ObjectivesPsychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.MethodsThis is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.Trial registration: ISRCTN 11913964
Background and Purpose: Measures taken to prevent COVID-19 infections, aside from causing disruptions in many facets of our daily life, have impeded education, including the higher education process, as never seen before on a global scale. Recent studies have indicated the potential negative impact of the COVID-19 pandemic on the mental health trajectory of university students. Anxiety and depression can seriously hamper students' quality of life and educational achievement. This study explored anxiety and depression among university students in Kosovo during the lockdown as a result of COVID-19 pandemics. The study was implemented during the initial phase of the pandemic. This study also explored the impact of selected determinants on the reported mental health of students. Methods: In total, 904 university students from the largest public university in Kosovo were enrolled in a web-based cross-sectional study during the early phase of the national lockdown due to the COVID-19 pandemic. Results: The first and second hierarchical regression models indicated that the anxiety and depression scores of students were predicted by gender, knowing someone who was infected with COVID-19, concerns about the potential financial impact of measures taken by governments to respond to the COVID-19 pandemic and excessive information seeking about COVID-19. The third model improved significantly when the variables concerns about family members' health, concerns about being lonely, problems with online lectures and requests for help from the university related to online lectures were added to the model. Overall, the findings indicated that situational variables associated with measures taken to respond to the COVID-19 pandemic appeared to predict anxiety and depression among students. Conclusion: These findings indicate that universities and public health ARTICLE HISTORY
The overall purpose of this study was to achieve a contextual understanding of war and displacement stressors and coping mechanisms among urban refugee families from Syria living in Istanbul. This study was informed primarily by Walsh's family resilience framework and Weine's Family Consequences of Refugee Trauma empirical model. Qualitative family interviews were conducted with a purposive sample of 30 Syrian refugee families from the Çapa and Esenler neighborhoods of Istanbul. Data were analyzed using a grounded theory approach and Atlas/ti software. The analysis identified a total of 21 war and displacement stressors for families across 3 categories: (a) Surviving war and border crossing; (b) Living as urban refugees, and; (c) Parenting children in refuge. The analysis also identified a total of 16 coping mechanisms for families across 4 themes: (a) Flexible and reciprocal family organization; (b) Hopeful family beliefs and communication; (c) Staying connected with family in Syria and in exile, and; (d) Making the best of living in a new country. These findings underlie the need for several practice and policy priorities including: (a) Increasing the number of children attending Turkish schools and decreasing child labor; (b) Incorporating faith into psycho-social and mental health interventions, and; (c) Developing family focused interventions conducted by community-based lay providers that draw upon empirical models of family stressors and coping.
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