Barbara Lopes Cardozo

Mental health, social functioning, and feelings of hatred and revenge of Kosovar Albanians one year after the war in Kosovo

A cross-sectional cluster sample survey was conducted in June 2000 in Kosovo to assess the prevalence of mental health problems associated with traumatic experiences, feelings of hatred and revenge, and the level of social functioning among Kosovar Albanians approximately 1 year after the end of the war. Findings of the second cross-sectional survey were compared with those from our 1999 mental health survey in Kosovo. Included in the survey were 1399 Kosovar Albanians aged 15 years or older living in 593 randomly selected households across Kosovo. Twenty-five percent of respondents reported PTSD symptoms, compared with 17.1% in 1999. The MOS-20 social functioning score improved to 69.8 from 29.5 in 1999. In the 2000 survey 54% of men felt hatred toward the Serbs, compared with 88.7% in 1999.

Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka

CONTEXT Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons. OBJECTIVES To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka. DESIGN, SETTING, AND PARTICIPANTS Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health. MAIN OUTCOME MEASURES Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure. CONCLUSION Among residents of Jaffna District in Sri Lanka, prevalence of symptoms of war-related mental health conditions was substantial and significantly associated with displacement status and underlying trauma exposure.

Mental health status of human rights workers, Kosovo, June 2000

Human rights workers in humanitarian relief settings may be exposed to traumatic events that put them at risk for psychiatric morbidity. We conducted a cross-sectional survey in June 2000 to study the prevalence of psychiatric morbidity among 70 expatriate and Kosovar Albanian staff collecting human rights data in Kosovo. Among those surveyed, elevated levels of anxiety, depression, and posttraumatic stress disorder symptoms were found in 17.1, 8.6, and 7.1% respectively. Multiple regression analysis revealed that human rights workers at risk for elevated anxiety symptoms were those who had worked with their organization longer than 6 months, those who had experienced an armed attack, and those who experienced local hostility. Our study indicates that human rights organizations should consider mental health assessment, care, and prevention programs for their staff.

Stress, Mental Health, and Burnout in National Humanitarian Aid Workers in Gulu, Northern Uganda

This study examined the mental health of national humanitarian aid workers in northern Uganda and contextual and organizational factors predicting well-being. A cross-sectional survey was conducted among 376 national staff working for 21 humanitarian aid agencies. Over 50% of workers experienced 5 or more categories of traumatic events. Although, in the absence of clinical interviews, no clinical diagnoses were able to be confirmed, 68%, 53%, and 26% of respondents reported symptom levels associated with high risk for depression, anxiety disorders, and posttraumatic stress disorder (PTSD), respectively. Between one quarter and one half of respondents reported symptom levels associated with high risk regarding measured dimensions of burnout. Female workers reported significantly more symptoms of anxiety, depression, PTSD, and emotional exhaustion than males. Workers with the United Nations and related agencies reported fewest symptoms. Higher levels of social support, stronger team cohesion, and reduced exposure to chronic stressors were associated with improved mental health. National humanitarian staff members in Gulu have high exposure to chronic and traumatic stress and high risk of a range of poor mental health outcomes. Given that work-related factors appear to influence the relationship between the two strategies are suggested to support the well-being of national staff working in such contexts.

Predeployment Mental Health and Trauma Exposure of Expatriate Humanitarian Aid Workers: Risk and Resilience Factors

Expatriate aid workers (n = 214) representing 19 nongovernmental organizations (NGOs) completed a predeployment survey, including measures of mental health (depression, anxiety, and posttraumatic stress disorder [PTSD]); risk factors (childhood trauma, family risk, and adult trauma exposure); and resilience factors (coping, social support, and healthy lifestyle) to assess their baseline mental health during preparation for deployment. Multiple regression analysis indicated that childhood trauma/family risk was not significantly related to depression, anxiety, or PTSD symptoms when controlling for report of prior mental illness; yet, adult trauma exposure was significantly related to all three. Social support contributed significant variance to depression and PTSD. NGOs can help applicants recognize the effects of recent trauma and the resilience provided by a healthy social network.

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011

An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.

Factors Associated With Adverse Mental Health Outcomes in Locally Recruited Aid Workers Assisting Iraqi Refugees in Jordan

Nongovernmental organizations (NGOs) serve Iraqis living in Jordan as “guests.” In 2008, 258 Jordanian humanitarian staff and Iraqi volunteers working for NGOs completed a needs assessment survey. Work characteristics, stressors, and support variables were evaluated regarding their influence on depression, anxiety, post-traumatic stress disorder (PTSD), and burnout through multivariate logistic regressions. There was a significant difference in depression, anxiety, and burnout across nationality. Traumatic exposure increased the risk for anxiety, depression, and PTSD. Working longer in the humanitarian sector was associated with less risk of anxiety and depression, and lower social support was a risk for anxiety. Managers were at higher risk for burnout, and low team cohesion was a risk for burnout. Implications for aid organizations are discussed.

Mental health survey among landmine survivors in Siem Reap province, Cambodia

Many survivors of the Khmer Rouge period in Cambodia and the subsequent war with Vietnam have now returned to Cambodia. In this two-stage household cluster survey in Siem Reap Province in Cambodia, we explored the mental health consequences on 166 landmine injury survivors selected from 1000 household in 50 clusters and an oversample of all landmine survivors. We found a prevalence of anxiety of 62% for all respondents, 74% for depression, and 34% for post-traumatic stress disorder (PTSD). These prevalences were statistically significantly higher than among the adult population who had not been injured by landmines. These data underscore the importance of providing mental health care services for the people in Siem Reap Province in Cambodia who have been injured by landmines.

Understanding Bhutanese Refugee Suicide Through the Interpersonal-Psychological Theory of Suicidal Behavior

Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community.

A cross-sectional survey on gender-based violence and mental health among female urban refugees and asylum seekers in Kampala, Uganda

To assess gender‐based violence and mental health outcomes among a population of female urban refugees and asylum seekers.