Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions

Tol, Wietse A.; Stavrou, Vivi; Greene, M. Claire; Mergenthaler, Christina; Ommeren, Mark van; Moreno, Carmen

doi:10.1186/1752-1505-7-16

Cited by 95 publications

(85 citation statements)

References 32 publications

(37 reference statements)

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“…Despite the severe health and social burden associated with CRSV, virtually no evidence exists on how medical, mental health and psychosocial support (MHPSS) interventions work for men, boys and LGBT survivors of CRSV. One realist review was conducted on female CRSV [34], and two systematic reviews on CRSV interventions have been carried out [35,36]. However, male and LGBT survivors were either not explicitly considered, or due to the lack of specific quantitative studies on these groups, did not allow for inclusion in the systematic reviews.…”

Section: Introductionmentioning

confidence: 99%

Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries

Kiss

Quinlan-Davidson

Pasquero³

et al. 2020

Confl Health

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Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.

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Section: Introductionmentioning

confidence: 99%

Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries

Kiss

Quinlan-Davidson

Pasquero³

et al. 2020

Confl Health

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“…Few psychological interventions targeting survivors of GBV in LMIC have undergone rigorous scientific evaluation and therefore their efficacy and effectiveness remain indeterminate [5, 13]. One randomized controlled trial conducted by Bass and colleagues [14] investigated the effectiveness of group cognitive processing therapy (CPT), a trauma-focused psychological intervention.…”

Section: Introductionmentioning

confidence: 99%

Feasibility trial of a scalable psychological intervention for women affected by urban adversity and gender-based violence in Nairobi

Dawson

Schafer

Anjuri³

et al. 2016

BMC Psychiatry

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BackgroundLiving in conditions of chronic adversity renders many women more vulnerable to experiencing gender-based violence (GBV). In addition to GBV’s physical and social consequences, the psychological effects can be pervasive. Access to evidence-based psychological interventions that seek to support the mental health of women affected by such adversity is rare in low- and middle-income countries.MethodsThe current study evaluates a brief evidence-informed psychological intervention developed by the World Health Organization for adults impacted by adversity (Problem Management Plus; PM+). A feasibility randomised control trial (RCT) was conducted to inform a fully powered trial. Community health workers delivered the intervention to 70 women residing in three peri-urban settings in Nairobi, Kenya. Women, among whom 80% were survivors of GBV (N = 56), were randomised to receive five sessions of either PM+ (n = 35) by community health workers or enhanced treatment as usual (ETAU; n = 35).ResultsPM+ was not associated with any adverse events. Although the study was not powered to identify effects and accordingly did not identify effects on the primary outcome measure of general psychological distress, women survivors of adversity, including GBV, who received PM+ displayed greater reductions in posttraumatic stress disorder symptoms following treatment than those receiving ETAU.ConclusionsThis feasibility study suggests that PM+ delivered by lay health workers is an acceptable and safe intervention to reach women experiencing common mental disorders and be inclusive for those affected by GBV and can be studied in a RCT in this setting. The study sets the stage for a fully powered, definitive controlled trial to assess this potentially effective intervention.Trial registration ACTRN12614001291673, 10/12/2014, retrospectively registered during the recruitment phase.

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“…The most promising research is emerging from conflict settings where adaptation of CBT have shown promise with hope that such interventions are not impossible in poor resource settings with high prevalence of rape. 28 Another challenge is the low levels of mental health literacy and capacity among service providers. This may have contributed to the poor response and recognition of survivor's mental health needs as well as an understanding of how their interactions impact on survivors' mental health.…”

Section: Discussionmentioning

confidence: 99%

A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape

Abrahams

Gevers

2017

S. Afr. J. Psych.

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Background: Despite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care.Aim: The aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services. Method: We conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis.Results: Survivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue.Conclusion: Providing effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services.

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Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions

Cited by 95 publications

References 32 publications

Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries

Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries

Feasibility trial of a scalable psychological intervention for women affected by urban adversity and gender-based violence in Nairobi

A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape

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