Description and Predictive Factors of Individual Outcomes in a Refugee Camp Based Mental Health Intervention (Beirut, Lebanon)

Abstract

BackgroundThere is little evidence on the effectiveness of services for the care of people with mental disorders among refugee populations. Médecins sans Frontières (MSF) has established a mental health centre in a mixed urban-refugee population in Beirut to respond to the significant burden of mental health problems. Patients received comprehensive care through a multidisciplinary team. A cohort of people with common and severe mental disorders has been analysed between December 2008 and June 2011 to evaluate individual outcomes of treatment in terms of functionality.MethodsAll patients diagnosed with mental disorders were included in the study. The Global Assessment of Functioning (GAF) and the Self Reporting Questionnaire–20 items (SRQ 20) were used as tools for baseline assessment, monitoring and evaluation of patients. Predictors of evolution of SRQ20 and GAF over visits were explored using a linear mixed model.ResultsUp to June 2011, 1144 patients were followed, 63.7% of them Lebanese, 31.8% Palestinians and 1.2% Iraqis. Females represented 64.2% of the patient population. Mean age was 39.2 years (28.5–46.5). The most frequent primary diagnoses were depressive disorders (28.8%), anxiety disorders (15.6%) and psychosis (11.5%). A lower baseline SRQ20 score/higher baseline GAF score (indicators of severity), being diagnosed with anxiety (compared to being diagnosed with depression or psychosis) and a higher level of education were associated with better outcomes.DiscussionIn this MSF program, we observed a significant decrease of SRQ20 individual scores and a significant increase of individual GAF scores. This corresponded to an improvement in the functionality of our patients. Analysis of the predictors of this positive evolution indicates that we need to adapt our model for the more severe and less educated patients. It also makes us reflect on the length of the individual follow-up. Further research could include a qualitative evaluation of the intervention. Results of this study have been presented at the World Congress of the World Federation for Mental Health in Cape Town, October 2011.

Trauma-affected refugees treated with basic body awareness therapy or mixed physical activity as augmentation to treatment as usual—A pragmatic randomised controlled trial

“…Secondary outcomes were the self-administered rating scales Hopkins Symptom Check List (HSCL-25), assessing the severity of anxiety and depression symptoms [32], the somatisation scale of Symptom Checklist-90 (SCL-90) [33], quality of life evaluated on WHO-5 [34] and the Sheehan Disability Scale (SDS) [35] for level of functioning. Observer ratings included the Global Assessment of Functioning for symptoms and functioning (GAF-S and -F) [36], HoNOS assessing health and social functioning [37], and the Hamilton Depression and Anxiety scales (HAM-D and HAM-A) [38], which were conducted by blinded assessors. Pain was assessed by two self-administered rating scales: Visual Analogue Scale (VAS); and Brief Pain Inventory short form (BPI) [39,40].…”

Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study

“…The primary outcome measure was self-reported PTSD symptoms assessed using part IV of the Harvard Trauma Questionnaire (HTQ), which has been developed primarily for trauma-affected refugees and validated in several languages and settings [26, 27]. Secondary outcome measures included depression and anxiety symptoms measured on the Hopkins Symptom Check List-25 (HSCL-25) [28] and on the Hamilton Depression and Anxiety Ratings Scales (HAM-D and HAM-A) [29], social functioning measured on the Social Adjustment Scale Self Report (SAS-SR) short version [30], social support assessed on the Crisis Support Scale (CSS) [31], level of functioning assessed on the Sheehan Disability Scale (SDS) [32], quality of life assessed on the WHO-Five Well-being Index (WHO-5) [33], the somatisation scale of SCL-90, the mean score of pain in four different body areas rated on Visual Analogue Scales (VAS) and levels of symptoms and functioning assessed on the Global Assessment of Functioning (GAF) [34]. These measures were all self-report ratings except the GAF-scores, which were completed by the doctor in charge of the treatment and the HAM-D and HAM-A, which were completed by blinded assessors as described above.…”

A life in waiting: Refugees' mental health and narratives of social suffering after European Union border closures in March 2016

“…Recent studies among refugee populations in camps or in transit concerned populations in a transit situation for years outside Europe (Akinyemi et al, 2016;El-Shaarawi, 2015;Hoffman, 2011), or mainly used epidemiological surveys as methods (Bastin et al, 2013;Crepet et al, 2017). The present study responds to the call made by Kienzler (2008) and others for mixedmethods studies of refugee mental health (Weine et al, 2014).…”