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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 20 | Issue 2
Page Nos. 137-195

Online since Monday, October 31, 2022

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EDITORIAL  

Approaching 20 Years of Publishing Intervention Journal p. 137
Wendy Ager
DOI:10.4103/intv.intv_18_22  
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ARTICLES Top

Highlighting Complementary Benefits of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) Interventions Delivered Alongside Broader Community MHPSS Programming in Zummar, Ninewa Governorate of Iraq p. 139
Protus Musotsi, Phiona Koyiet, Neenib Bihnan Khoshaba, Aveen Hussein Ali, Fahad Elias, Muhammad Waduallah Abdulmaleek, Ken Simiyu, Eva Rosenkranz
DOI:10.4103/intv.intv_7_22  
Internally displaced persons (IDPs), refugees, returnees and host communities in conflict settings experience high rates of mental health problems associated with prolonged and repeated exposure to multiple exposure to distress, as is the case in Iraq. We sought to highlight the outcomes and complementarity of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) in addressing the mental health and psychosocial support needs of IDPs, returnees and host community teens and adults in Zummar, Iraq. A total of 290 adults were included in the PM+ intervention, while DWM included 648 adults and 282 teens. DWM was delivered to adults with accessibility barriers to receiving PM+ and to all teens in the study due to security reasons and COVID-19 restrictions. The Patient Health Questionnaire (PHQ-9) and World Health Organization Disability Assessment Schedule (WHODAS 2.0) were used to measure psychological distress and functioning in adults, respectively. The Revised Children Anxiety and Depression Scale (RCADS) was also used to measure symptoms of depression and anxiety in teens pre and postintervention. Personally identified problems were measured using the Psychological Outcome Profiles (PSYCHLOPS) for adults and teens. Psychological and emotional challenges were the main problem faced by both teens and adults at baseline. For PM+ and DWM interventions in adults, the mean difference in PSYCHLOPS, WHODAS and PHQ-9 scores between preintervention and postintervention assessment were significant (P < 0.001). For DWM teens, the paired mean difference for pre and postintervention RCADS and PSYCHLOPS teens was 55.9 (SD = 8.0) and 4.8 (SD = 2.40), respectively (P < 0.001, Cohen’s d > 2). There was a significant reduction in the number of days off work and increased ability to carry out usual activities after both interventions. The study findings highlight the applicability of PM+ and DWM in conflict settings of Iraq when there are barriers to applying one.
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Mental Health and Perceived Social Support of Humanitarian Workers in Bangladesh During the COVID-19 Pandemic p. 151
Tahmina Parvin, Simon Rosenbaum, Sanem Ozen, Lilian Ewagata, Peter Ventevogel
DOI:10.4103/intv.intv_18_21  
Humanitarian workers are at risk of experiencing emotional distress and mental health problems. The COVID-19 pandemic created additional stress and challenges for staff in ongoing emergencies who had to continue delivering humanitarian assistance. The primary objective of this study was to assess the mental health status of humanitarian staff working in the Rohingya refugee operation in Cox’s Bazar, Bangladesh, amid the COVID-19 pandemic. A sample of 307 national and international humanitarian staff working in person or remotely within the Rohingya refugee operation in Cox’s Bazar anonymously completed an online questionnaire. Outcome measures included 1) the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings which measures six symptoms related to mental health problems, 2) the Perceived Social Support Questionnaire and 3) questions about help-seeking. The self-reported mental health burden among humanitarian workers was high. The result demonstrates that most participants felt so afraid and severely upset about the emergency/COVID-19 pandemic that they avoided people or places. One in three respondents felt so angry that they were unable to carry out essential activities at least some of the time. Significant differences between national and international staff were found, with national staff more likely than international staff to feel afraid, angry, hopeless and unable to carry out essential activities (all P-values < 0.05). Nearly three out of 10 humanitarian workers reported a lack of social support. Less than one in five had sought professional help, while around half of all respondents indicated that they would want mental health support. The need for mental health support for humanitarian staff in Cox’s Bazar, Bangladesh, during the COVID-19 pandemic was high. It is important to strengthen strategies to proactively make services for mental health support available and accessible to humanitarians, building upon existing structures and allocating appropriate resources.
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Mechanisms of Change for Child Mental Health and Psychosocial Support in Conflict Settings: A Systematic Review p. 161
Tania Bosqui, Anas Mayya, Aws Al-Kadasi
DOI:10.4103/intv.intv_25_21  
There is a growing evidence-base for the effectiveness of mental health and psychosocial support (MHPSS) programmes for children affected by conflict for a range of mental health and wellbeing outcomes, but with limited evidence for how these interventions produce change. This study aimed to review the evidence for mechanisms of change of MHPSS interventions for children affected by conflict. Systematic review methodology was used to screen the PubMed, Published International Literature on Traumatic Stress (PILOTS) and PsycInfo databases for primary quantitative studies. Out of 3,903 records, seven studies were included, all evaluations of school-based preventative programmes. Results showed a mediation effect of peer relations on treatment change for wellbeing outcomes, while a predictable and cooperative learning environment partially mediated treatment change for academic outcomes, victimisation and mental health. One study found a small negative mediation effect of play-based social support for posttraumatic stress disorder. No evidence was found for any other mechanisms. The findings of this review highlight the role of social relationships as mechanisms of change in MHPSS programmes, but with limited studies to draw from. Future programme evaluations should include measures of proposed mechanisms to further our understanding of how MHPSS programmes work to continue to improve their relevance and scope and to do no harm.
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“Doing What Matters in Times of Stress” to Decrease Psychological Distress During COVID-19: A Randomised Controlled Pilot Trial p. 170
Ceren Acarturk, Gulsah Kurt, Zeynep Ilkkursun, Ersin Uygun, Akfer Karaoglan-Kahilogullari
DOI:10.4103/intv.intv_29_21  
Despite the increasing psychological distress during COVID-19, utilisation of face-to-face psychological interventions decreased profoundly. The aim of this study involving two parallel, two-armed pilot randomised controlled trials was to examine the effectiveness of a guided self-help intervention “Doing What Matters in Times of Stress” (DWM) in decreasing psychological distress in Turkish and Syrian participants. Seventy-four Turkish nationals and 50 Syrian refugee adults with psychological distress were randomly allocated to a DWM group or wait-list control group. The primary outcome measure was the Patient Health Questionnaire 9 postintervention. Secondary outcome measures were the Generalised Anxiety Disorder Scale, posttraumatic stress disorder (PTSD) Checklist for DSM-5, Generalized Self-Efficacy Scale and Acceptance and Action Questionnaire-II postintervention. Although this study was not powered to detect a significant effect for DWM postassessment between DWM and the control group, results showed a significant improvement in depression symptoms among Turkish participants in the DWM group (d = 0.46) and in PTSD symptoms among Syrian participants in the DWM group (d = 0.67) from pre- to postintervention assessment. These results indicate the potential of DWM to decrease mental health problems during the pandemic and importance of a fully powered, definitive controlled trial to examine its effectiveness both for the host community and refugees to reduce psychological distress during COVID-19.
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Cognitive Processing Therapy for the Treatment of PTSD, Depression and Anxiety in Syrian Refugees in Egypt p. 179
Amani Safwat ElBarazi, Rajiv Tikamdas, Salma Ahmed, Salma Ramadan
DOI:10.4103/intv.intv_33_21  
The purpose of this study is to examine the efficacy of cognitive processing therapy (CPT) in treating posttraumatic stress disorder (PTSD), depression and anxiety among Syrian refugees who have experienced war trauma. Clinicians interviewed 94 patients and asked them to complete the Clinician-Administered PTSD Scale three times: pretreatment, posttreatment and at the 12-month follow-up. In addition, PTSD, depression and anxiety were assessed using the PTSD Checklist, Beck Depression Inventory and Beck Anxiety Inventory at pretreatment, weekly, posttreatment and 12-month follow-up. At posttreatment evaluation, CPT led to decreases in PTSD, depression and anxiety (Ps < 0.000). These decreases continued after a year of follow-up (Ps < 0.000). Among Syrian refugees, the symptoms of PTSD, depression and anxiety all showed significant improvement after receiving CPT.
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COMMENTARY Top

The Accumulating Evidence-Base Regarding Child Friendly Spaces: Policy and Practice Implications p. 188
Alastair Ager, Janna Metzler
DOI:10.4103/intv.intv_12_22  
For over 25 years child friendly spaces (CFS) have been at the forefront of humanitarian response. Initially there was a weak evidence-base informing this approach, but the last 10 years have seen a substantial increase in research and evaluation in this area. This accumulating evidence has informed the evolution of guidance and training on implementing effective CFS interventions, but there remains uncertainty about the key messages emerging from studies. This commentary summarises the key findings of CFS-related research over the last decade and identifies key implications for policy and practice. There is no basis for discarding the approach, but nor is there for using it as a ubiquitous, prolonged response to diverse needs. The key imperatives are to mainstream quality and contextualisation in the implementation of CFS as a mechanism for emergency response; to structure CFS within a phased intervention strategy incorporating education and community-based approaches; and to further develop resources to support quality, contextualised and phased provision for children.
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LETTER TO EDITOR Top

Assessment of Mental Health and Psychosocial Support Limitations, Needs, and Recommendations in Iraq p. 193
Darya Rostam Ahmed
DOI:10.4103/intv.intv_13_22  
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ERRATUM Top

Erratum: Drama Therapy as a Mental Health Intervention for Women in the Shatila Refugee Camp, Lebanon p. 195

DOI:10.4103/1571-8883.359984  
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