Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review

Kamali, Mahdis; Munyuzangabo, Mariella; Siddiqui, Fahad Javaid; Gaffey, Michelle F; Meteke, Sarah; Als, Daina; Jain, Reena; Radhakrishnan, Amruta; Shah, Shailja; Ataullahjan, Anushka; Bhutta, Zulfiqar A

doi:10.1136/bmjgh-2019-002014

Cited by 36 publications

(43 citation statements)

References 138 publications

(184 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 36 School based programs can help overcome some of the barriers to access to care and improve educational outcomes. 44 Awareness of trauma also allows teachers to create a safe and stable environment for students to buffer their stress response. The trauma informed approach focuses on nurturing relations and attachments, increasing ability to self-regulate, and cultivating students’ developmental competencies.…”

Section: Mitigating Strategiesmentioning

confidence: 99%

“…A recent systematic review on the mental health of women, children, and adolescents affected by conflict highlighted the need for interventions to be described in more detail in research papers. 44 Moreover rigorous evaluation of success, failure, and effectiveness of interventions and strategies for widescale implementation in conflict affected regions should be prioritised. 44 Most research has not included children affected by conflict and displacement, and knowledge of best practices for these contexts is limited (box 2).…”

Section: Next Stepsmentioning

confidence: 99%

“… 44 Moreover rigorous evaluation of success, failure, and effectiveness of interventions and strategies for widescale implementation in conflict affected regions should be prioritised. 44 Most research has not included children affected by conflict and displacement, and knowledge of best practices for these contexts is limited (box 2). Existing interventions to reduce toxic stress in regions affected by conflict need to be adapted to take account of cultural context and values, vulnerable subgroups, and resource constraints in their design and delivery.…”

Section: Next Stepsmentioning

confidence: 99%

“…Community based interventions are important in the short and long term rehabilitation of children experiencing toxic stress 36. School based programs can help overcome some of the barriers to access to care and improve educational outcomes 44. Awareness of trauma also allows teachers to create a safe and stable environment for students to buffer their stress response.…”

Section: Mitigating Strategiesmentioning

confidence: 99%

“…Despite the growing evidence on toxic stress in children affected by conflict and displacement, gaps in our knowledge persist. A recent systematic review on the mental health of women, children, and adolescents affected by conflict highlighted the need for interventions to be described in more detail in research papers 44. Moreover rigorous evaluation of success, failure, and effectiveness of interventions and strategies for widescale implementation in conflict affected regions should be prioritised 44.…”

Section: Next Stepsmentioning

confidence: 99%

See 4 more Smart Citations

Mitigating toxic stress in children affected by conflict and displacement

Ataullahjan

Samara

Betancourt

et al. 2020

BMJ

Self Cite

View full text Add to dashboard Cite

Armed conflict and displacement pose a threat to the health and wellbeing of children. As the global community begins to recognize the cumulative effects of conflict and displacement related stressors, our attention has shifted to toxic stress and its short and long term health effects. 1 Toxic stress, regarded as the result of prolonged activation of the stress response, can occur before birth and during childhood is known to contribute to epigenetic changes, with health and neurodevelopmental consequences. 2 However, various social factors and early and appropriate intervention can help mitigate the negative effects. 3 How conflict and displacement affect children Over 415 million children were living in conflict affected countries in 2018, 4 including 33 million displaced children (16 million refugees and asylum seekers, and 17 million internally displaced children). 5 Although all children are vulnerable to toxic stress, certain subgroups are particularly vulnerable because of their marginalization-for example, orphaned or unaccompanied children, girls, children with HIV infection, and children with developmental disorders or a disability. These groups may face additional stressors and have reduced access to services. The emergence of covid-19 has also raised concerns about spread in conflict affected populations adding to the risk of toxic stress (box 1). Box 1: Covid-19 in humanitarian settings Conflict affected populations are particularly vulnerable to covid-19. Overcrowding and inadequate water and sanitation systems in refugee camps and informal settlements, coupled with previously existing illnesses, may increase the spread and severity of covid-19. 6 7 Moreover, resource and health system constraints may restrict access to adequate and appropriate care. 6 7 Control measures such as physical distancing may be difficult and may also increase economic precarity, intimate partner violence, and food insecurity in populations already vulnerable because of conflict or displacement. There are concerns that the health needs of conflict affected populations may be deprioritized by host 1

show abstract

Section: Mitigating Strategiesmentioning

confidence: 99%

Section: Next Stepsmentioning

confidence: 99%

Section: Next Stepsmentioning

confidence: 99%

Section: Mitigating Strategiesmentioning

confidence: 99%

Section: Next Stepsmentioning

confidence: 99%

See 3 more Smart Citations

Mitigating toxic stress in children affected by conflict and displacement

Ataullahjan

Samara

Betancourt

et al. 2020

BMJ

Self Cite

View full text Add to dashboard Cite

show abstract

Why We Need Stricter Oversight of Research Involving Human Subjects Affected by Conflict

Ataullahjan

Aziz

et al. 2022

AMA Journal of Ethics

View full text Add to dashboard Cite

Background: Despite the potential for ethical violations when research is conducted with conflict-affected populations, there is limited information on how and the extent to which ethical considerations specific to doing research with these populations are integrated into national and international ethics guidelines and, in turn, how these guidelines translate into practice. This study aims to fill this gap by systematically analyzing the existing research ethics guidance of humanitarian donor countries, conflict-affected countries, United Nations (UN) agencies, and funding agencies, as well as ethics reporting in research articles on conflict-affected populations published in peer-reviewed journals.Methods: A review of 32 research ethics guidelines and granting regulations from UN agencies, donor agencies, and governments was conducted, and the reporting of ethics procedures and practices of 498 articles published in peer-reviewed journals was analyzed.Results: Of the reviewed guidelines and regulations, 87.5% did not mention conflict-affected populations, and only one guideline (3.1%) catalogued any of the complexities of conducting research with conflictaffected populations. Among the reviewed published research articles on conflict-affected populations, obtaining ethics approval or a waiver was reported in only 48.2% of articles, and obtaining informed consent was reported in only 46.6% of studies. In the subset of articles that did not report receiving ethics approval, 88.5% were published in journals that required reporting of ethics approval.Conclusions: This study highlighted a gap in current research guidelines and granting regulations on the ethical conduct of research with conflictaffected populations and illustrated the need for such guidance to be integrated into governing documents and research practices. Moreover, this study demonstrated that there is a need for stricter enforcement of

show abstract

Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises

Papola,

Prina,

Ceccarelli

et al. 2024

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low‐ and middle‐income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well‐being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health. Objectives To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises. Search methods We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews. Selection criteria Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut‐off score on a screening measure). Data collection and analysis We used standard Cochrane methods. Our primary outcomes were mental well‐being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well‐being, functioning, and prosocial behaviour. Main results We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration ...

show abstract

Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review

Cited by 36 publications

References 138 publications

Mitigating toxic stress in children affected by conflict and displacement

Mitigating toxic stress in children affected by conflict and displacement

Why We Need Stricter Oversight of Research Involving Human Subjects Affected by Conflict

Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises

Contact Info

Product

Resources

About