The power of siblings and caregivers: under-explored types of social support among children affected by HIV and AIDS.

Children affected by HIV and AIDS have significantly higher rates of mental health problems than unaffected children. There is a need for research to examine how social support functions as a source of resiliency for children in high HIV-prevalence settings such as South Africa. The purpose of this research was to explore how family social support relates to depression, anxiety, and post-traumatic stress (PTS). Using the ecological model as a frame, data were drawn from a 2011 cross-sectional study of 1380 children classified as either orphaned by AIDS and/or living with an AIDS sick family member. The children were from high-poverty, high HIV-prevalent rural and urban communities in South Africa. Social support was analyzed in depth by examining the source (e.g. caregiver, sibling) and the type (e.g. emotional, instrumental, quality). These variables were entered into multiple regression analyses to estimate the most parsimonious regression models to show the relationships between social support and depression, anxiety, and PTS symptoms among the children. Siblings emerged as the most consistent source of social support on mental health. Overall caregiver and sibling support explained 13% variance in depression, 12% in anxiety, and 11% in PTS. Emotional support was the most frequent type of social support associated with mental health in all regression models, with higher levels of quality and instrumental support having the strongest relation to positive mental health outcomes. Although instrumental and quality support from siblings were related to positive mental health, unexpectedly, the higher the level of emotional support received from a sibling resulted in the child reporting more symptoms of depression, anxiety, and PTS. The opposite was true for emotional support provided via caregivers, higher levels of this support was related to lower levels of all mental health symptoms. Sex was significant in all regressions, indicating the presence of moderation.

Effects of the 2002 sniper attacks on the homeless population in Washington, DC.

OBJECTIVE: Despite the prevalence of homelessness, this population has rarely been included in disaster and terrorism planning. To better understand the mental health needs of the homeless during a terrorist event and to highlight the need to address methodological limitations in research in this area, we examined responses to the October 2002 Washington, DC, sniper attacks. METHODS: We interviewed 151 homeless individuals 1 year after the Washington, DC, sniper attacks. RESULTS: The majority (92.7%) was aware of the sniper events; 84.1% stayed informed through the media and 72.7% had someone to turn to for emotional support. Almost half (44%) reported identification with victims and 41% increased substance use during the attacks. More than half (61.7%) felt extremely frightened or terrified and 57.6% reported high perceived threat. Females, nonwhites, and participants with less than a high school education experienced greater threat. Women, nonwhites, and younger (<43 years old) participants were more likely to have decreased more activities and 32.7% increased confidence in local law enforcement; however, 32.7% became less confident. CONCLUSIONS: During a terrorist attack the homeless population may be difficult to reach or reluctant to comply with public health programs. Addressing barriers to health care in vulnerable groups is critical to effective public health disaster response.

Post-civil war adaptation and need in Managua, Nicaragua.

Within seven years after the end of the Nicaraguan civil war in 1990, forced migrants, whose lives had been most disrupted by the conflict, were self-settled in a squatter community in the capital city of Managua and lived in extreme poverty with minimal health, education, security and social service supports. Compared with voluntary migrant neighbours, whose lives had been less affected by the conflict, forced migrants exhibited equal clinically significant symptoms of physical and mental health and psychosocial maladaptation. These findings run counter to generally held theory and assumptions about the negative long-lasting effects of the trauma and stress of war, forced migration and resettlement. Explanations are offered to explain the discrepancies between theory and the study findings as well as the dominance of poverty and socioeconomic status. Implications are also drawn for increasing social support and other durable forms of assistance that emerge from the study as important to meeting the needs of equally poor and unhealthy forced and voluntary migrants in proliferating squatter communities throughout the Third World.

Manual de la atención de salud mental para víctimas de desastres / Handbook for mental health care of disaster victims

Esta obra es de gran utilidad para el personal administrativo y organizativo, asi como los practicantes de servicios de salud mental en diversos niveles. Aporta conocimientos actualizados sobre la intervención en crisis y los trabajos de salud mental en situaciones de emergencia. Introduce al lector en problemas que surgen en las diversas fases de un desastre y esboza los problemas con que se topa el profesional. Los conceptos básicos necesarios para comprender la conducta en situaciones de desastre se definen al hablar de estrés, crisis, perdidas, duelo y pena, junto con respuestas emocionales menos ususales

Problemas de salud mental después de una situación de desastre

Presenta los resultados de una investigación realizada para explorar y analizar las consecuencias psicosociales producidas por un desastre natural. Como resultado del estudio de las historias médicas del Hospital Psiquiátrico Nacional de Managua se ha desarrollado un perfil psicosocial de los pacientes y se han establecido comparaciones de los datos correspondientes a los períodos anterior y posterior a la catástrofe. Sobre la base de los resultados obtenidos, los autores sostienen que es muy importante planificar y organizar un servicio adecuado de salud mental inmediatamente después de producida una situación de desastre. Existe además la necesidad de futuras investigaciones que incluyen el estudio longitudinal de los efectos de un desastre durante un período de más de un año, así como de la naturaleza de las alteraciones emocionales producidas y el tipo de tratamiento requerido para aliviarlas