1. This study compared mental health in a cohort in Nepal before and after exposure to political violence during the People's War from 1996-2006. In 2000 before violence reached their community, 30.9% screened positive for depression and 26.2% for anxiety. In 2007-2008 after the war, these increased to 40.6% for depression and 47.7% for anxiety.
2. Exposure to conflict was associated with increased anxiety but not depression when controlling for age. Anxiety increases showed a dose-response relationship with conflict exposure.
3. No demographic group showed unique vulnerability to mental health effects of the war, indicating other chronic social problems like poverty were also important influences.
Risk Factors for Suicide in Bipolar I Disorder in Two Prospectively Studied C...Abby Kriener
The document summarizes two studies that examined risk factors for suicide in patients with bipolar I disorder. The first study prospectively followed 288 patients for up to 30 years, while the second matched patient identifiers to national death records. Both found that a history of suicide attempt was a robust risk factor for future suicide. However, the studies differed in suicide rates and other risk factors identified. Differences in how subjects were recruited and followed up can impact findings on suicide risk factors. [/SUMMARY]
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
Medical Co Morbidities in Patients of Frontal Temporal Dementia -A Hospital B...CrimsonpublishersMedical
Medical Co Morbidities in Patients of Frontal Temporal Dementia -A Hospital Based Study by Manjunadh Muralleedharan in Research in Medical & Engineering Sciences
Caregivers’ perspective on non-fatal deliberate self harmiosrjce
This document summarizes a study examining caregivers' perspectives on non-fatal deliberate self-harm. Fifty patients who engaged in deliberate self-harm and were admitted to a hospital were evaluated. Caregivers of these patients were interviewed using a 15-item questionnaire to assess their attitudes. Common characteristics of the self-harm incidents were that they occurred when someone else was present and no suicide notes were left. The most common psychiatric diagnosis among patients was major depressive disorder. Most caregivers reported feeling shock, anger, and a need to overprotect the individual after the self-harm incident. A significant association was found between caregivers perceiving an unsympathetic family attitude and repetition of deliberate self-harm.
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
Domestic violence and its relationship with depression, anxiety and quality o...Dr.Nasir Ahmad
Objectives: To find out the relationship of domestic violence with depression, anxiety and quality of life
in married women in hospitals of Rawalpindi and Islamabad.
Methods: This co-relational study was conducted in Rawalpindi Institute of Health Sciences from January
2019 to December 2019. All the females’ patients who were the victim of domestic violence were the
population of the study. Consecutive non-probability sampling technique was used for selection of sampling
from the target population. The inclusion criterion for this study was diagnosed case of domestic violence.
DASS 21 (The Depression, Anxiety and Stress Scale) and Quality of life (WHO) scales were administered to
116 patients.
Results: The study’s key results were that domestic abuse has positive relationship with depression,
anxiety, and stress. It was also found that domestic abuse has a negative relationship with quality of life of
those who have been subjected to domestic violence of this sort.
Conclusion: It was concluded that domestic violence whether verbal, physical, emotional or sexual has
strongly effects the mental health and quality of life of abused women
1 suicidejocelyn s. barrioseh1020patti smithsmile790243
This document summarizes the pedagogical aids used in most chapters of the textbook "Role Development in Professional Nursing Practice, Fifth Edition" to drive student comprehension and engagement. It lists learning aids such as chapter objectives, key terms, case studies, and critical thinking questions. The purpose is to address different learning styles and ensure mastery of concepts. Additionally, it provides publishing information for Jones & Bartlett Learning including contact details.
23 introduction to social worksecond edsmile790243
This document provides an introduction to the second edition of the textbook "Introduction to Social Work: An Advocacy-Based Profession" by Lisa E. Cox, Carolyn J. Tice, and Dennis D. Long. It includes information about the authors, a brief contents section, and details on ordering and copyright. The introduction to social work textbook covers topics such as understanding the social work profession, history of social work, generalist practice, advocacy, responding to needs like poverty and health challenges, and working in changing contexts.
Risk Factors for Suicide in Bipolar I Disorder in Two Prospectively Studied C...Abby Kriener
The document summarizes two studies that examined risk factors for suicide in patients with bipolar I disorder. The first study prospectively followed 288 patients for up to 30 years, while the second matched patient identifiers to national death records. Both found that a history of suicide attempt was a robust risk factor for future suicide. However, the studies differed in suicide rates and other risk factors identified. Differences in how subjects were recruited and followed up can impact findings on suicide risk factors. [/SUMMARY]
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
Medical Co Morbidities in Patients of Frontal Temporal Dementia -A Hospital B...CrimsonpublishersMedical
Medical Co Morbidities in Patients of Frontal Temporal Dementia -A Hospital Based Study by Manjunadh Muralleedharan in Research in Medical & Engineering Sciences
Caregivers’ perspective on non-fatal deliberate self harmiosrjce
This document summarizes a study examining caregivers' perspectives on non-fatal deliberate self-harm. Fifty patients who engaged in deliberate self-harm and were admitted to a hospital were evaluated. Caregivers of these patients were interviewed using a 15-item questionnaire to assess their attitudes. Common characteristics of the self-harm incidents were that they occurred when someone else was present and no suicide notes were left. The most common psychiatric diagnosis among patients was major depressive disorder. Most caregivers reported feeling shock, anger, and a need to overprotect the individual after the self-harm incident. A significant association was found between caregivers perceiving an unsympathetic family attitude and repetition of deliberate self-harm.
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
Domestic violence and its relationship with depression, anxiety and quality o...Dr.Nasir Ahmad
Objectives: To find out the relationship of domestic violence with depression, anxiety and quality of life
in married women in hospitals of Rawalpindi and Islamabad.
Methods: This co-relational study was conducted in Rawalpindi Institute of Health Sciences from January
2019 to December 2019. All the females’ patients who were the victim of domestic violence were the
population of the study. Consecutive non-probability sampling technique was used for selection of sampling
from the target population. The inclusion criterion for this study was diagnosed case of domestic violence.
DASS 21 (The Depression, Anxiety and Stress Scale) and Quality of life (WHO) scales were administered to
116 patients.
Results: The study’s key results were that domestic abuse has positive relationship with depression,
anxiety, and stress. It was also found that domestic abuse has a negative relationship with quality of life of
those who have been subjected to domestic violence of this sort.
Conclusion: It was concluded that domestic violence whether verbal, physical, emotional or sexual has
strongly effects the mental health and quality of life of abused women
1 suicidejocelyn s. barrioseh1020patti smithsmile790243
This document summarizes the pedagogical aids used in most chapters of the textbook "Role Development in Professional Nursing Practice, Fifth Edition" to drive student comprehension and engagement. It lists learning aids such as chapter objectives, key terms, case studies, and critical thinking questions. The purpose is to address different learning styles and ensure mastery of concepts. Additionally, it provides publishing information for Jones & Bartlett Learning including contact details.
23 introduction to social worksecond edsmile790243
This document provides an introduction to the second edition of the textbook "Introduction to Social Work: An Advocacy-Based Profession" by Lisa E. Cox, Carolyn J. Tice, and Dennis D. Long. It includes information about the authors, a brief contents section, and details on ordering and copyright. The introduction to social work textbook covers topics such as understanding the social work profession, history of social work, generalist practice, advocacy, responding to needs like poverty and health challenges, and working in changing contexts.
The Socioeconomic Consequences and Costs of Mental IllnessMika Truly
The document summarizes several socioeconomic consequences and costs of mental illness. It discusses how approximately half of adults with severe mental illnesses also have a substance abuse disorder, but only a small percentage receive treatment for both. It also examines how substance abuse and lack of medication adherence in the mentally ill have been associated with increased violence. Additionally, the document outlines how treating the mentally ill with co-occurring substance abuse disorders results in significantly higher psychiatric care costs. Lastly, it explores the high rates of incarceration and homelessness among the mentally ill population and the financial costs these issues impose on society.
Substance Abuse Vs Suicidal risk report Final Draft 06_04_2015Geoffrey Kip, MPH
1. This study examines the relationship between substance abuse and suicide risk among youth ages 14-24 in Philadelphia. It analyzes whether substance abuse scores and specific drugs (alcohol, marijuana, tobacco, illicit drugs) predict suicide ideation and lifetime suicide scores.
2. The study uses a cross-sectional design and secondary data from behavioral health screens administered in emergency departments, primary care offices, schools and other locations. Logistic regression is used to calculate odds ratios for substance abuse variables predicting suicide history.
3. Preliminary results found that substance abuse scores and use of marijuana, alcohol, tobacco and other illicit drugs were all significant predictors of history of suicide in participants. Race also significantly predicted suicide history for those
Life style factors in late onset depressionramkumar g s
this study explores lifestyle factors like diet, exercise, socialization, leisure activities and alcohol, tobacco use in geriatric depression. it is a cross-sectional comparative study of elderly with depression and age, sex and education matched healthy controls.
Suicide is defined as a deliberately initiated act with a fatal outcome. Durkheim's theory studies the influence of social integration and found that higher integration prevents suicide while lower integration increases risk. Suicide is influenced by sociological factors like social integration, psychological factors like depression, and genetic factors. Risk factors include male gender, older age, white race, unemployment and mental illness. Common methods are pesticide poisoning and hanging. Warning signs include feelings of hopelessness and making final arrangements. Protective factors are strong social connections, problem solving skills, beliefs against suicide, and access to mental healthcare. Suicide rates are high in Bangladesh with over 10,000 deaths annually mainly by poisoning and hanging.
This research is based on general practice in the psychiatric institutions. It involves a qualitative research method that that uses three peer-reviewed journal article containing information about the scope of psychiatry, emerging issues in accommodating patients and highlight on medication of mental illness
This document reviews the relationship between suicidal behavior and alcohol abuse. It finds that alcohol use is highly associated with suicide in three ways: through its disinhibiting effects on suicide attempts and completions, by increasing suicide risk among those with alcohol use disorders, and through correlations found between alcohol consumption and suicide rates at population levels. The review examines evidence from studies searching medical databases on this topic. It finds that psychiatric disorders like depression and substance abuse are often linked to suicide cases. However, comorbid psychopathology is neither sufficient nor necessary to explain the relationship between alcohol and suicide.
This article summarizes a review of the medical literature on the concept of pseudoaddiction. Pseudoaddiction was coined in 1989 to describe patients who exhibit behaviors that mimic addiction but are actually due to under-treatment of pain with opioids. The review found 224 articles discussed pseudoaddiction since 1989. However, none empirically tested or confirmed its existence. Articles supporting pseudoaddiction described it as caused by withholding opioids and treated by more aggressive opioid treatment. In contrast, articles questioning pseudoaddiction found no evidence it is a distinct diagnosis from addiction. While widely cited to justify opioid therapy, the concept of pseudoaddiction lacks empirical evidence and may have complicated accurate pain treatment and contributed to the opioid addiction epidemic.
Preventing Suicide in Discharged Service MembersKyri Barilone
This study aims to explore whether receiving caring letters and informational materials can reduce rates of depression and suicidality in veterans. Over 1600 discharged service members from across the US will be recruited and randomly assigned to either receive monthly caring letters and educational brochures (experimental group) or only questionnaires (control group) for one year. Depression and suicidal ideation will be measured at discharge, 6 months, and 1 year using clinical scales. Statistical analysis will compare changes in scores between the two groups over time to determine if the letters and materials are effective in preventing military suicide.
1. Social and economic factors may have changed between the time periods studied, such as increases in unemployment, poverty, or family disruption, which could impact rates of psychiatric morbidity.
2. Changes may have occurred in how psychiatric disorders are diagnosed and classified between 1977 and 1985 that could influence prevalence findings.
3. Increased awareness, destigmatization of mental health issues, and expansion of treatment services between the periods may have impacted help-seeking behaviors and the proportion of cases identified.
This study analyzed a cohort of 1,182 people in New Zealand who were identified as having inadequate housing based on hospital admission records from 2002-2014. 10.7% of the cohort died during a median follow-up of 5.7 years. The median survival of the cohort was 63.5 years, about 20 years less than the general population. Within the cohort, Māori individuals and those diagnosed with substance use disorders or diabetes were at significantly higher risk of premature death.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
The document discusses the evolution of definitions and classifications of mental disorders from DSM-II to the current DSM-5. It notes that DSM-III represented a radical departure by focusing on defining disorders based on observable symptoms rather than etiology. This symptom-based model allowed for more standardized diagnosis and epidemiological research but was also influenced by various political and economic pressures from pharmaceutical companies, clinicians, and insurers. Subsequent DSM revisions have continued expanding diagnoses and faced criticism for potentially overmedicalizing human suffering.
This document discusses addiction to prescription painkillers and the role that doctors play. It provides background on a 2011 pharmacy shooting committed by David Laffer, a prescription painkiller addict, who had been prescribed over 4,000 pills in the first half of the year. This led to investigations of the prescribing doctors. The document argues that while doctors fulfill their duty to treat patients' pain, they can also indirectly cause addiction. However, addicted patients also manipulate doctors to maintain their drug supply. Therefore, both doctors and patients share blame. It notes the taboo nature of discussing both addiction and doctors' involvement due to the high status of medicine. In the end, some doctors in the Laffer case were arrested, showing that
Violence against Women living with HIV A Cross Sectional Study in NepalNabaraj Mudwari
This study examined violence against women living with HIV in Nepal through interviews with 43 HIV-positive women. The study found that the vast majority (93%) of participants had experienced at least one form of violence, and prevalence of violence increased sharply after being diagnosed with HIV (93% vs 54% before diagnosis). Husbands and mothers-in-law were the most common perpetrators, and consequences included self-humiliation and health/treatment problems. This cross-sectional study suggests violence is highly prevalent among HIV-positive women in Nepal.
Mental Health Policy - Mental Illness and the Criminal Justice SystemDr. James Swartz
These slides are from a lecture on the criminal justice system and mental illness and considers factors related to the criminalization of those with mental illnesses, characteristics of those with mental illness under criminal justice supervision, and the role of drug and mental health courts.
—Reproductive health development depends on the menstrual hygiene in adolescence. Half of all mental health disorders in adulthood start during adolescence. Drug, alcohol and tobacco use is major concern in this group. The present study was conducted to study the reproductive health, mental health and various addictions in urban adolescents. This cross sectional study was conducted among 506 adolescents from standard 9 th and 10 th in a high school in Margao city of South Goa district in year 2015. Study participants were sampled by census method and interviewed by using a pretested, structured questionnaire. The mean age of study participants i.e. in girls it was 16.30 years & in boys it was observed 16.43 years. 85.4% of the study participants experienced one of the feelings of being anxious, sad, irritable or stressed, 74.4% of the study participants experienced feelings suggestive of psychosomatic disorder and 48.4% participants felt they were good for nothing. 58.1% had normal cycles of 21-35 days while 30.7% and 11.2% of the girls had cycles of < 21 days & 36-60 days respectively. 49.2% experienced mild symptoms of dysmenorrhoea, equal percentage experienced moderate symptoms and 1.6% experienced severe dysmenorrhoea. 40.4% had curdy white vaginal discharge, 5.5% had greenish yellow discharge and 19.8% had blood stained vaginal discharge. 5.5% of the adolescents smoked.1.2% of the participants chewed Gutkha. 26.5% had consumed alcohol & 3.8% had tried drugs. The study shows that adolescents face various problems which need to be addressed.
This document discusses suicide clustering and contagion. It describes different types of suicide clusters including point clusters, mass clusters, and echo clusters. It outlines the Suicide Support and Information System in Ireland which aims to identify emerging suicide clusters early. The system identified a cluster of 22 suicides by young men in Cork between 2008-2011. Responses to clusters should involve a multidisciplinary team and address the immediate aftermath, reactive period, and long-term outreach. More research is still needed on factors that reinforce suicide contagion.
This document summarizes findings from the Global Burden of Disease Study 2010 regarding the burden of depressive disorders by country, sex, age, and year. Some key findings include:
1. Depressive disorders, specifically major depressive disorder and dysthymia, were the second leading cause of years lived with disability globally in 2010.
2. Major depressive disorder accounted for 8.2% of global years lived with disability and 2.5% of global disability-adjusted life years. Dysthymia accounted for 1.4% of years lived with disability and 0.5% of disability-adjusted life years.
3. There was more regional variation in burden for major depressive disorder than dysthymia,
Social Unrest and Mental Health
World Association of Social Psychiatry (WASP) Symposium
at the American Psychiatric Association Annual Meeting 2021
Vincenzo Di Nicola, MPhil, MD, PhD, DFAPA, FCPA President, CASP; President-Elect, WASP Professor of Psychiatry, University of Montreal, QC
Learning objectives
To understand the association between social unrest and mental health …
Specifically, to:
Identify the social determinants of unrest
Offer case examples of social unrest
Review WHO prevalence estimates and overall mental health impacts of social unrest
Discuss special considerations for children, youth & families
Plan for presentation
Social unrest and mental health: 30-45 minutes – V Di Nicola Social determinants: Triggers, aggravators & attenuators, circularity
Case examples (evidence-based studies)
Hong Kong Protests Black Lives Matter
WHO Prevalence Estimates (data)
Protests, Riots & Revolutions: A systematic review
Children, Youth & Families: Special considerations
From Populations to Patients - Di Nicola - WPA World Congress, Bangkok, Thail...Université de Montréal
V Di Nicola (Invited Panelist),
“From Populations to Patients: The Clinical Relevance of the Social Determinants of Health for Social Psychiatry,”
WPA Interorganizational Symposium WPA, WASP, IFP, RANZCP,
V Di Nicola, M Botbol (Co-Chairs),
D Moussaoui, V Di Nicola, P Udomratn, K Wannasewok, A Bush, A Abu Bakar (Presenters),
22nd World Congress of Psychiatry: “The Need for Empathy and Action,” World Psychiatric Association (WPA), Bangkok, Thailand,
August 3, 2022.
Objectives:
1. To review social psychiatry’s powerful populational studies on psychiatric epidemiology and Social Determinants of Health & Mental Health (SDH/MH)
2. To promote translational research of social psychiatric studies – redefining health in social terms
3. To provide ground-level prescriptions aimed at prevention, promotion, intervention, and adaptation in clinical social psychiatry
The Socioeconomic Consequences and Costs of Mental IllnessMika Truly
The document summarizes several socioeconomic consequences and costs of mental illness. It discusses how approximately half of adults with severe mental illnesses also have a substance abuse disorder, but only a small percentage receive treatment for both. It also examines how substance abuse and lack of medication adherence in the mentally ill have been associated with increased violence. Additionally, the document outlines how treating the mentally ill with co-occurring substance abuse disorders results in significantly higher psychiatric care costs. Lastly, it explores the high rates of incarceration and homelessness among the mentally ill population and the financial costs these issues impose on society.
Substance Abuse Vs Suicidal risk report Final Draft 06_04_2015Geoffrey Kip, MPH
1. This study examines the relationship between substance abuse and suicide risk among youth ages 14-24 in Philadelphia. It analyzes whether substance abuse scores and specific drugs (alcohol, marijuana, tobacco, illicit drugs) predict suicide ideation and lifetime suicide scores.
2. The study uses a cross-sectional design and secondary data from behavioral health screens administered in emergency departments, primary care offices, schools and other locations. Logistic regression is used to calculate odds ratios for substance abuse variables predicting suicide history.
3. Preliminary results found that substance abuse scores and use of marijuana, alcohol, tobacco and other illicit drugs were all significant predictors of history of suicide in participants. Race also significantly predicted suicide history for those
Life style factors in late onset depressionramkumar g s
this study explores lifestyle factors like diet, exercise, socialization, leisure activities and alcohol, tobacco use in geriatric depression. it is a cross-sectional comparative study of elderly with depression and age, sex and education matched healthy controls.
Suicide is defined as a deliberately initiated act with a fatal outcome. Durkheim's theory studies the influence of social integration and found that higher integration prevents suicide while lower integration increases risk. Suicide is influenced by sociological factors like social integration, psychological factors like depression, and genetic factors. Risk factors include male gender, older age, white race, unemployment and mental illness. Common methods are pesticide poisoning and hanging. Warning signs include feelings of hopelessness and making final arrangements. Protective factors are strong social connections, problem solving skills, beliefs against suicide, and access to mental healthcare. Suicide rates are high in Bangladesh with over 10,000 deaths annually mainly by poisoning and hanging.
This research is based on general practice in the psychiatric institutions. It involves a qualitative research method that that uses three peer-reviewed journal article containing information about the scope of psychiatry, emerging issues in accommodating patients and highlight on medication of mental illness
This document reviews the relationship between suicidal behavior and alcohol abuse. It finds that alcohol use is highly associated with suicide in three ways: through its disinhibiting effects on suicide attempts and completions, by increasing suicide risk among those with alcohol use disorders, and through correlations found between alcohol consumption and suicide rates at population levels. The review examines evidence from studies searching medical databases on this topic. It finds that psychiatric disorders like depression and substance abuse are often linked to suicide cases. However, comorbid psychopathology is neither sufficient nor necessary to explain the relationship between alcohol and suicide.
This article summarizes a review of the medical literature on the concept of pseudoaddiction. Pseudoaddiction was coined in 1989 to describe patients who exhibit behaviors that mimic addiction but are actually due to under-treatment of pain with opioids. The review found 224 articles discussed pseudoaddiction since 1989. However, none empirically tested or confirmed its existence. Articles supporting pseudoaddiction described it as caused by withholding opioids and treated by more aggressive opioid treatment. In contrast, articles questioning pseudoaddiction found no evidence it is a distinct diagnosis from addiction. While widely cited to justify opioid therapy, the concept of pseudoaddiction lacks empirical evidence and may have complicated accurate pain treatment and contributed to the opioid addiction epidemic.
Preventing Suicide in Discharged Service MembersKyri Barilone
This study aims to explore whether receiving caring letters and informational materials can reduce rates of depression and suicidality in veterans. Over 1600 discharged service members from across the US will be recruited and randomly assigned to either receive monthly caring letters and educational brochures (experimental group) or only questionnaires (control group) for one year. Depression and suicidal ideation will be measured at discharge, 6 months, and 1 year using clinical scales. Statistical analysis will compare changes in scores between the two groups over time to determine if the letters and materials are effective in preventing military suicide.
1. Social and economic factors may have changed between the time periods studied, such as increases in unemployment, poverty, or family disruption, which could impact rates of psychiatric morbidity.
2. Changes may have occurred in how psychiatric disorders are diagnosed and classified between 1977 and 1985 that could influence prevalence findings.
3. Increased awareness, destigmatization of mental health issues, and expansion of treatment services between the periods may have impacted help-seeking behaviors and the proportion of cases identified.
This study analyzed a cohort of 1,182 people in New Zealand who were identified as having inadequate housing based on hospital admission records from 2002-2014. 10.7% of the cohort died during a median follow-up of 5.7 years. The median survival of the cohort was 63.5 years, about 20 years less than the general population. Within the cohort, Māori individuals and those diagnosed with substance use disorders or diabetes were at significantly higher risk of premature death.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
The document discusses the evolution of definitions and classifications of mental disorders from DSM-II to the current DSM-5. It notes that DSM-III represented a radical departure by focusing on defining disorders based on observable symptoms rather than etiology. This symptom-based model allowed for more standardized diagnosis and epidemiological research but was also influenced by various political and economic pressures from pharmaceutical companies, clinicians, and insurers. Subsequent DSM revisions have continued expanding diagnoses and faced criticism for potentially overmedicalizing human suffering.
This document discusses addiction to prescription painkillers and the role that doctors play. It provides background on a 2011 pharmacy shooting committed by David Laffer, a prescription painkiller addict, who had been prescribed over 4,000 pills in the first half of the year. This led to investigations of the prescribing doctors. The document argues that while doctors fulfill their duty to treat patients' pain, they can also indirectly cause addiction. However, addicted patients also manipulate doctors to maintain their drug supply. Therefore, both doctors and patients share blame. It notes the taboo nature of discussing both addiction and doctors' involvement due to the high status of medicine. In the end, some doctors in the Laffer case were arrested, showing that
Violence against Women living with HIV A Cross Sectional Study in NepalNabaraj Mudwari
This study examined violence against women living with HIV in Nepal through interviews with 43 HIV-positive women. The study found that the vast majority (93%) of participants had experienced at least one form of violence, and prevalence of violence increased sharply after being diagnosed with HIV (93% vs 54% before diagnosis). Husbands and mothers-in-law were the most common perpetrators, and consequences included self-humiliation and health/treatment problems. This cross-sectional study suggests violence is highly prevalent among HIV-positive women in Nepal.
Mental Health Policy - Mental Illness and the Criminal Justice SystemDr. James Swartz
These slides are from a lecture on the criminal justice system and mental illness and considers factors related to the criminalization of those with mental illnesses, characteristics of those with mental illness under criminal justice supervision, and the role of drug and mental health courts.
—Reproductive health development depends on the menstrual hygiene in adolescence. Half of all mental health disorders in adulthood start during adolescence. Drug, alcohol and tobacco use is major concern in this group. The present study was conducted to study the reproductive health, mental health and various addictions in urban adolescents. This cross sectional study was conducted among 506 adolescents from standard 9 th and 10 th in a high school in Margao city of South Goa district in year 2015. Study participants were sampled by census method and interviewed by using a pretested, structured questionnaire. The mean age of study participants i.e. in girls it was 16.30 years & in boys it was observed 16.43 years. 85.4% of the study participants experienced one of the feelings of being anxious, sad, irritable or stressed, 74.4% of the study participants experienced feelings suggestive of psychosomatic disorder and 48.4% participants felt they were good for nothing. 58.1% had normal cycles of 21-35 days while 30.7% and 11.2% of the girls had cycles of < 21 days & 36-60 days respectively. 49.2% experienced mild symptoms of dysmenorrhoea, equal percentage experienced moderate symptoms and 1.6% experienced severe dysmenorrhoea. 40.4% had curdy white vaginal discharge, 5.5% had greenish yellow discharge and 19.8% had blood stained vaginal discharge. 5.5% of the adolescents smoked.1.2% of the participants chewed Gutkha. 26.5% had consumed alcohol & 3.8% had tried drugs. The study shows that adolescents face various problems which need to be addressed.
This document discusses suicide clustering and contagion. It describes different types of suicide clusters including point clusters, mass clusters, and echo clusters. It outlines the Suicide Support and Information System in Ireland which aims to identify emerging suicide clusters early. The system identified a cluster of 22 suicides by young men in Cork between 2008-2011. Responses to clusters should involve a multidisciplinary team and address the immediate aftermath, reactive period, and long-term outreach. More research is still needed on factors that reinforce suicide contagion.
This document summarizes findings from the Global Burden of Disease Study 2010 regarding the burden of depressive disorders by country, sex, age, and year. Some key findings include:
1. Depressive disorders, specifically major depressive disorder and dysthymia, were the second leading cause of years lived with disability globally in 2010.
2. Major depressive disorder accounted for 8.2% of global years lived with disability and 2.5% of global disability-adjusted life years. Dysthymia accounted for 1.4% of years lived with disability and 0.5% of disability-adjusted life years.
3. There was more regional variation in burden for major depressive disorder than dysthymia,
Social Unrest and Mental Health
World Association of Social Psychiatry (WASP) Symposium
at the American Psychiatric Association Annual Meeting 2021
Vincenzo Di Nicola, MPhil, MD, PhD, DFAPA, FCPA President, CASP; President-Elect, WASP Professor of Psychiatry, University of Montreal, QC
Learning objectives
To understand the association between social unrest and mental health …
Specifically, to:
Identify the social determinants of unrest
Offer case examples of social unrest
Review WHO prevalence estimates and overall mental health impacts of social unrest
Discuss special considerations for children, youth & families
Plan for presentation
Social unrest and mental health: 30-45 minutes – V Di Nicola Social determinants: Triggers, aggravators & attenuators, circularity
Case examples (evidence-based studies)
Hong Kong Protests Black Lives Matter
WHO Prevalence Estimates (data)
Protests, Riots & Revolutions: A systematic review
Children, Youth & Families: Special considerations
From Populations to Patients - Di Nicola - WPA World Congress, Bangkok, Thail...Université de Montréal
V Di Nicola (Invited Panelist),
“From Populations to Patients: The Clinical Relevance of the Social Determinants of Health for Social Psychiatry,”
WPA Interorganizational Symposium WPA, WASP, IFP, RANZCP,
V Di Nicola, M Botbol (Co-Chairs),
D Moussaoui, V Di Nicola, P Udomratn, K Wannasewok, A Bush, A Abu Bakar (Presenters),
22nd World Congress of Psychiatry: “The Need for Empathy and Action,” World Psychiatric Association (WPA), Bangkok, Thailand,
August 3, 2022.
Objectives:
1. To review social psychiatry’s powerful populational studies on psychiatric epidemiology and Social Determinants of Health & Mental Health (SDH/MH)
2. To promote translational research of social psychiatric studies – redefining health in social terms
3. To provide ground-level prescriptions aimed at prevention, promotion, intervention, and adaptation in clinical social psychiatry
From Populations to Patients: The Clinical Relevance of Populational Studies ...Université de Montréal
This document summarizes a presentation on applying social psychiatry principles to clinical practice. It reviews influential population studies on topics like adverse childhood experiences and treatment gaps. It promotes translating this research to redefine health in social terms and integrating services in communities. It provides prescriptions for prevention, including addressing common issues and integrating primary and specialty care. The presentation argues for a social psychiatry approach in clinical teaching, interventions, policy, and advocacy.
Advancing Suicide Prevention Research With Rural American Indian a.docxdaniahendric
Advancing Suicide Prevention Research With Rural American Indian and Alaska Native Populations
| Lisa Wexler, PhD, Michael Chandler, PhD, Joseph P. Gone, PhD, Mary Cwik, PhD, Laurence J. Kirmayer, MD, Teresa LaFromboise, PhD, Teresa Brockie, PhD, Victoria O'Keefe, MA, John Walkup, MD, and James Allen, PhD
As part of the National Action Alliance for Suicide Prevention's American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can offer vital and unique insights with relevance to other rural and marginalized groups. Outcomes from this meeting include identifying the central challenges impeding progress in this subfield and a description of promising research directions to yield practical results. These proposed directions expand the alliance's prioritized research agenda and offer pathways to advance the field of suicide research in Indigenous communities and beyond. (Am J Public Health. 2015;105:891-899. doi:10.2105/AJPH.2014. 302517)
Although the Surgeon General published a call to action to prevent suicide in 1999,1 national rates of suicide have shown little improvement, and from 2002 to 2010 suicide moved from the 11th to the 10th leading cause of death in the United States2,3 National suicide rates are consistently higher among White men aged 65 years and older than in younger age groups.3 However, suicide remains one of the top 5 causes of death for American adults younger than 45 years and one of the top 3 for adolescents and young adults.2 Although suicide is clearly an important public health priority for all Americans, it is an especially critical issue for American Indians and Alaska Natives (AI/ANs). North America’s Indigenous peoples have disproportionately high rates of suicide deaths, attempts, and ideation, and suicide deaths are approximately 50% higher for AI/AN people than for White people.1,3 However, AI/AN elder suicides are quite rare. Suicide is the second leading cause of death among AI/AN adolescents and young adults, and their rate of suicide is 2.5 times as high as the national average across all ethnocultural groups.2 AI/AN young men are particularly vulnerable4; the Centers for Disease Control and Prevention has reported that AI/AN youths aged 10 to 24 years have the highest suicide rates of all ethnocultural groups
in the United States, at 31.27 per 100 000 among male youths and 10.16 per 100 000 among female youths. To eliminate this health disparity, research identifying the unique factors contributing to AI/AN suicide is essential to tailor interventions to fit the particular cultural and situational contexts in which they occur.1 Driven by the pressing need to better understand and reduce AI/AN suicide, the AI/AN Task Force of the National Action Alliance for Suicide Prevention (NAASP) crea ...
Brief on the Science Behind Civility and the Mayors' AccordDennis Embry
The Mayors' Accord intends to reduce incivility in American cities and towns, which scientific studies have shown increases education, health, safety, and economic outcomes when decreased. A call to action invites mayors to lead by promoting proven practices that increase civility, such as improved language development in children, academic achievement, and reduced health issues. Highly regarded scientific studies have demonstrated the community and national benefits of increased civility.
Social Psychiatry Perspectives - Di Nicola & Marussi - CPA Toronto - 29.10.2...Université de Montréal
CASP Workshop on Social Psychiatry
Canadian Psychiatric Association 72nd Annual Conference
Toronto, Ontario
October 27 – 29, 2022
Title:
Social Psychiatry Perspectives on the Health of Canadians:
A Social Psychiatry Manifesto & Intimate Partner Violence
Symposium Panel:
1. Vincenzo Di Nicola (Chair & Presenter, Montreal, QC)
2. Daphne Marussi (Presenter, Sherbrooke, QC)
Abstract:
This workshop sponsored by the Canadian Association of Social Psychiatry (CASP) reviews two contemporary Canadian psychiatric issues from a social psychiatry perspective:
1. Vincenzo Di Nicola (Montreal, QC) presents a social psychiatry manifesto with an overview of Social Psychiatry in the 21st century by surveying three main branches of Social Psychiatry: (1) psychiatric epidemiological studies and public health; (2) community psychiatry; and (3) relational and social therapies such as couple, family and community therapies. Implications for research, practice, and teaching in social psychiatry will be outlined.
2. Daphne Marussi (Sherbrooke, QC) explores Intimate Partner Violence (IPV) which describes an alarming aspect of relational violence with major social psychiatric consequences: the physical, sexual, or psychological harm by a current/former partner that is associated with many mental disorders from anxiety and depression to eating and substance abuse disorders. This presentation discusses different forms of psychological abuse and coercive control in IPV, the abused/abuser bond and their impacts and consequences.
References:
1. Di Nicola, V. Review article—“A person is a person through other persons”: A Social Psychiatry manifesto for the 21st century. World Social Psychiatry, 2019, 1(1): 8-21.
2. Snyder, R.L. No Visible Bruises - What We Don’t Know About Domestic Violence Can Kill Us. New York, NY, Bloomsbury Publishing, 2019.
Learning Objectives:
1. Redefine Social Psychiatry, name and describe its main branches: psychiatric epidemiology, community psychiatry, and relational therapies.
2. Describe Intimate Partner Violence (IPV) mainly against women, with examples of its mental health impacts, and its importance in Canadian society.
DOI: 10.13140/RG.2.2.32952.62728
The Suicide (SPI) and Violence Potential Indices (VPI)from t.docxarnoldmeredith47041
This study evaluated the validity of the Suicide Potential Index (SPI) and Violence Potential Index (VPI) from the Personality Assessment Inventory (PAI) in assessing risk of harm to self and others. The study compared SPI and VPI scores between 158 psychiatric outpatients with and without histories of suicide attempts, violence, and psychiatric diagnoses. Results supported the validity of the SPI in differentiating groups with and without suicide histories. The VPI differentiated groups with and without violence histories. Both the SPI and VPI scores varied significantly across psychiatric groups and were elevated for patients with executive dysfunction, supporting their use in risk assessment.
This literature review examines research on risk factors for suicide among military personnel. Studies have found that deployment is not consistently associated with higher suicide rates. Some factors that increase risk include psychiatric illnesses, substance abuse, relationship or financial problems, and impulsivity. Protective factors include social support networks. Research findings differ across military branches and countries. The US Air Force program that reduced stigma around mental healthcare saw a 33% decline in suicide rates. Gaps in research include differences in record keeping and a lack of prospective studies. Recommendations include promoting mental health services, restricting access to lethal means, and addressing risk factors through screening and treatment.
Social and behavioral determinants lit reviewRosella Anstine
This document provides a summary of a literature review on social and behavioral determinants of adult vaccination. The review identified 71 relevant publications, with 25 focusing on social determinants and 14 on behavioral determinants. For social determinants, key findings included barriers to adult vaccination like lack of access and programs, as well as racial/ethnic divides in vaccination rates. Models like the Diderichsen Framework and theories of intermediary determinants were also discussed. For behavioral determinants, the Health Belief Model and Theory of Planned Behavior were strong predictors of vaccination behavior based on factors like perceived benefits, barriers, and social norms. A gap identified was the lack of research on determinants in low- and middle-income countries.
RELATIONSHIP BETWEEN DEPRESSION, MENTAL HEALTH AND RELIGIOSITY AMONGST MENTAL...IAEME Publication
The objective of this study was to determine the relationship between the level of depression, mental health and religiosity amongst mentally ill patients inhospital Tanjung Rambutan Ulu Kinta Perak with demographic aspects. The subjects selected were 40 women amongst mentally ill patients inhospital Tanjung Rambutan Ulu Kinta Perak. The assessment method administered consisted of Beck Depression Inventory, General Health Questionnaire-28, Provision and demographic questions. The questionnaires were distributed among the sample followed by a brief introduction about the assessment. Data analysis indicated that there was a significant difference between the age of the sample and their mental health (p=0.005. Furthermore, depression experienced by the victims significantly influenced their mental health (R2=0.70, [F (1, 25) = 41.517, p<0.002]). The study also indicated that there was a positive correlation between mental health and depression (r=0.68). This showed that the higher the levelof depression experienced by the samples, the higher the effect of their mental health and religiosity.
Religion on Psychological Well-Being and Self-Efficacy among Secondary School...IJSRP Journal
In recent years, psychological well-being has been critical element in a students’ life. This study has investigated the effect of religious faith on psychological well-being and self-efficacy among secondary school students in Kulim district of Kedah. Quantitative approaches of survey design were used for this study. A number of ninety four secondary school students comprised from form four, and form five were selected using purposive sampling methods as studied subjects. The modified version of Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ), Psychological Well Being Inventory (The Ryff Scale) and Self-efficacy for Self-regulated Learning Scale were administered in this study. The finding of linear regression indicated that religious faith is a significant predictor of psychological well-being and self-efficacy among secondary school students in Kulim district of Kedah. The finding also revealed that psychological well-being is a significant predictor of self-efficacy among secondary school students in Kulim district of Kedah. As a conclusion, study disclosed that psychological well-being intensely related to an individual religious faith and proven to lead positive attitude among students in realize their own capability.
From Populations to Patients: Social Determinants of Health & Mental Health i...Université de Montréal
Abstract:
The overall objective of this webinar is to harness the powerful data of populational studies to patients in clinical practice.
This is effectively a plan for applying social psychiatry to the clinic –a call for “Clinical Social Psychiatry.”
This objective will be addressed through three goals with seven steps:
(A) Review social psychiatry’s powerful populational studies on psychiatric epidemiology and Social Determinants of Health & Mental Health (SDH/MH)
1. Adverse Childhood Experiences (ACE) Studies
2. Global Mental Health (GMH) – Treatment Gaps
3. Epidemiology to reflect the burden of disease
(B) Promote translational research of social psychiatric studies – redefining health in social terms
4a. Translational research to redefine health
4b. Mental health in a social context (C) Provide ground-level prescriptions aimed at prevention, promotion, intervention, and adaptation
5. Mental health services to be delivered where people live
6. Shared care/integrated care/collaborative care
7. We can’t do everything – address common and pressing problems
Keywords: Populational studies, social determinants of health & mental health (SDH/MH), translational research, ground-level prescriptions
This document describes a study that evaluated the effectiveness of a culturally adapted cognitive behavioral therapy (CBT) treatment protocol for Māori clients in New Zealand diagnosed with major depression. The treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. It was administered to 16 Māori clients and resulted in large, significant reductions in depressive symptomatology and negative cognition based on standardized assessments. This was the first study to examine individual psychotherapy outcomes for an indigenous population using an effectiveness design. The findings provide support for culturally adapting psychological treatments for ethnic minority groups.
Running head PTSD ANNOTATED BIBLIOGRAPHY 1PTSD ANNOTATED .docxtoltonkendal
Running head: PTSD ANNOTATED BIBLIOGRAPHY
1
PTSD ANNOTATED BIBLIOGRAPHY
2
PTSD Annotated Bibliography
Student’s name
University affiliation
PTSD Annotated Bibliography
Post-Trauma Stress Disorder (PTSD) is a condition that individuals who involve in forms of psychologically stressing situations and events attain. This condition is significant since it has caused a large number of individuals to live lives that are not as comfortable as they would have wished to live. Due to this reason, a large number of individuals have authored articles and other literal sources that address aspects of this topic. PTSD revolves around four main topics of psychology. These topics include:
i. Social Psychology
ii. Contemporary issues in psychology
iii. Crisis and emergency intervention
iv. Psychopathology
This paper provides articles and their explanations grouped within these four main topics, which provides information relating to the condition of PTSD.
Social Psychology Topic
Magdalena, K. & Bogdan, Z. (2012). Exposure to Trauma, Emotional Reactivity, and Its Interaction as Predictors of the Intensity of PTSD Symptoms in the Aftermath of Motor Vehicle Accidents: Journal of Russian & East European Psychology. Retrieved from http://bit.ly/2lGXePY
This article provides information on post-traumatic stress disorder obtained from individuals that have been involved in a form of car accident. The individuals are considered to be people that have experienced stress in a certain way, mainly due to the experience of involving in the car accident. The authors of the article explain that majority of the individuals attain the condition due to the situation that they believe they were in during the occurrence of the accident. The article involves an original study that involves experimentation of how the individuals were exposed to trauma due to the occurrence of the accident.
Maja, O., Mathias, L., Helle, S. & Ask, E. (2007). The Impact of Different Diagnostic Criteria on PTSD Prevalence: A Comparison of PTSD Prevalence Using the DSM-IV and ICD-10 PTSD-Criteria on a Population of 242 Danish Social Work Students: Nordic Psychology, Vol 59(4). Retrieved from http://bit.ly/2mTh3nq
This article explains that a large number of individuals obtains the PTSD disorder from many causes. Unlike many other diseases, an individual can obtain the PTSD condition from either an accident, an action that is committed to him or her by another individual like rape, or even a bad decision that he or she makes. The impact that these diseases and conditions have on such individuals are significantly different. Trauma that is brought about by rape, for example, is significantly different with the trauma that is brought about by events like accidents. The authors examine the causes of trauma and in their article explain the difference in effect that the individuals from various sources of the condition obtain. This article is thus significantly important and ...
Running head THE PSYCHOLOGICAL EFFECTS OF DOMESTIC VIOLENCE .docxagnesdcarey33086
Running head: THE PSYCHOLOGICAL EFFECTS OF DOMESTIC VIOLENCE 1
The Psychological Effects of Domestic Violence
Janet Goris
GEN499: General Education Capstone (GSV1514B)
Instructor: Lance Bernard
April 20, 2015
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[no notes on this page]
THE PSYCHOLOGICAL EFFECTS OF DOMESTIC VIOLENCE 2
The Psychological Effects of Domestic Violence
Children who have witnessed violence between their parents have become visibly the
center of public attention. Domestic violence is a continuing experience of psychological,
physical, and sexual abuse in some homes. It is used to establish control and power over one
another. Major research has focused on the implications of domestic violence on some key
victims. Witnessing domestic violence has major effects on “secondary victims including
children who live in houses where the partners fight. In America, for instance, 3.2 million
children witness incidents of violence annually.” (Bowland, 2012) It is important to understand
that there are secondary impacts of domestic violence. Witnessing violence can cause children to
develop negative including psychological ones. Women whose rights were violated may also be
affected by these events. They are at a risk of internalized behavior including depression and
anxiety, while children are at a risk of externalized behavior, including bullying, fighting, lying,
and cheating. The results of these are disobedience in school and at home and social competence
problems including difficulty in relationships with others and poor school performance. This
paper reviews literature on the primary and secondary psychological impacts of domestic
violence, and how it changes the victims.
Bowland, S., Edmond, T., & Fallot, R. D. (2012). Evaluation of a spiritually focused
intervention with older trauma survivors. Social Work, 57(1), 73-82.
The study by Bowland et al. (2012) was used to evaluate the efficiency of an eleven-
session focus group involving older women who had endured domestic violence. It sought
information from women aged fifty-five and above and who survived personal trauma including
sexual assault, child abuse or domestic violence. The intention was to help reduce trauma-related
- 2 -
1
1. victims.
the thesis statement isn't
quite clear here [Lance
Bernard]
THE PSYCHOLOGICAL EFFECTS OF DOMESTIC VIOLENCE 3
depression symptoms ranging from anxiety, post-traumatic stress, and trauma-related depressive
symptoms. Forty three women were randomly picked for treatment. They discussed spiritual
struggles that come as a result of abuse and the spiritual resources the group developed for
handling. The group had low depressive symptoms and anxiety than the control group. In
another analysis, the symptoms of post-traumatic stress also dropped considerably. The results
were supported with a three month.
Assignment 2 Defining the Problem and Research MethodsSecdesteinbrook
Assignment 2: Defining the Problem and Research Methods
Sections 1 and 2 of Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem
How do culture and environment influence health? What role does personality play in health outcomes? How do stressful life events influence disease? As a health care professional, you have most likely witnessed the influence of psychosocial factors on individual health. These factors also have a significant impact on population health. Chronic conditions such as high blood pressure and heart disease, as well as degenerative diseases, can be studied at the population level through the use of epidemiologic methods (Friis, 2014). The insights gained from this type of research can then positively impact health outcomes locally, nationally, and globally.
As you continue working on Assignment 2, which is due
by Thursday 04/05/2018 Day 5 of this week
, consider how psychosocial factors influence your population and population health issue.
To complete:
In 5–6 pages, APA format with a minimum of five (5) scholarly references (see list of required readings below), write the following sections of your paper:
Section 1: The Problem
1) Introduction (ending with a purpose statement: “the purpose of this paper is…)
2) A brief outline of the environment you selected (i.e., home, workplace, school)
3) A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)
4) Research question/hypothesis (same as the one in assignment 1. I’m including an attachment of assignment 1 you did for me).
Section 2: Research Methods
1) The epidemiologic study design you would use to assess and address your population health problem
2) Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools, you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)
3) Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)
4) Conclusion of the whole paper.
Required Readings
Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
Chapter 10, “Data Interpretation Issues”
Chapter 15, “Social, Behavioral, and Psychosocial Epidemiology”
Appendix A – Guide to the Critical Appraisal of an Epidemiologic/Public Health Research Article
In Chapter 10, the authors describe issues related to data interpretation and address the main types of research errors that need to be considered when conducting epidemiologic research, as well as when analyzing published results. It also presents techniques for reducing bias. Chapter 15 features psychosocial, behavioral, ...
Respond to posts of two peers in this discussion. As part of your.docxlanagore871
Respond to posts of two peers in this discussion. As part of your reply, comment on the ways in which your peer's annotated entries were effective in summarizing the studies for you, and ways in which the annotated entries could be more effective.. You need to respond about each peers posting which contains two articles.
Laurie Leitch, M., Vanslyke, J., & Allen, M. (2009). Somatic experiencing treatment with social service workers following hurricanes katrina and rita. Social Work, 54(1), 9-18.
Laurie Leitch, PhD, is the research director for the Foundation of Human Enrinchment and a coufounder of the Trauma Research Institute. Jan Vanslyke, PhD, and Marisa Allen, ABD, are senior evaluation specialists at Reid and Associates. The purpose of this study was to determine if the Somatic Experiencing Trauma Resiliency Model (SE/TRM) could "reduce the post disaster symptoms of social service workers“ who deliver services to individuals and communities after a disaster.
The researchers conducted a quantitative study of 142 social service workers who provided service after huricanes Katrina and Rita in New Orleans. The study was conducted on a nonrandom sample of 142 social service workers. 91 participants received SE/TRM and they were compared with 51 workers who did not receive SE/TRM and were matched via propensity score matching. They hypothesis was that the use of SE/TRM could reduce the symptoms of disaster relief workers post disaster. Data analysis showed that there was a significant difference between the two groups in relation to post disaster relief. The group that received SE/TRM showed significantly lower PTSD symptoms and psychological distress and higher levels of resiliency. The authors noted that all of the participants in this study were employed, which sets them apart from many disaster survivors as well as the study was not a „randomized control study“. Further research is needed to further study the effectiveness of SE/TRM in the field of disaster treatment.
Metcalf, O., Varker, T., Forbes, D., Phelps, A., Dell, L., DiBattista, A., Ralph, N., & O’Donnell, M. (2016). Efficacy of Fifteen Emerging Interventions for the Treatment of Posttraumatic Stress Disorder: A Systematic Review. Journal of Traumatic Stress, 29, 88-92.
The purpose of this study was to evaluate the effectiveness of 15 "new or novel interventions“ that are being utilizef for the treatment of PTSD. This work was funded by the Department of Veterans‘ Affaris and National Health and Medical Research Council Programs. The study eliminated appraoches that did not offer "moderate quality evidence from randomized controlled trials“ by a team of 5 Trauma Experts. To be included, studies also required adults over 18 years of age, 70% of the sample majority were diagnosed with PTSD and outcome data were reported for severity of symptoms and diagnosis. The approaches that fulfilled this critera are emotional freedom technique, yoga, mantra-based meditation and ac.
1Running Head FINAL PROPOSAL CHILD ABUSE AND ADULT MENTAL HEAL.docxdrennanmicah
1
Running Head: FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
2
FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
Diamond Newton
Southern New Hampshire University
March 3, 2019
Problem Statement
Several adults struggle from a variety of mental health issues (suicidal thoughts and tendencies, alcoholism, depression, and drug abusers.) A lot of those issues may stem from what took place during an adult’s childhood that stem from a variety of reasons. Some adults seek help and some refuse to seek help. The adults who do seek help come to realize that their current issues stem from when they were a child and still developing as a human. Child abuse can come in many forms, physical, mental, and sexual. Adults who have been exposed or experienced this are likely to suffer from some form of mental health issue. It is important to figure out the root of mental health issues in adults so the root can be addressed. Children need to be in a healthy environment with nothing short of love and care. Exposing children to a harsh reality is only breeding them into an adult who suffers from mental health issues.
Literature Review
The study of psychology helps researchers to understand better what is going on with a person. Researchers studied what happened in a person's life that causes them to make the decisions they do and behave in a certain way. Adults have this stigmatism that they can do whatever they want because they are "grown." Many adults suffer from something that can cause to lead towards suicidal thoughts and tendencies, alcoholism, depression, and drug abusers. A lot of those issues may stem from what took place during an adult’s childhood. There could be some reasons adults tend to display certain mental health traits that have been studied in many different forms by researchers. What we will be reviewed is the abuse, physical or mental, that an adult endured as a child and how it affects them in their adulthood.
Blanco, C., Grant, B. F., Hasin, D. S., Lin, K. H., Olfson, M. Sugaya, L. (2012) recognized that child physical abuse had been associated with an increased risk of suicide attempts. The study conducted included Blacks, Hispanics and young adults between the ages of 18-24 in 2001-2002 and 2004-2005. In person, interviews were conducted in Wave 1. In Wave 2 used similar methods as Wave 1 but it excluded the individuals who were not eligible. Wave 2 also interviews went into depth about the questions asked for the participants first 17 years of life. There are many other variables that have been added to the data that relate to childhood physical abuse and mental health distress in adult years. Those other adversatives included the history of child sexual abuse and neglect, parental psychopathology, and perceived parental support, described as emotional neglect.
The advantages to this design would be the inclusion of other childhood adversities that could contribute to adult psychiatri.
Lesson 3 Epi emiologyof Readings Predictors for the Daily Value.docxSHIVA101531
This document provides an overview of epidemiology and discusses its importance in studying mental health outcomes. It defines key epidemiological concepts like incidence and prevalence rates. It also summarizes several major epidemiological studies that estimate the prevalence of various mental illnesses in populations globally and in the US. These studies find that anxiety disorders are among the most common illnesses. The document stresses that epidemiological research can help identify at-risk groups, understand the costs of mental illness, and inform health policies and resource allocation.
Spirituality and Religious Coping in African American Youth with Depressive I...Jonathan Dunnemann
The document summarizes a study that analyzed qualitative data from 28 African American adolescents to identify how they experience and cope with depression in relation to spirituality and religion. 6 primary themes were identified: 1) religion as incentive to seek treatment, 2) use of prayer and feelings of agency, 3) mixed emotions, 4) belief that religion doesn't hurt and may help, 5) finding support in church, and 6) perceptions of prayer and church as barriers to treatment. Overall, the data suggests spirituality and religion play a key role in how African American youth experience depression and may impact treatment-seeking behaviors.
Similar to Kohrt2012_BJP_Nepal prospective mental health and political violence study (20)
Spirituality and Religious Coping in African American Youth with Depressive I...
Kohrt2012_BJP_Nepal prospective mental health and political violence study
1. 10.1192/bjp.bp.111.096222Access the most recent version at DOI:
2012, 201:268-275.BJP
Jordans, Navit Robkin, Vidya Dev Sharma and Mahendra K. Nepal
Nawaraj Upadhaya, Nanda Raj Acharya, Suraj Koirala, Suraj B. Thapa, Wietse A. Tol, Mark J. D.
Brandon A. Kohrt, Daniel J. Hruschka, Carol M. Worthman, Richard D. Kunz, Jennifer L. Baldwin,
Political violence and mental health in Nepal: prospective study
References
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2. Low-income countries are home to more than one-sixth of the
world’s population, but bear a disproportionate burden of the
world’s violent conflicts.1
Cross-sectional epidemiological studies
have demonstrated the association of torture and political terror
with psychiatric morbidity.2
However, a weakness of psychiatric
epidemiology studies in low-income countries has been a lack
of pre-war estimates of mental illness prevalence. Owing to
limitations in studying unpredictable events and the lack of
routine psychiatric surveillance in low-resource settings,
researchers generally rely upon observations after a violent conflict
to estimate how war influences mental health. This has led some
mental health experts to conclude that post-conflict psychiatric
morbidity is attributable predominantly to war experiences. A
review of violent conflict and mental health in low- and middle-
income countries exemplifies the problematic conclusions drawn
from existing epidemiological studies: ‘The exposure [to war] of
large population groups, mostly having no mental health problems
prior to the exposure, and the subsequent development, in a
significant proportion of the population, of a variety of psychiatric
symptoms and disorders represent both a challenge and an
opportunity for psychiatrists’ (emphasis added).3
These authors
also suggest that the impact on mental health as a result of war
are greater for children, women and elderly people.3
However,
these conclusions are difficult to support without evidence of
low psychiatric morbidity prior to political violence. War trauma
may not be the sole or dominant determinant of post-conflict
mental health. Psychiatric morbidity may have been elevated
before the outbreak of war. Populations in low-income countries
not only suffer from war trauma but also from other psychiatric
risk factors such as poverty, high burdens of infectious disease,
high maternal and infant mortality, gender-based violence and
limited access to healthcare and education.4–6
Moreover, high
prevalence rates among certain demographic groups, such as
women and elderly people, may not reflect greater vulnerability
to the effects of war. Elevated rates in certain groups could result
from factors that operate similarly in non-war settings, such as
gender discrimination.7,8
It is difficult to disentangle the influence
of war from these chronic societal problems because of the lack of
pre-conflict data.
The goal of this study is to use a prospective design to address
three questions: (a) is there an increase in mental health problems
from the pre- to post-conflict period, (b) if there were an increase,
could it be attributed to conflict-related exposures, and (c) are
some groups more vulnerable to the effects of conflict on mental
health? To answer these questions, the mental health of a cohort in
Nepal is compared across two time points: in 2000 before the
outbreak of conflict-related violence in their community and in
2007–2008 after the signing of peace accords. This is the first study
conducted in a low-income country that examines individual
differences in mental health before and after exposure to war.
Method
Setting and study participants
Nepal is among the world’s poorest countries9
and recently
endured the People’s War fought between the Communist Party
of Nepal (Maoists) and government security forces from 1996
until 2006. Although the People’s War officially began in 1996,
its effects were differentially felt throughout the country during
the early years of the insurgency. Prior to 2000, violence was
268
Political violence and mental health in Nepal:
prospective study*{
Brandon A. Kohrt, Daniel J. Hruschka, Carol M. Worthman, Richard D. Kunz, Jennifer L. Baldwin,
Nawaraj Upadhaya, Nanda Raj Acharya, Suraj Koirala, Suraj B. Thapa, Wietse A. Tol,
Mark J. D. Jordans, Navit Robkin, Vidya Dev Sharma and Mahendra K. Nepal
Background
Post-conflict mental health studies in low-income countries
have lacked pre-conflict data to evaluate changes in
psychiatric morbidity resulting from political violence.
Aims
This prospective study compares mental health before and
after exposure to direct political violence during the People’s
War in Nepal.
Method
An adult cohort completed the Beck Depression Inventory
and Beck Anxiety Inventory in 2000 prior to conflict violence
in their community and in 2007 after the war.
Results
Of the original 316 participants, 298 (94%) participated in the
post-conflict assessment. Depression increased from 30.9 to
40.6%. Anxiety increased from 26.2 to 47.7%. Post-conflict
post-traumatic stress disorder (PTSD) was 14.1%. Controlling
for ageing, the depression increase was not significant. The
anxiety increase showed a dose–response association with
conflict exposure when controlling for ageing and daily
stressors. No demographic group displayed unique
vulnerability or resilience to the effects of conflict exposure.
Conclusions
Conflict exposure should be considered in the context of
other types of psychiatric risk factors. Conflict exposure
predicted increases in anxiety whereas socioeconomic
factors and non-conflict stressful life events were the major
predictors of depression. Research and interventions in post-
conflict settings therefore should consider differential
trajectories for depression v. anxiety and the importance of
addressing chronic social problems ranging from poverty to
gender and ethnic/caste discrimination.
Declaration of interest
None.
The British Journal of Psychiatry (2012)
201, 268–275. doi: 10.1192/bjp.bp.111.096222
*Paper presented in part as the John P. Spiegel Fellowship Lecture for the
Society for the Study of Psychiatry and Culture 2011 Annual Meeting, Seattle,
Washington, USA.
{
See editorial, pp. 255–257, this issue.
3. limited to a few regions of Nepal, and most of the general
population considered the Maoists a ‘law and order problem’
rather than a significant military threat.10
This study was
conducted in Jumla, a mountainous district in northwestern
Nepal with no conflict mortality prior to 2001. It is important
to note that the term ‘pre-conflict’ is employed in this study to
refer to the data collection in 2000 because this was prior to any
Maoist attacks in the study area of Jumla. Also, ethnographic
research in Jumla during 2000 found that Maoist-related concerns
did not dominate health narratives among people with anxiety
and depression.11
It was not until after the Royal Massacre of
2001 when King Gyanendra came to power that the Royal Nepal
Army became engaged in the conflict. Of the 14 000 killed in
the decade-long war, 92.5% of all deaths occurred after King
Gyanedra assumed power in 2001.12
In the study area of Jumla,
there were no war-related casualties until late 2001. Between
2001 and 2006, Jumla suffered the effects of the People’s War,
including major battles leading to civilian, Maoist and
government casualties, destruction of all telecommunication
infrastructure, abduction and torture of residents, government
blockades, decreased food availability, bombing of schools and
destruction of medical infrastructure.13
(See Tol et al’s review
for more information on the war history and psychosocial
impacts.14
)
The baseline ‘pre-conflict’ data for this study are from a
community epidemiology study of depression and anxiety
conducted in Jumla in 2000. The baseline study was an evaluation
of somatisation, depression and anxiety,15
as well as caste and
gender differences in mental health.16–18
In the baseline study,
random sampling of one adult per household was used for
recruitment with an nth-household sampling strategy.16
After
the war ended in late 2006, the research team began tracking
original participants for post-conflict interviews, which took place
in 2007–2008. In cases of participants who died in the interim of
2000 to 2007, the cause, age and year of death were recorded.
In 2000, all participants were aged 18 years or older. Consent
was recorded with a signature for literate participants or a
thumbprint for illiterate participants. Participants did not receive
compensation. The Department of Psychiatry at Tribhuvan
University Teaching Hospital/Institute of Medicine (TUTH/IOM)
in Kathmandu provided consultation prior to and during the
assessment and gave final approval for the study in 2000. The
protocol for the follow-up study in 2007–2008 was approved by
the Institutional Review Board of Emory University and the
Nepal Health Research Council, with modifications approved by
TUTH/IOM. Interviews at both waves of assessment were
conducted in participants’ homes with only the interviewer and
participant present. Interviews lasted 60–90 min. In 2007–2008,
participants with high levels of psychological distress and
impaired functioning (58 individuals) were evaluated by the
study’s principal investigator. A subset of these was referred for
psychosocial care (43 individuals).
Instruments
The 21-item Beck Depression Inventory (BDI)19
and Beck Anxiety
Inventory (BAI)20
were used to assess depression and anxiety
symptoms over the prior 2 weeks. Items are scored 0–3 with an
instrument range of 0 to 62. Scales were validated for use in
Nepal21,22
with clinical DSM-IV23
diagnoses of major depressive
disorder or generalised anxiety disorder: area under the curve
(AUC) 0.92 (95% CI 0.88–0.96) for the BDI and 0.85 (95% CI
0.79–0.91) for the BAI; internal reliability (Cronbach alpha),
BDI a = 0.90 and BAI a = 0.90. Based on the clinical validation
of the BDI in Nepal, a score of 20 or higher suggests moderate
depression symptoms with the need for mental health intervention
(sensitivity 0.73, specificity 0.91).21
On the BAI, a score of 17 or
higher indicates moderate anxiety symptoms with need for
intervention (sensitivity 0.77, specificity 0.81).22
These cut-off
scores are intended only to reflect symptom burden at the level
requiring intervention; the cut-offs do not indicate diagnoses of
major depressive disorder or generalised anxiety disorder. Test–
retest reliability Spearman–Brown coefficients for the BDI were
0.84 and for the BAI were 0.88. The validated BDI and BAI were
used in the pre-conflict and post-conflict assessments.
The 17-item Post-traumatic stress disorder (PTSD) Checklist-
Civilian Version (PCL-C) is a self-report rating scale for assessing
PTSD symptoms and severity within the past week.24
The English-
language measure has good psychometric properties in Western
populations24
and the validated Nepali version performs
similarly,25
with a cut-off score of 50 or above indicating need
for intervention.26
For this study, internal reliability was 0.83.
Test–retest reliability was 0.82.
The 64-item Stressful Life Events Rating Scale for Cross
Cultural Research (SLERS) was used to assess stressful events
over the preceding 12 months prior to the 2000 and 2007
assessments.27
The SLERS has shown association with poor mental
health in other Asian populations.28,29
At the baseline pre-conflict
assessment in 2000, greater frequency of stressful life events in the
preceding 12 months as measured with the SLERS was associated
with greater depression,16
anxiety,17
psychosomatic complaints15
and general psychological morbidity.18
A self-report conflict exposure scale was developed to assess
exposures to political violence-related traumatic events during
the People’s War. The items were chosen based on focus-group
discussions, key informant interviews and review of documents
about the conflict in Jumla. Mental health professionals who are
natives of Jumla reviewed the political violence questionnaire for
content and comprehensibility. Additionally, 30 Jumla residents
conducted pile sorts and ranking tasks to indicate level of
traumatic severity. Factor analysis demonstrated one cultural
model for the group of traumatic events, i.e. there were not
significant differences in rankings of traumatic events. For the
analyses presented here, objective items (such as abduction,
witnessed a killing) were retained, and subjective items (such as
less access to healthcare, unable to meet daily needs) were
removed because of increased risk of appraisal bias from current
mental health status. Of the 32 proposed items, the final
instrument included 14 items (Cronbach’s a = 0.69), which were
considered locally severe and putatively objective. For these
analyses, the results were dichotomised to ‘0’ no exposure and
‘1’ any exposure. The total number of types of exposure were
summed (total: 0 to 14), and individuals were categorized into
four groups according to quartiles of total exposures (0–3, 4–5,
6–7, 47 exposures). Only four individuals reported no trauma
exposures; they were included in the low-exposure quartile.
Analyses
We first compared baseline (pre-conflict) characteristics between
those who did and did not participate in the follow-up. Chi-
squared for categorical outcomes tested differences among three
groups: those who participated in the follow-up study, those
who died before the follow-up study and those who were lost to
follow-up or refused to participate. McNemar chi-squared tests
were used to assess crude changes in income, education, stressful
life events and depression and anxiety.
Generalised estimating equations (GEEs) were used to model
the effect of assessment period (0: pre-conflict, 1: post-conflict),
age (divided into 7-year age brackets), gender, caste (Bahun –‘high
269
Political violence and mental health in Nepal
4. Kohrt et al
caste’, Chhetri – ‘high caste’, Dalit – ‘low caste’ and Janajati-
Buddhist ethnic minority groups), education (no education v.
any education), income (no income v. any income), and stressful
life events (median split: 515 events v. 515 events) and conflict
exposure (quartiles) on binary outcomes for depression and
anxiety. Generalised estimating equations can be used for
longitudinal data analysis,30
such as this study that includes two
data points (pre- and post-conflict) for each individual. We used
GEEs to ensure appropriate estimates and inferences from
correlated repeated measures within individuals.
We used GEEs to test four models. In the first model, the effect
of period of assessment (pre- v. post-conflict) on depression and
anxiety was calculated to determine whether rates increased over
time. In the second model, gender, age and caste were included
to determine whether the effect of period of assessment remained
significant after controlling for ageing. Gender and caste were
included because of their association with outcomes in the
pre-conflict period.16,17
By including current age in 7-year age
brackets in the model, we account for the effect of ageing of the
sample over the 7 years between assessment periods. In the third
model, the level of conflict exposure was entered to determine
whether this accounted for the differences in period of assessment.
In the final model, stressful life events in the past year and income
were entered to determine whether conflict exposure remained
significant when controlling for these more proximal stressors.
We used GEEs to determine whether specific demographic
groups demonstrated greater change in mental health from the
pre- to post-conflict period. Separate models were created for each
interaction of interest: exposure (pre- v. post-conflict)6gender,
exposure6age and exposure6caste. The sample was dichotomised
at 39 years old to compare differential effect by age. For the caste
model, Dalit v. all other groups was compared because the Dalit
caste displayed the poorest outcomes in pre-conflict analysis.16
In the final analysis, logistic regression was used to determine
the effects of pre-conflict depression, anxiety, education and
income on post-conflict PTSD, when controlling for age, gender
and caste. This was done because PTSD was not assessed in the
pre-conflict period. P-values less than 0.05 were considered
statistically significant unless otherwise noted. Statistical analyses
were performed with SPSS v.16.0 for Windows.
Results
Table 1 presents the baseline characteristics of the sample prior to
conflict, categorised by follow-up status. Of the original 316
participants, 298 people were re-interviewed at follow-up (94%
of the original participants). Of these 298 follow-up participants,
266 (89.3%) were residing in Jumla and 32 (10.7%) had moved to
other Nepal districts. Twelve (3.8%) of the original 316 participants
were deceased. Of the remaining six people (1.9%) who did not
participate, one refused participation and the other five were lost
to follow-up.
There were no significant differences in baseline characteristics
between the six people who did not participate and those who did
participate in the follow-up study. The three groups (follow-up,
270
Table 1 Baseline characteristics of all participants (pre-conflict, year 2000) (n = 316)
n (%) Test statistic
Total original
participants (n = 316)
Follow-up
participants (n = 298)
Deceased at follow-up
(n = 12)
Lost to follow-up
(n = 6) w2
P
Gender 5.06 0.08
Male 183 (57.9) 168 (56.4) 10 (83.3) 5 (83.3)
Female 133 (42.1) 130 (43.6) 2 (16.7) 1 (16.7)
Age (years) 57.22 50.001
18–24 81 (25.6) 79 (26.5) 0 (0) 2 (33.3)
25–31 67 (21.2) 66 (22.1) 0 (0) 1 (16.7)
32–38 58 (18.4) 58 (19.5) 0 (0) 0 (0)
39–45 45 (14.2) 44 (14.8) 0 (0) 1 (16.7)
46–51 25 (7.9) 22 (7.4) 3 (25.0) 0 (0)
52+ 40 (12.7) 29 (9.7) 9 (75.0) 2 (33.3)
Caste 14.00 0.03
Bahun 79 (25.0) 75 (25.2) 2 (16.7) 2 (33.3)
Chhetri 153 (48.4) 149 (50.0) 2 (16.7) 2 (33.3)
Dalit 75 (23.7) 65 (21.8) 8 (66.7) 2 (33.3)
Janajati 9 (2.8) 9 (3.0) 0 (0) 0 (0)
Education 4.22 0.12
No education 137 (43.4) 125 (41.9) 8 (66.7) 4 (66.7)
Any education 179 (56.6) 173 (58.1) 4 (33.3) 2 (33.3)
Household income 4.65 0.10
No income 142 (44.9) 130 (43.6) 9 (75.0) 3 (50.0)
Any income 174 (55.1) 168 (56.4) 3 (25.0) 3 (50.0)
Stressful life events 0.08 0.96
0–14 events 201 (63.6) 189 (63.4) 8 (66.7) 4 (66.7)
515 events 115 (36.4) 109 (36.6) 4 (33.3) 2 (33.3)
Depression, BDIa
10.23 0.006
Below cut-off 213 (67.4) 206 (69.1) 3 (25.0) 4 (66.7)
Above cut-off 103 (32.6) 92 (30.9) 9 (75.0) 2 (33.3)
Anxiety, BAIb
6.37 0.04
Below cut-off 230 (72.8) 220 (73.8) 5 (41.7) 5 (83.3)
Above cut-off 86 (27.2) 78 (26.2) 7 (58.3) 1 (16.7)
BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory.
a. Cut-off is 20 or greater.
b. Cut-off is 17 or greater.
5. Political violence and mental health in Nepal
deceased and lost to follow-up) only differed in baseline character-
istics for age, caste and mental health. Of the 12 participants who
died, one was killed in crossfire between Maoists and the Nepal
Army. The other 11 died from health problems, most commonly
respiratory disease. Participants who died were more likely to be
older, Dalit and have had depression (75%) and anxiety (58%)
at the baseline pre-conflict assessment. When examining pre- to
post-conflict changes in variables among all follow-up participants,
the participants were more likely to have any education, any
household income and a greater number of recent stressful
events during the post-conflict assessment compared with the
pre-conflict period (Table 2).
Depression and anxiety prevalence increased from the pre- to
post-conflict assessment periods (Table 2). During the pre-conflict
period, 92 of the 298 follow-up participants (30.9%) were above
the cut-off for depression. At post-conflict assessment, 121
(40.6%) were above the cut-off for depression. For anxiety, 78
of the 298 participants (26.2%) were above the cut-off at baseline.
At follow-up, 142 of the 298 participants (47.7%) were above the
cut-off. The correlation between BDI measures pre- and post-
conflict was 0.37 (P50.001). For the BAI, the correlation between
pre- and post-conflict measures was 0.34 (P50.001).
The odds of depression and anxiety increased from the pre- to
post-conflict period (Table 3, Model 1). When using GEE to
account for ageing of the population, there is not a significant
effect of assessment period (pre- to post-conflict) on depression
whereas the assessment period remains a significant predictor of
anxiety (Table 3, Model 2). Figure 1 is a presentation of this effect
of ageing for depression and anxiety. The increase in depression
from pre- to post-conflict is no greater than what would be
expected with ageing of the population alone. In contrast, increases
in anxiety were greater than would be expected from ageing.
The next step was to evaluate whether conflict-related
traumas can account for observed changes in anxiety. Participants
experienced a range of exposures to political violence (Table 4).
When conflict exposure was entered into the GEE, the effect of
pre- v. post- conflict assessment period was no longer significant
for anxiety (Table 3, Model 3), suggesting that conflict exposure
accounts for the difference in anxiety levels between the two
assessments. Moreover, this showed a dose–response effect of
number of types of conflict events on anxiety. In the final GEE
model, conflict exposure remained significant in a dose–response
relationship for anxiety even when controlling for stressful life
events in the past year and household income (Table 3, Model
4). Table 5 presents the final model including the effects of gender,
age, caste, education, income and stressful life events. For
depression, these factors are significant. For anxiety, gender, age,
caste and stressful life events are significant in addition to conflict
exposure. For both depression and anxiety, Dalit caste had the
greatest odds of poor mental health compared with other
ethnic/caste groups.
We evaluated whether any specific demographic group showed
greater change in mental health outcomes between the pre- and
post- conflict periods. The absolute increases were greater for
271
Table 2 Comparison of characteristics between pre-conflict
(year 2000) and post-conflict (year 2007) among follow-up
participants (n = 298)
n (%)
Pre-conflict Post-conflict McNemar w2
, P
Education 50.001
No education 125 (41.9) 92 (30.9)
Any education 173 (58.1) 206 (69.1)
Household income 50.001
No income 130 (43.6) 72 (24.2)
Any income 168 (56.4) 226 (75.8)
Stressful life events 50.001
0–14 events 189 (63.4) 106 (35.6)
515 events 109 (36.6) 192 (64.4)
Depression, BDIa
0.005
Below cut-off 206 (69.1) 177 (59.4)
Above cut-off 92 (30.9) 121 (40.6)
Anxiety, BAIb
50.001
Below cut-off 220 (73.8) 156 (52.3)
Above cut-off 78 (26.2) 142 (47.7)
BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory.
a. Cut-off is 20 or greater.
b. Cut-off is 17 or greater.
Table 3 Generalised estimating equations for effect of assessment period and conflict exposure on depression and anxiety among
follow-up participants (n = 298)a
Model 1 Model 2 Model 3 Model 4
OR (95% CI) P OR (95% CI) P OR (95% CI) P OR (95% CI) P
Depression, BDIb
Assessment period 0.009 0.22 0.66 0.97
Pre-conflict (year 2000) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)
Post-conflict (year 2007) 1.44 (1.09–1.91) 1.27 (0.87–1.84) 0.88 (0.50–1.55) 0.99 (0.54–1.79)
Conflict exposure N/A N/A 0.36 0.56
0–3 events 1 (Reference) 1 (Reference)
4–5 events 1.75 (0.89–3.45) 1.49 (0.75–2.95)
6–7 events 1.42 (0.70–2.91) 1.32 (0.63–2.75)
8–13 events 1.80 (0.81–4.00) 1.72 (0.76–3.89)
Anxiety, BAIc
Assessment period 50.001 50.001 0.54 0.57
Pre-conflict (year 2000) 1 (Reference) 1.0 (Reference) 1 (Reference) 1 (Reference)
Post-conflict (year 2007) 2.46 (1.82–3.32) 3.04 (2.03–4.53) 1.22 (0.64–2.31) 1.21 (0.63–2.33)
Conflict exposure N/A N/A 50.001 0.001
0–3 events 1 (Reference) 1 (Reference)
4–5 events 2.32 (1.11–4.83) 1.96 (0.92–4.16)
6–7 events 4.26 (1.93–9.41) 3.17 (1.41–7.23)
8–13 events 6.64 (2.90–15.19) 5.73 (2.38–13.84)
BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; N/A, not applicable.
a. All predictors are measured at pre- and post-conflict, except conflict exposure. Model 1: pre- v. post-conflict assessment period; Model 2: Model 1 plus age, caste, gender and
education; Model 3: Model 2 plus conflict exposure; Model 4: Model 3 plus past year stressful life events and household income.
b. Cut-off is 20 or greater.
c. Cut-off is 17 or greater.
6. Kohrt et al
anxiety v. depression for all groups (Fig. 2). Using GEE accounting
for the two observations per person, interaction effects were ex-
amined in separate models for gender6exposure, age6exposure,
and Dalit6exposure. In each of the separate models, interactions
were not significant (P50.05). Women, elderly people and
marginalised caste groups did not show a greater increase in
psychiatric morbidity compared with other demographic groups.
Post-traumatic stress disorder was assessed only during the
post-conflict period. Based on the validated cut-off score of 50
or greater, 42 participants (14.1%) met criteria for PTSD. In a
logistic regression including gender, age, caste, conflict exposure
and pre-conflict measures of education, income, depression and
anxiety, the only significant predictors were conflict exposure
(P50.05) and pre-conflict anxiety, with the latter showing a
protective relationship for PTSD risk (odds ratio (OR) = 0.33,
95% CI 0.11–0.97).
Discussion
Main findings and their signficance
The goal of this study was to examine the effects of exposure to
war on mental health using a prospective cohort design comparing
prevalence of depression and anxiety prior to the outbreak of
widespread violence v. after peace accords were signed. This is
the first study to assess the same group of individuals before
and after a violent conflict in a low-income country. Crude
prevalence rates increased. Anxiety rose from 26.2 to 47.7%.
Participants had nearly three times greater risk for anxiety during
the post-conflict period compared with the pre-conflict period,
even when controlling for ageing of the cohort. The number of
conflict exposures had a dose–response effect on anxiety. When
controlling for pre- to post-conflict changes in recent stressful
life events, conflict exposure continued to predict anxiety in a
dose–response manner.
Depression rose from 30.9 to 40.6%. In contrast to anxiety, the
increase in depression was attributable to ageing of the population
but was not associated with war trauma. Regarding reputed
vulnerable groups, we found that women, elderly people and
those from marginalised caste groups were not more susceptible
to increases in either depression or anxiety because of the
conflict. These groups had a high symptom burden prior to
conflict exposure. In summary, exposure to political violence led
to an increase in anxiety but not depression in a rural
community in Nepal, and the effects of political violence on
psychiatric morbidity were felt equally across demographic
groups.
These findings challenge some generalisations about the effects
of war on mental health. Counter to the assumption that societies
have low psychiatric morbidity prior to war,3
this study suggests
that (a) post-conflict societies may have had high rates of
mental health problems prior to conflict exposure, especially in
marginalised communities such as this study site, (b) exposure
to conflict may play a dominant role in anxiety prevalence but
may not be the primary risk factor for other forms of psychiatric
morbidity such as mood disorders, which may be influenced
more by ongoing non-war risk factors such as poverty and
ethnic/caste-based discrimination, and (c) putative risk groups
may not show a greater rise in psychiatric problems as a result
of conflict exposure but instead may have chronically elevated
risks observable even during peacetime.
272
100 –
90 –
80 –
70 –
60 –
50 –
40 –
30 –
20 –
10 –
0 –
Proportionabovecut-off(s.e.)
(a) (b)
18–24 25–31 32–38 39–45 46–51 52–80
Age group, years
18–24 25–31 32–38 39–45 46–51 52–80
Age group, years
Pre-conflict
Post-conflict
*
*
*
Fig. 1 (a) Depression (Beck Depression Inventory (BDI)) and (b) anxiety (Beck Anxiety Inventory (BAI)) by age at time of pre- v. post-
conflict assessment.
There are no participants in the 18- to 24-year-old age group at the post-conflict assessment because they aged out of this cohort. Error bars represent standard error of the
proportion above the cut-off. Cut-off for BDI is 20 or greater, and cut-off for BAI is 17 or greater. The ‘*’ refers to pre- v. post-conflict differences P50.05 for the specific age group.
Table 4 Conflict exposure among follow-up participants
(n = 298)
Exposure type n (%)
House searched by armed groupa
256 (85.9)
Witnessing someone killed by armed group 234 (78.5)
Forced to feed and shelter armed group 220 (73.8)
Witnessing someone beaten by armed group 213 (71.5)
Witnessing bomb explosion 191 (64.1)
Threatened by armed group for political involvement 121 (40.6)
Family member tortured by armed group 75 (25.2)
Forced into political involvement by armed group 64 (21.5)
Family member abducted by armed group 37 (12.4)
Property damaged in battle 35 (11.7)
Displaced due to conflict 34 (11.4)
Sexual violence perpetrated by armed group 26 (8.7)
Domestic violence perpetrated by family member
in armed group 23 (7.7)
Family member killed by armed group 14 (4.7)
Total conflict exposure (quartiles)
0–3 exposures 75 (25.2)
4–5 exposures 85 (28.5)
6–7 exposures 92 (30.9)
8–13 exposures 46 (15.4)
a. ‘Armed group’ can refer to either government forces (Nepal Army and Armed
Police Force) or Maoist forces (People’s Liberation Army).
7. Political violence and mental health in Nepal
Our study also suggests different trajectories and risk factors
for mood v. anxiety disorders. Studies in Algeria and Afghanistan
also have demonstrated trauma exposure associated with
increased risk of anxiety but not depression.31,32
In a study of
2000 survivors of 9/11, there were different profiles for depression
including one group characterised by chronic depression with risk
factors including high stressors, low social support, a lifetime
history of depression and non-terror chronic traumas;33
this
depression subgroup parallels the profile of depression in our
Nepal sample. Furthermore, there is increasing evidence for
differing trajectories and risk factors for mood and anxiety
disorders in non-conflict affected populations.34,35
Therefore,
whereas others have argued that the distinction between anxiety
and depression in low-income settings is not clinically relevant,36
the differences in trajectory suggest some divergence in public
health prevention strategies for mood and anxiety disorders.
273
80 –
70 –
60 –
50 –
40 –
30 –
20 –
10 –
0 –
Proportionabovecut-offs(s.e.),%
Men Women 539 years 539 years Dalit Other
Gender Age Ethnicity/caste
Men Women 539 years 539 years Dalit Other
Gender Age Ethnicity/caste
(a) (b) Pre-conflict
Post-conflict
*
*
*
*
*
*
Fig. 2 (a) Depression (Beck Depression Inventory (BDI)) and (b) anxiety (Beck Anxiety Inventory (BAI)) by demographic group pre- and
post-conflict.
Error bars represent standard error of the proportion above the cut-off. Cut-off for BDI is 20 or greater, and cut-off for BAI is 17 or greater. The ‘*’ refers to pre- v. post-conflict
differences P50.05 for the specific demographic group.
Table 5 Generalised estimating equations for predictors of depression and anxiety among follow-up participants (n = 298)a
Depression, Beck Depression Inventoryb
Anxiety, Beck Anxiety Inventoryc
OR (95% CI) P OR (95% CI) P
Gender 50.001 50.001
Male 1 (Reference) 1 (Reference)
Female 3.02 (1.85–4.92) 4.55 (2.67–7.74)
Age, years 50.001 50.001
25–31 1 (Reference) 1 (Reference)
32–38 2.05 (0.90–4.64) 0.44 (0.21–0.92)
39–45 3.56 (1.57–8.06) 1.12 (0.51–2.47)
46–51 7.60 (2.94–19.68) 1.86 (0.80–4.33)
52–80 10.91 (4.58–25.99) 2.81 (1.28–6.20)
Caste 0.04 50.001
Chhetri 1 (Reference) 1 (Reference)
Dalit 1.69 (1.01–2.83) 5.80 (3.44–9.78)
Bahun 1.06 (0.65–1.75) 2.51 (1.55–4.06)
Janajati 0.10 (0.01–0.92) 0.11 (0.01–1.19)
Education 0.03 0.26
Any education 1 (Reference) 1 (Reference)
No education 1.72 (1.07–2.76) 1.33 (0.81–2.20)
Household cash income 50.001 0.44
Any income 1 (Reference) 1 (Reference)
No income 2.49 (1.65–3.76) 1.19 (0.77–1.85)
Stressful life events in past year 0.005 50.001
0–14 events 1 (Reference) 1 (Reference)
515 events 1.86 (1.20–2.88) 2.55 (1.60–4.05)
Conflict exposure 0.56 0.001
0–3 events 1 (Reference) 1 (Reference)
4–5 events 1.49 (0.75–2.95) 1.96 (0.92–4.16)
6–7 events 1.32 (0.63–2.75) 3.17 (1.41–7.23)
8–13 events 1.72 (0.76–3.89) 5.73 (2.38–13.84)
Assessment period 0.97 0.57
Pre-conflict (year 2000) 1 (Reference) 1 (Reference)
Post-conflict (year 2007) 0.99 (0.54–1.79) 1.21 (0.63–2.33)
a. All predictors are measured at pre- and post-conflict, except conflict exposure.
b. Cut-off is 20 or greater.
c. Cut-off is 17 or greater.
8. Kohrt et al
Strengths and limitations
The strengths of this study include the use of validated
instruments, the ability to employ a prospective sample, and a
follow-up rate of 98% of living original participants. Regarding
limitations, it is difficult to specify what qualifies as ‘pre-conflict’
mental health. As with most settings of political violence, the
historical date a war begins, the date violence reaches a
community and the time when a community suffers the
psychological sequelae of political violence all may differ. Even
though direct violence did not occur in Jumla before this study
was conducted, anticipatory concerns cannot be excluded. Anxiety
rates may have been lower in this community prior to the war’s
officially recognised start date in 1996. There is likely a gradient
ranging from anticipating conflict to actually experiencing
violence. The increase in anxiety that occurred after direct
violence reached the community in 2001 and the dose–response
pattern suggest that direct exposure to violence has an added effect
upon anxiety beyond possible pre-violence anticipatory anxiety.
Ceiling effects also may have influenced the findings in that high
levels of depression prior to the conflict may have precluded
observing a significant increase at the post-conflict assessment.
A major limitation is that PTSD was not assessed in 2000, so
the change in prevalence attributable to the conflict could not
be quantified.
Implications
These findings have implications for global mental healthcare.
Whereas high levels of mental health problems alone demand
attention and intervention, prevention and palliative treatment
will differ depending on the nature of war-related factors v. other
risk factors.37–39
More detailed knowledge of the impact of
political violence v. other chronic social problems can lead to
better-informed interventions in post-conflict settings with scarce
resources. The identification of mental health problems in these
settings preceding conflict demonstrates the need for investment
in mental healthcare infrastructure and other psychosocial services
in impoverished communities.40
Social marginalisation can be as
damaging to mental health as war trauma: being from a low caste
Dalit group has the same effect size (OR = 5.80) as having
experienced conflict exposure at the highest quartile (OR = 5.73)
for anxiety. Therefore, although trauma-specific interventions
may be helpful for anxiety, social interventions to reduce and
prevent depression and anxiety in this setting should focus on
education, poverty reduction, minimising stressful life events,
improving healthcare and reducing other risk factors associated
with ageing, low caste and female gender.
Mounting evidence suggests that the impact on mental health
of war is not inevitable, but rather intimately related to the social,
economic and cultural conditions that precede and follow violent
conflict.5,38,39,41
These suppositions are in no way intended to
diminish the emphasis placed upon the suffering caused by
political violence. Rather, the goal is to increase attention to the
equally damaging forces of chronic injustice in the form of
ongoing financial, social and health-related threats that erode
everyday mental health. Moreover, pre-conflict marginalisation
may increase vulnerability to exploitation by militant groups.
Maoists used the promise of eradicating social inequities to recruit
adults and children into their military.14,42
This leads to a final
important observation of this study: psychiatric morbidity did
not decrease for any demographic group. This challenges
suggestions, such as those proffered by militant revolutionary
movements, that violent uprising is a form of psychological
emancipation. Ultimately, addressing risk factors for poor mental
health such as poverty, lack of education, inadequate healthcare
and gender- and ethnic/caste-based discrimination, in addition
to trauma healing, may not only ameliorate mental health
problems, but also help to reduce vulnerability to exploitation
and involvement in political violence.
Brandon A. Kohrt, MD, PhD, Department of Psychiatry and Behavioral Sciences, The
George Washington University, Washington DC, USA; Daniel J. Hruschka, PhD, MPH,
School of Human Evolution and Social Change, Arizona State University, Tempe,
Arizona, USA; Carol M. Worthman, PhD, Department of Anthropology, Emory
University, Atlanta, Georgia, USA; Richard D. Kunz, MD, Department of Physical
Medicine & Rehabilitation, Virginia Commonwealth University Health Systems,
Richmond, Virginia, USA; Jennifer L. Baldwin, MA, MPH, Department of
Anthropology, University of Illinois-Urbana Champaign, Urbana Champaign, Illinois,
USA; Nawaraj Upadhaya, MA, University of Amsterdam, Amsterdam, The
Netherlands; Nanda Raj Acharya, Suraj Koirala, MA, Transcultural Psychosocial
Organization Nepal, Kathmandu, Nepal; Suraj B. Thapa, MD, Institute of Psychiatry,
University of Oslo, Institute of Psychiatry, Oslo, Norway; Wietse A. Tol, PhD,
Department of Anthropology, Yale University, New Haven, Connecticut, USA;
Mark J. D. Jordans, PhD, Department of Research and Development, HealthNet TPO
& Centre for Global Mental Health, London School of Hygiene and Tropical Medicine;
Navit Robkin, MPH, Rollins School of Public Health, Emory University, Atlanta,
Georgia, USA; Vidya Dev Sharma, MBBS, MD, Mahendra K. Nepal, MBBS, MD,
Department of Psychiatry, Institute of Medicine, Tribhuvan University Teaching
Hospital, Maharajgunj, Nepal
Correspondence: Brandon A. Kohrt, Department of Psychiatry and Behavioral
Sciences, The George Washington University, 2150 Pennsylvania Avenue, 8th
Floor, Washington, DC 20037, USA. Email: brandonkohrt@gmail.com
First received 1 May 2011, final revision 23 Jan 2012, accepted 22 Feb 2012
Funding
Funding was provided through a National Institute of Mental Health – National Research
Service Award (NIMH-NRSA F31 MH075584), a Wenner-Gren Dissertation Fieldwork Grant,
a Fulbright Fellowship and the Graduate School of Arts and Sciences of Emory University.
Acknowledgements
Renu Shrestha, Krishna Maya Neupane, Mukunda Chaulagain, Indra Rai, Diya Khatri, Raj
Budthapa, Lok Bahadur Rawal, Khem Singh Kathaya, Chandra Devkota, and Sabitri Devkota
conducted field research in Jumla. Thanks to Ganesh Rokaya and his family for hosting the
research team and to 4S Nepal and the Jumla Hospital staff for providing logistical
assistance. Thanks to Peter Brown, Mel Konner, and Ian Harper for reading earlier
manuscript drafts. Special thanks to Christina Chan.
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