère la rencontre avec le trauma qu'impliquent les scènes de violence, ainsi qu'avec la jouissance qui jaillit de la proximité avec l'Autre totalitaire. Ces voies peuvent se constituer à partir de la ressource symbolique de chaque sujet, mais aussi à partir de l'expérience du non-sens

The stress of war. Recommendations for the protection of mental health and wellbeing for both Ukrainian refugees as well as Poles supporting them. / Stres wojny. Zalecenia dotyczace ochrony zdrowia psychicznego i dobrostanu zarówno uchodzców ukrainskich, jak i Polaków zaangazowanych w ich wsparcie.

The presence of large numbers of Ukrainians looking for refuge in Poland is a new experience for Poles. The ongoing war and the uncertainty of the situation of those displaced may cause anxiety and lead to stressful reactions, exacerbated by endlessly circulating information on hostilities. Therefore, the sense of security may be threatened not only among Ukrainians who have fled to Poland, but also among people who support Ukrainians, who offer them help and shelter. Prolonged support, if not accompanied by proper selfcare can increase the risk of burnout as well as lead to distressful emotional states, such as a feeling of helplessness, hopelessness, reluctance to provide further help, or even demonstrate hostility. The article presents the situation and current psychosocial needs of Ukrainian refugees in Poland and provides a set of recommendations regarding the organization of mental health care in the face of the ongoing war in Ukraine. There are available tools to use by Polish specialists and lay helpers to support Ukrainian refugees. The Mental Health and Psychosocial Support (MHPSS) Intervention Pyramid, developed by the Inter-Agency Standing Committee, is used to classify suggested interventions. Appropriate care should be available to both refugees as well as the host population involved in their care.