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Archives of Public Health = Archives... May 2024Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This...
BACKGROUND
Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps.
METHODS
The review employed the Arksey and O'Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings.
RESULTS
After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies (n = 15; 75%) from South Africa (n = 11; 55%), and involved women (n = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries.
CONCLUSION
This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA.
PubMed: 38773645
DOI: 10.1186/s13690-024-01307-3 -
The Cochrane Database of Systematic... May 2024Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.
OBJECTIVES
To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure).
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour.
MAIN RESULTS
We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.
AUTHORS' CONCLUSIONS
To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
Topics: Humans; Randomized Controlled Trials as Topic; Mental Health; Developing Countries; Quality of Life; Adult; Child; Psychosocial Intervention; Adaptation, Psychological; Altruism; Adolescent; Refugees; Bias; Health Promotion; Psychosocial Functioning; Female; Stress Disorders, Post-Traumatic; Mental Disorders
PubMed: 38770799
DOI: 10.1002/14651858.CD014300.pub2 -
Psychology Research and Behavior... 2024In the Indian setting, communal riots characterized by intergroup violence have been common and have had an impact on the lives of both people and communities. The goal... (Review)
Review
OBJECTIVE
In the Indian setting, communal riots characterized by intergroup violence have been common and have had an impact on the lives of both people and communities. The goal of this systematic review is to investigate the psychological effects of Indian communal riots in depth. Through a comprehensive review of the literature, the study aims to identify recurring themes, patterns, and variances in the psychological effects encountered by victims of community violence.
METHODS
The researcher searched Science Direct, PubMed, Web of Science, Google Scholar, and PsycINFO for research published between the year 2000 and the year 2022 in each of these databases. The Newcastle-Ottawa Scale was employed to evaluate the study's quality.
RESULTS
After identifying 1189 publications in all, 195 of them were chosen for full-text examination, and 41 research were ultimately included. Twenty studies examined depression and mental health with a prevalence rate of 49%. Five studies (12%) examined post-traumatic stress disorder. In places devastated by riots, the prevalence of post-traumatic stress disorder varied from 4% to 41%. Other studies investigated anxiety, alcohol abuse, and homelessness. However, two studies revealed that group activities could lower depression and suicide rates, perhaps as a result of increased social cohesiveness and group catharsis among subpopulations.
CONCLUSION
The researcher investigated the connection between collective activities and mental health in this systematic review, providing strong evidence that riots, protests, and other collective actions-even peaceful ones-can harm mental health outcomes. Thus, healthcare providers must be aware of the psychological and emotional effects of riots, revolutions, and demonstrations. It is essential to do more study on this newly identified sociopolitical driver of mental health.
PubMed: 38766318
DOI: 10.2147/PRBM.S455783 -
Journal of Anxiety Disorders Jun 2024Post-traumatic stress disorder (PTSD) is a debilitating, often chronic condition with substantial cross-national lifetime prevalence. Although mindfulness-based... (Meta-Analysis)
Meta-Analysis
Post-traumatic stress disorder (PTSD) is a debilitating, often chronic condition with substantial cross-national lifetime prevalence. Although mindfulness-based interventions (MBIs) may help reduce PTSD symptoms, efficacy results are inconsistent. Despite many systematic reviews (SRs) examining MBIs for PTSD, SR quality has been neither evaluated nor synthesized. We conducted an umbrella review to summarize and evaluate existing evidence regarding MBIs for PTSD, identifying 69 SRs (27 meta-analyses), consisting of 83 primary studies. Using AMSTAR2 (a valid SR quality assessment tool), we evaluated each SR on key domains relevant to methodological rigor and rated the confidence of inferences. Results found SRs were 65.2% non-rigorous, 27.5% likely rigorous, and 7.2% rigorous; common limitations included inadequate risk of bias assessment, extractions not completed in duplicate, and lack of pre-registration, highlighting the need for higher quality SRs. We then performed a meta-meta-analysis to estimate the efficacy of MBIs to reduce PTSD symptoms, yielding a medium effect size (SMD=0.41, p < .001), derived from 22 meta-analyses (with replicable data) and 35 unique articles. Analyses were consistent across control conditions and MBI type (first-generation/narrow [i.e., MBIs with well-established protocols]) versus broad (i.e., other MBI types), comparable with second-line treatments (e.g., pharmacotherapy). Findings were narratively synthesized; areas for methodological improvements in MBI research were identified.
Topics: Humans; Mindfulness; Stress Disorders, Post-Traumatic
PubMed: 38761551
DOI: 10.1016/j.janxdis.2024.102859 -
Journal of Psychiatric Research May 2024Deep transcranial magnetic stimulation (dTMS) has gained attention as an enhanced form of traditional TMS, targeting broader and deeper regions of the brain. However, a... (Review)
Review
Deep transcranial magnetic stimulation (dTMS) has gained attention as an enhanced form of traditional TMS, targeting broader and deeper regions of the brain. However, a fulsome synthesis of dTMS efficacy across psychiatric and cognitive disorders using sham-controlled trials is lacking. We systematically reviewed 28 clinical trials comparing active dTMS to a sham/controlled condition to characterize dTMS efficacy across diverse psychiatric and cognitive disorders. A comprehensive search of APA PsycINFO, Cochrane, Embase, Medline, and PubMed databases was conducted. Predominant evidence supports dTMS efficacy in patients with obsessive-compulsive disorder (OCD; n = 2), substance use disorders (SUDs; n = 8), and in those experiencing depressive episodes with major depressive disorder (MDD) or bipolar disorder (BD; n = 6). However, the clinical efficacy of dTMS in psychiatric disorders characterized by hyperactivity or hyperarousal (i.e., attention-deficit/hyperactivity disorder, posttraumatic stress disorder, and schizophrenia) was heterogeneous. Common side effects included headaches and pain/discomfort, with rare but serious adverse events such as seizures and suicidal ideation/attempts. Risk of bias ratings indicated a collectively low risk according to the Grading of Recommendations, Assessment, Development, and Evaluations checklist (Meader et al., 2014). Literature suggests promise for dTMS as a beneficial alternative or add-on treatment for patients who do not respond well to traditional treatment, particularly for depressive episodes, OCD, and SUDs. Mixed evidence and limited clinical trials for other psychiatric and cognitive disorders suggest more extensive research is warranted. Future research should examine the durability of dTMS interventions and identify moderators of clinical efficacy.
PubMed: 38759496
DOI: 10.1016/j.jpsychires.2024.05.011 -
PloS One 2024Humanitarian crises and disasters affect millions of people worldwide. Humanitarian aid workers are civilians or professionals who respond to disasters and provide... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Humanitarian crises and disasters affect millions of people worldwide. Humanitarian aid workers are civilians or professionals who respond to disasters and provide humanitarian assistance. In doing so, they face several stressors and traumatic exposures. Humanitarian aid workers also face unique challenges associated with working in unfamiliar settings.
OBJECTIVE
To determine the occurrence of and factors associated with mental ill-health among humanitarian aid workers.
SEARCH STRATEGY
CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2005-2020. Grey literature was searched on Google Scholar.
SELECTION CRITERIA
PRISMA guidelines were followed and after double screening, studies reporting occurrence of mental ill-health were included. Individual narratives and case studies were excluded, as were studies that reported outcomes in non-humanitarian aid workers.
DATA ANALYSIS
Data on occurrence of mental ill-health and associated factors were independently extracted and combined in a narrative summary. A random effects logistic regression model was used for the meta-analysis.
MAIN RESULTS
Nine studies were included with a total of 3619 participants, reporting on five types of mental ill-health (% occurrence) including psychological distress (6.5%-52.8%); burnout (8.5%-32%); anxiety (3.8%-38.5%); depression (10.4%-39.0%) and post-traumatic stress disorder (0% to 25%). Hazardous drinking of alcohol ranged from 16.2%-50.0%. Meta-analysis reporting OR (95% CI) among humanitarian aid workers, for psychological distress was 0.45 (0.12-1.64); burnout 0.34 (0.27-0.44); anxiety 0.22 (0.10-0.51); depression 0.32 (0.18-0.57) and PTSD 0.11 (0.03-0.39). Associated factors included young age, being female and pre-existing mental ill-health.
CONCLUSIONS
Mental ill-health is common among humanitarian aid workers, has a negative impact on personal well-being, and on a larger scale reduces the efficacy of humanitarian organisations with delivery of aid and retention of staff. It is imperative that mental ill-health is screened for, detected and treated in humanitarian aid workers, before, during and after their placements. It is essential to implement psychologically protective measures for individuals working in stressful and traumatic crises.
Topics: Humans; Mental Disorders; Mental Health; Relief Work; Altruism; Stress Disorders, Post-Traumatic; Burnout, Professional; Anxiety; Female; Male; Depression; Psychological Distress
PubMed: 38748709
DOI: 10.1371/journal.pone.0292107 -
The mental health of migrants living in limbo: A mixed-methods systematic review with meta-analysis.Psychiatry Research Jul 2024The number of forcibly displaced people has more than doubled over the past decade. Many people fleeing are left in limbo without a secure pathway to citizenship or... (Meta-Analysis)
Meta-Analysis
The number of forcibly displaced people has more than doubled over the past decade. Many people fleeing are left in limbo without a secure pathway to citizenship or residency. This mixed-methods systematic review reports the prevalence of mental disorders in migrants living in limbo, the association between limbo and mental illness, and the experiences of these migrants in high income countries. We searched electronic databases for quantitative and qualitative studies published after January 1, 2010, on mental illness in precarious migrants living in HICs and performed a meta-analysis of prevalence rates. Fifty-eight articles met inclusion criteria. The meta-analysis yielded prevalence rates of 43.0 % for anxiety disorders (95 % CI 29.0-57.0), 49.5 % for depression (40.9-58.0) and 40.8 % for posttraumatic stress disorder (30.7-50.9). Having an insecure status was associated with higher rates of mental illness in most studies comparing migrants in limbo to those with secure status. Six themes emerged from the qualitative synthesis: the threat of deportation, uncertainty, social exclusion, stigmatization, social connection and religion. Clinicians should take an ecosocial approach to care that attends to stressors and symptoms. Furthermore, policymakers can mitigate the development of mental disorders among migrants by adopting policies that ensure rapid pathways to protected status.
Topics: Humans; Mental Disorders; Mental Health; Prevalence; Transients and Migrants
PubMed: 38733932
DOI: 10.1016/j.psychres.2024.115931 -
World Psychiatry : Official Journal of... Jun 2024Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the...
Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.
PubMed: 38727072
DOI: 10.1002/wps.21203 -
EClinicalMedicine Jun 2024Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is...
BACKGROUND
Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with rare cancers.
METHODS
This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis.
FINDINGS
We included 32 studies with 57,470 patients with rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes.
INTERPRETATION
We highlight the need for early identification of psychological maladjustment in patients with rare cancers. Additionally, studies to identify effective interventions are imperative.
FUNDING
This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.
PubMed: 38726223
DOI: 10.1016/j.eclinm.2024.102631 -
BMC Pregnancy and Childbirth May 2024Posttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify...
BACKGROUND
Posttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify sociodemographic, pregnancy and birth, and psychological factors associated with PTS and anxiety in this population.
METHOD
Studies published up to December 2022 were retrieved by searching Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health electronic databases. The modified Newcastle-Ottawa Scale for cohort and cross-sectional studies was used to assess the methodological quality of included studies. This review was pre-registered in PROSPERO (CRD42021270526).
RESULTS
Forty-nine studies involving 8,447 parents were included; 18 studies examined factors for PTS, 24 for anxiety and 7 for both. Only one study of anxiety factors was deemed to be of good quality. Studies generally included a small sample size and were methodologically heterogeneous. Pooling of data was not feasible. Previous history of mental health problems (four studies) and parental perception of more severe infant illness (five studies) were associated with increased risk of PTS, and had the strongest evidence. Shorter gestational age (≤ 33 weeks) was associated with an increased risk of anxiety (three studies) and very low birth weight (< 1000g) was associated with an increased risk of both PTS and anxiety (one study). Stress related to the NNU environment was associated with both PTS (one study) and anxiety (two studies), and limited data suggested that early engagement in infant's care (one study), efficient parent-staff communication (one study), adequate social support (two studies) and positive coping mechanisms (one study) may be protective factors for both PTS and anxiety. Perinatal anxiety, depression and PTS were all highly comorbid conditions (as with the general population) and the existence of one mental health condition was a risk factor for others.
CONCLUSION
Heterogeneity limits the interpretation of findings. Until clearer evidence is available on which parents are most at risk, good communication with parents and universal screening of PTS and anxiety for all parents whose babies are admitted to NNU is needed to identify those parents who may benefit most from mental health interventions.
Topics: Humans; Stress Disorders, Post-Traumatic; Parents; Infant, Newborn; Anxiety; Female; Risk Factors; Intensive Care Units, Neonatal; Pregnancy
PubMed: 38724899
DOI: 10.1186/s12884-024-06383-5