Bayard Roberts

Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda

BackgroundThe 20 year war in northern Uganda between the Lords Resistance Army and the Ugandan government has resulted in the displacement of up to 2 million people within Uganda. The purpose of the study was to measure rates of post-traumatic stress disorder (PTSD) and depression amongst these internally displaced persons (IDPs), and investigate associated demographic and trauma exposure risk factors.MethodsA cross-sectional multi-staged, random cluster survey with 1210 adult IDPs was conducted in November 2006 in Gulu and Amuru districts of northern Uganda. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression were measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association of demographic and trauma exposure variables on the outcomes of PTSD and depression.ResultsOver half (54%) of the respondents met symptom criteria for PTSD, and over two thirds (67%) of respondents met symptom criteria for depression. Over half (58%) of respondents had experienced 8 or more of the 16 trauma events covered in the questionnaire. Factors strongly linked with PTSD and depression included gender, marital status, distance of displacement, experiencing ill health without medical care, experiencing rape or sexual abuse, experiencing lack of food or water, and experiencing higher rates of trauma exposure.ConclusionThis study provides evidence of exposure to traumatic events and deprivation of essential goods and services suffered by IDPs, and the resultant effect this has upon their mental health. Protection and social and psychological assistance are urgently required to help IDPs in northern Uganda re-build their lives.

Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan

BackgroundThe signing of the Comprehensive Peace Agreement in January 2005 marked the end of the civil conflict in Sudan lasting over 20 years. The conflict was characterised by widespread violence and large-scale forced migration. Mental health is recognised as a key public health issue for conflict-affected populations. Studies revealed high levels of post-traumatic stress disorder (PTSD) amongst populations from Southern Sudan during the conflict. However, no studies have been conducted on mental health in post-war Southern Sudan. The objective of this study was to measure PTSD and depression in the population in the town of Juba in Southern Sudan; and to investigate the association ofdemographic, displacement, and past and recent trauma exposure variables, on the outcomes of PTSD and depression.MethodsA cross-sectional, random cluster survey with a sample of 1242 adults (aged over 18 years) was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association ofdemographic, displacement and trauma exposure variables on the outcomes of PTSD and depression. Multivariate logistic regression was also conducted to investigate which demographic and displacement variables were associated with exposure to traumatic events.ResultsOver one third (36%) of respondents met symptom criteria for PTSD and half (50%) of respondents met symptom criteria for depression. The multivariate logistic regression analysis showed strong associations of gender, marital status, forced displacement, and trauma exposure with outcomes of PTSD and depression. Men, IDPs, and refugees and persons displaced more than once were all significantly more likely to have experienced eight or more traumatic events.ConclusionThis study provides evidence of high levels of mental distress in the population of Juba Town, and associated risk-factors. Comprehensive social and psychological assistance is urgently required in Juba.

A systematic review of the influence on alcohol use of community level availability and marketing of alcohol.

PURPOSE Exposure to a high number of alcohol outlets and adverts within a community may lead to higher alcohol use by local residents. The aim of this systematic review was to explore evidence on the influence on alcohol use of community level availability and marketing of alcohol. RESULTS 26 studies met the eligibility criteria. While the findings were not conclusive, there was some indication that higher outlet density and greater exposure to advertising in a local community may be associated with an increase in alcohol use, particularly among adolescents. CONCLUSIONS This review disentangled the existing evidence on the overall relationships between availability, marketing and alcohol use at a community level. Further studies are required to better understand the influence of these factors on alcohol use.

Health Care Reform in the Former Soviet Union: Beyond the Transition.

OBJECTIVE To assess accessibility and affordability of health care in eight countries of the former Soviet Union. DATA SOURCES/STUDY SETTING Primary data collection conducted in 2010 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia, and Ukraine. STUDY DESIGN Cross-sectional household survey using multistage stratified random sampling. DATA COLLECTION/EXTRACTION METHODS Data were collected using standardized questionnaires with subjects aged 18+ on demographic, socioeconomic, and health care access characteristics. Descriptive and multivariate regression analyses were used. PRINCIPAL FINDINGS Almost half of respondents who had a health problem in the previous month which they viewed as needing care had not sought care. Respondents significantly less likely to seek care included those living in Armenia, Georgia, or Ukraine, in rural areas, aged 35-49, with a poor household economic situation, and high alcohol consumption. Cost was most often cited as the reason for not seeking health care. Most respondents who did obtain care made out-of-pocket payments, with median amounts varying from

A systematic review of factors influencing the psychological health of conflict-affected populations in low- and middle-income countries

13 in Belarus to

Bacillus thuringiensis israelensis (Bti) for the control of dengue vectors: systematic literature review.

100 in Azerbaijan. CONCLUSIONS Access to health care and within-country inequalities appear to have improved over the past decade. However, considerable problems remain, including out-of-pocket payments and unaffordability despite efforts to improve financial protection.

Drinking and displacement: a systematic review of the influence of forced displacement on harmful alcohol use.

Abstract Background. Elevated levels of poor mental health have been recorded amongst populations affected by armed conflict. The aim of this study was to systematically review existing evidence on the factors influencing general psychological health of conflict-affected populations in low- and middle-income countries. Methods. Quantitative studies that described statistically significant associations with general psychological health of adult conflict-affected persons in low- and middle-income countries were included. Bibliographic databases and humanitarian agency websites were searched, and a screening, selection and review process was applied. The findings are described using commonly recurring categories of demographic characteristics, socio-economic factors and exposure to traumatic events. Results. Fifteen studies met the inclusion criteria. Factors with an association with worse general psychological health were demographic factors of gender (women), older age and not being married; socio-economic factors, such as low education level, low income and assets, not working, residential status, living conditions and insecurity; and a number of violent and traumatic events including forced displacement – particularly internal displacement. Conclusions. The evidence base was weak and methodological limitations were noted. Further research is required to better understand the factors influencing general psychological health amongst conflict-affected populations in low- and middle-income countries.

Tracking official development assistance for reproductive health in conflict-affected countries.

To systematically review the literature on the effectiveness of Bacillus thuringiensis israelensis (Bti), when used as a single agent in the field, for the control of dengue vectors.

A systematic review of the influence of community level social factors on alcohol use

This paper systematically reviews evidence about factors associated with harmful alcohol use amongst forcibly displaced persons, including refugees and internally displaced persons. Bibliographic and humanitarian-related databases were searched. The number of quantitative and qualitative studies that were screened and reviewed was 1108. Only 10 studies met inclusion criteria. Risk factors identified included gender, age, exposure to traumatic events and resulting posttraumatic stress disorder, prior alcohol consumption-related problems, year of immigration, location of residence, social relations, and postmigration trauma and stress. The evidence base was extremely weak, and there is a need to improve the quantity and quality of research about harmful alcohol use by forcibly displaced persons.

Changes in Smoking Prevalence in 8 Countries of the Former Soviet Union Between 2001 and 2010

Preeti Patel and colleagues report inequity in the disbursement of official development assistance for reproductive health between countries affected by conflict and those unaffected.