BackgroundExperiencing systematic violence and trauma increases the risk of poor mental health outcomes; few interventions for these types of exposures have been evaluated in low resource contexts. The objective of this randomized controlled trial was to assess the effectiveness of two psychotherapeutic interventions, Behavioral Activation Treatment for Depression (BATD) and Cognitive Processing Therapy (CPT), in reducing depression symptoms using a locally adapted and validated version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale. Secondary outcomes included posttraumatic stress, anxiety, and traumatic grief symptoms.MethodsTwenty community mental health workers, working in rural health clinics, were randomly assigned to training in one of the two interventions. The community mental health workers conducted baseline assessments, enrolled survivors of systematic violence based on severity of depression symptoms, and randomly assigned them to treatment or waitlist-control. Blinded community mental health workers conducted post-intervention assessments on average five months later.ResultsAdult survivors of systematic violence were screened (N = 732) with 281 enrolled in the trial; 215 randomized to an intervention (114 to BATD; 101 to CPT) and 66 to waitlist-control (33 to BATD; 33 to CPT). Nearly 70% (n = 149) of the intervention participants completed treatment and post-intervention assessments; 53 (80%) waitlist-controls completed post-intervention assessments. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively, comparing BATD participants to all controls and 0.84 and 0.79 respectively, compared to BATD controls only. Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only. Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models, BATD had significant effects on depression (p = .003) and dysfunction (p = .007), while CPT had a significant effect on dysfunction only (p = .004).ConclusionsBoth interventions showed moderate to strong effects on most outcomes. This study demonstrates effectiveness of these interventions in low resource environments by mental health workers with limited prior experience.Trial RegistrationClinicalTrials.Gov NCT00925262. Registered June 3, 2009.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0360-2) contains supplementary material, which is available to authorized users.
Background The COVID-19 outbreak is an unprecedented global public health burden, which popped up in China in late 2019 to early 2020 and distributed worldwide rapidly. Indeed, this pandemic transmission has raised global physical and mental health concerns. Mental health issues that concur with this public health emergency may pose anxiety, depression, and posttraumatic stress disorder. In Iraq, there are no registered known data on the psychological consequence of the public during the communicable disease outbreak. The ongoing study aims to address the paucity of these data as an appraisal of the mental health burden represented by anxiety disorder related to the global COVID-19 era. Results Among the 1591 Iraqi respondents, 788 (49.5%) accounted for having health anxiety over the current home restriction situation. Younger ages experienced more COVID-19-related health anxiety compared to older ages. Females reported higher health anxiety compared to males (57.7% vs 42.3%). The health care professionals reported 20.9% health anxiety. The Iraqi southern population displayed more health anxiety compared to the northern and middle portions. This work showed about half of the respondents were spending over 60 min focusing on news of COVID-19. We found that 80 to 90% carrying out preventive efforts and home quarantine against COVID-19 infection. Interestingly, participants experienced fear from the risk of COVID-19 infection, whether more or equal to a level of war scare, in 70.1% of the sample. Conclusions In Iraq, during the COVID-19 pandemic, nearly half of the respondents have health anxiety. Southern Iraqi cities displayed higher rates of anxiety. Also, being female, younger ages, holding an academic degree, or being a college student are associated with more prominent degrees of anxiety. Furtherly, it is important to adopt strategies for public health education and prevention and alerting future governmental responses focusing on psychological state impact among the general population.
To determine the rate of self-burning among all burns patients admitted to the Burns and Plastic Surgery Centre at Sulaimani University in Iraqi Kurdistan and to identify the risk factors and motives, all burns patients, aged 8 years and over, admitted between 1 September 2009 and 30 April 2010 were surveyed. Of the 200 patients interviewed, 54 (27%) reported self-burns and 146 (73%) reported accidental burns. The risk factors for self-burning included mental illness, female gender and younger age. Almost two-thirds of those who reported self-burns (32, 60.4%) had intended to kill themselves. The most commonly cited reasons for the act were family problems (24, 44%) and marital problems (13, 24%). Burns in the self-burning group were more severe and were associated with a higher mortality rate (34, 63%) than in the accidental burns group (29, 20%).
Infantile tremor syndrome is a rare condition which was described both in India and outside India as well. It was observed among children in Iraqi Kurdistan during the difficult economic situation under the UN Sanctions. The condition has the same features inside and outside India. The etiology is not very clear yet.
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