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Little is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies.
To investigate the prevalence and correlates of explosive anger among this population in Timor-Leste.
We assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3–6 months postpartum) residing in two districts of Timor-Leste (response >99%).
Two-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence.
A combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste.
A key issue in need of empirical exploration in the post-conflict and refugee mental health field is whether exposure to torture plays a role in generating risk of intimate partner violence (IPV), and whether this pathway is mediated by the mental health effects of torture-related trauma. In examining this question, it is important to assess the impact of socio-economic hardship which may be greater amongst survivors of torture in low-income countries.
The study data were obtained from a cohort of 870 women (recruited from antenatal clinics) and their male partners in Dili district, Timor-Leste. We conducted bivariate and path analysis to test for associations of men's age, socioeconomic status, torture exposure, and mental disturbance, with IPV (the latter reported by women).
The path analysis indicated positive paths from a younger age, torture exposure, and lower socio-economic status amongst men leading to mental disturbance. Mental disturbance, in turn, led to IPV. In addition, younger age, lower socio-economic status, torture exposure, and mental disturbance were directly associated with IPV.
Our data provide the first systematic evidence of an association between torture and IPV in a low-income, post-conflict country, confirming that low socio-economic status, partly related to being a torture survivor, adds to the risk. The high prevalence of IPV in this context suggests that other structural factors, such as persisting patriarchal attitudes, contribute to the risk of IPV. Early detection and prevention programs may assist in reducing the risk of IPV in families in which men have experienced torture.
Pharmacological treatment is widely used for post-traumatic stress
disorder (PTSD) despite questions over its efficacy.
To determine the efficacy of all types of pharmacotherapy, as
monotherapy, in reducing symptoms of PTSD, and to assess
A systematic review and meta-analysis of randomised controlled trials was
undertaken; 51 studies were included.
Selective serotonin reuptake inhibitors were found to be statistically
superior to placebo in reduction of PTSD symptoms but the effect size was
small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For
individual pharmacological agents compared with placebo in two or more
trials, we found small statistically significant evidence of efficacy for
fluoxetine, paroxetine and venlafaxine.
Some drugs have a small positive impact on PTSD symptoms and are
acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as
potential treatments for the disorder. For most drugs there is inadequate
evidence regarding efficacy for PTSD, pointing to the need for more
research in this area.
Post-conflict mental health studies in low-income countries have lacked
pre-conflict data to evaluate changes in psychiatric morbidity resulting
from political violence.
This prospective study compares mental health before and after exposure
to direct political violence during the People's War in Nepal.
An adult cohort completed the Beck Depression Inventory and Beck Anxiety
Inventory in 2000 prior to conflict violence in their community and in
2007 after the war.
Of the original 316 participants, 298 (94%) participated in the
post-conflict assessment. Depression increased from 30.9 to 40.6%.
Anxiety increased from 26.2 to 47.7%. Post-conflict post-traumatic stress
disorder (PTSD) was 14.1%. Controlling for ageing, the depression
increase was not significant. The anxiety increase showed a dose–response
association with conflict exposure when controlling for ageing and daily
stressors. No demographic group displayed unique vulnerability or
resilience to the effects of conflict exposure.
Conflict exposure should be considered in the context of other types of
psychiatric risk factors. Conflict exposure predicted increases in
anxiety whereas socioeconomic factors and non-conflict stressful life
events were the major predictors of depression. Research and
interventions in postconflict settings therefore should consider
differential trajectories for depression v. anxiety and
the importance of addressing chronic social problems ranging from poverty
to gender and ethnic/caste discrimination.
A principal strategy for the integration of mental health and psychosocial support in emergency settings is the training of front-line workers in international consensus-based guidelines.
This paper presents a pilot study evaluating changes in knowledge and understanding as a result of a brief training course in Nepal.
Evaluation questionnaires were distributed to participants in two-day courses (n = 109) before, directly after, and at two months following completion.
The course resulted in a post-training increase in correct answers of 21%, which further increased to 25% at two months.
A short training course based on widely endorsed guidelines to front-line staff can significantly increase mental health literacy for complex emergencies. While promising, the trend of knowledge gain is modest at most, and suggests a need for more intensive or more targeted training courses.
Jordans MJD, Luitel NP, Poudyal B, Tol WA, Komproe IH. Evaluation of a brief training on mental health and psychosocial support in emergencies: a pre- and post-assessment in Nepal. Prehosp Disaster Med. 2012;27(3):1-4.
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