Introduction: This pilot study investigated asylum seekers’ needs and expectations in the mental health field to develop a culturally sensitive psychosocial intervention. Method: Participants were residents of a certain asylum-seekers centre in the Netherlands, with most of them from the Middle East crisis. Needs and expectations were identified using therapy expectations questionnaire (11 participants) and two focus groups (17 participants). Results: Participants associated mental health problems with post-migration stressors more often than with past traumatic experiences. Often, health problems were silenced due to shame, guilt, anxiety and the fear of negative stigma. Individuals and communities were limited in their ability to provide support for those suffering from psychosocial distress due to heavy stigma and the burden of multiple stressors. Conclusion: We underscore the importance of considering the local knowledge of mental health in developing emergency interventions and emphasise the need to reach beyond the trauma-focused approach to strengthen capacities within the community. Key implications for practice

• Developing a culturally sensitive mental health intervention for asylum seekers requires local knowledge of mental health issues
• Mental health interventions in emergencies should reach beyond the individualistic trauma-focused approach to address the whole context of forced displacement
• Because armed conflict often leads to a disruption of the social ecology of a community, mental health interventions should build on existing local support and services and strengthen capacities within the community.

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Hundreds of thousands of Rohingya refugees fled from Myanmar to Bangladesh. The greatly increased mental health needs are paired with limited resources for mental health care, particularly human resources. Therefore, UNHCR, the refugee agency of the United Nations, designed a programme to integrate mental health within refugee primary health care, using the Mental Health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) as the central tool. The aim was to scale up mental health services through capacity building of medical staff in refugee health facilities to enable them to identify and manage people with mental, neurological and substance use conditions. This paper is a process description of the programme, using direct experience of the authors, analysis of training evaluations and data from the refugee health information system and clinical supervision reports. Sixty-two primary health care workers were trained. Participants of the mhGAP training showed clear improvements in the post-training knowledge test. These trained staff started providing mental health and psychosocial services after the training in primary health care centres in the refugee camps. Fifteen of them participated in a bi-weekly supervision/on-the-job training visit. Within this period of time, almost 1,200 mental health consultations were realised in the primary health care facilities. Supervision reports of mhGAP-trained participants showed that in order to become effective mental health providers, the participants need to strengthen various skills including performing mental state examinations, providing psychoeducation and using psychosocial support techniques. In conclusion, the integration of mental health within the Rohingya refugee settings faced many challenges but proved to be feasible.
Key implications for practice

• Health system preparation and readiness is an important pre-requirement for integration of mental health into primary health care services. This is particularly significant in humanitarian settings in which the health system is fragile and struggling to keep services at a minimally acceptable level.
• Capacity-building efforts alone cannot guarantee the success of the integration process, that is, adequate attention should be paid to communication with health policy and decision makers especially on facility and local level to foster the process of integration and support scaling up.
• On-the-job supervision is a critical factor in mental health capacity building of non-specialist health providers. Without supportive clinical supervision, any plan for integration of mental health into primary care should be considered deficient and ineffective.

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Jordan has been a host country to many refugees from neighbouring countries for many years and has recently become a place of refuge for thousands of Syrians. The Syrian crisis has resulted in millions of Syrians fleeing their homes, uncertain of When they will return. Most of those seeking refuge have witnessed and/or experienced traumatic events that have affected their mental well-being in addition to starting over as refugees. Despite the large number of non-profit organizations providing free mental health services to refugees, not everyone has equal access to these services. This report, based on a literature review and a focus group discussion, highlights the different gender dimensions of mental health among Syrian refugees in Jordan. These risk factors include access to and use of mental health services, manifestation of mental health and psychosocial problems, treatment by mental-health workers and the socio-economic outcomes of living with someone suffering from mental health. Key implications for practice

• To highlight the gender disparities in mental health among Syrian refugees residing in Jordan
• To highlight the gender differences in mental health needs and services among Syrian refugees in Jordan
• To provide insight about the level of mental health services provided for Syrian refugees in Jordan.

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Over the last decades, mental health surveys in Afghanistan found very high prevalence figures for mental health problems among the Afghans. These epidemiological data suggest that the majority of the Afghan population suffer from a mental disorder such as depression or post-traumatic stress disorder. Such findings are often met with surprise by the Afghans who doubt that most of the people around them would suffer from a psychiatric illness. This paper explores the discrepancy between the findings from surveys using brief symptom-based questionnaires and the lived reality of the Afghan people. The authors argue that the outcomes of such mental health surveys should be interpreted with caution and can be better seen as indicators of ‘non-disordered’ psychosocial distress rather than as a general mental disorder. To better understand psychosocial wellbeing of the Afghan people, the survey data need to be put into context and have an eye for the cultural and social ecologies in which symptoms are produced. Many symptoms may actually be normal responses to living in difficult circumstances. Moreover, mental health surveys may conflate cultural idioms of distress with mental illness and often do not take into consideration that the Afghan social world is highly gender segregated. Future mental health research in Afghanistan should use contextually appropriate and culturally validated instruments and be complemented by in-depth ethnographic explorations of emotional suffering among Afghans. Key implications for practice

• MHPSS practitioners should critically examine the results of psychiatric epidemiological surveys in humanitarian emergencies.
• Mental health researchers need to go beyond estimating prevalence figures of discrete mental disorders and move towards using dimensional approaches to mental health.
• Qualitative research can provide important insights around cultural idioms of distress that may be gender-specific.

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Sex and gender are important considerations within refugee studies. Risks to health and wellbeing may manifest differently for refugee women and men, as may the use of health and social services and responses to interventions. Since the 1980s, increased attention has been paid to the experience of girls and women in refugee and humanitarian research, however, much less attention has been paid to boys and men. The purpose of this systematic scoping review was to investigate whether there is a gender bias in refugee and humanitarian research on refugee trauma. Findings demonstrate that since 1988, fully 95% of gender focused refugee research addressed women’s issues, while only 5% addressed the experience of refugee men. This article offers possible explanations for this gap and discusses its ramifications for both research and clinical practice.

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Gender-based violence (GBV) remains a significant risk and everyday reality for Rohingya women and girls displaced in Cox’s Bazar district, Bangladesh. Women and girls face challenges in securing their safety, accessing information and services and negotiating decision-making. Restrictions on movement, cultural and social norms, low literacy and numeracy and reduced community and legal protections increase women and girls’ exposure to GBV. The current camp situation in combination with their experiences in Myanmar contribute to increased vulnerability to GBV. The aim of this paper is to highlight the role of psychosocial support in coping with incidents of GBV among the Rohingya refugees by exploring two particular cases. DanChurchAid (DCA) have found that useful approaches in this context have included the use of basic techniques for relaxation to help promote calmness in moments of anxiety and panic, plus reinforcement of positive coping strategies such as prayers, spending time with trusted people and engaging in productive activities (e.g., life skills training). This engagement has enabled Rohingya survivors of GBV to build relationships with other women, feel more relaxed and confident and able to respond effectively to issues affecting their lives.

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Mental health and psychosocial support (MHPSS) for Rohingya refugees in Bangladesh has been acknowledged as an important component of the humanitarian response. Despite this recognition, MHPSS programmes are still facing many challenges. These challenges are related to the care delivery systems, to factors in the affected community or to the humanitarian emergency context. Examples of these challenges include language barriers, monsoon-related events, coordination of MHPSS services and community perceptions of mental health and mental health services. Drawing from local, regional and global experiences, we recommend practical solutions to overcome these challenges and improve the outcome of the MHPSS response to the Rohingya refugee crisis.

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Frequently, community based strategies include engagement with local faith leaders. However, there have been few systematic attempts to document how faith leaders themselves define their roles in these initiatives. This study examined local faith leaders and their spouses, in flood affected areas of Malawi, who had been oriented to child protection issues through World Vision workshops aimed explicitly at relating protection concerns to religious teachings. Many participants reported that attending a workshop had been transformational in terms of their perspectives regarding the protection of children. The key child protection issues identified by participants included child marriage, lack of attendance at school, child labour (including forced labour), harsh physical punishment and sexual abuse. Many faith leaders − and their wives − became active in addressing child protection issues as a result of the programme, although the form of this action varied widely and was significantly influenced by their varied status and capacities.

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A main gap in the delivery of mental health and psychosocial (MHPSS) services to Rohingya refugees in Cox’s Bazar district in Bangladesh is the limited coverage of psychotherapeutic interventions. There is a shortage of mental health professionals who can provide culturally adapted and linguistically appropriate psychotherapeutic interventions that are congruent with the refugee experience. This article describes preliminary work on training Bangladeshi psychologists and para-professionals in applying a novel group-based psychological intervention for refugees, Group Integrative Adapt Therapy (IAT-G). This is a pragmatic, eclectic and transdiagnostic approach, based on the Adaptation and Development After Persecution and Trauma (ADAPT) model. It aims to help refugees to develop resilience and capacities for managing maladaptive reactions to trauma and post-migration living difficulties. This paper describes the key strategies and challenges during the first phase of the project. Activities included an extensive desk review, a one-week training workshop with competency assessments, cultural adaptation of the treatment manual and assessment measures, training on digital literacy and electronic data collection and a blended supervisory model (involving onsite and online sessions). It proved to be generally feasible but not easy to introduce IAT-G in this population. Key implications for practice

• The introduction of a brief scalable psychological intervention within an acute and ongoing emergency was feasible, but faced considerable challenges including high staff turnover.
• Implementation involves multiple components including stakeholder engagement, contextual adaptation of tools and materials, training and supervision and setting up a monitoring system.
• Setting up a supervision is of critical importance but can be complicated in the context of an unfolding emergency.

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After a migration process, people begin to yearn for the settledness of their previous lives; this includes those in the education process. After the crisis in Syria, millions of refugees came to Turkey, in that, many of whom were students. The students started to enrol and although the schools’ curricula are in Arabic, students of these schools must pass a university entrance exam in the Turkish language to apply. There is also a quota limitation imposed on foreign students in universities. As these obstacles evoke extra-migratory stress among young refugees, the psychosocial support (PSS) needs become even more pronounced. The PSS workshop series outlined in this field report was conducted for Syrian students as they prepare for university admission. The series aimed to support participants to deal with this stressful process through six sessions using art and creativity methods and social theatre tools, including drama therapy games and forum theatre techniques. Through such techniques, the participants were encouraged to express their fears and future anxieties as well as find solutions for self-defined obstacles.

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Ebola virus disease (EVD) is an infectious disease with serious individual health and population consequences. While Ebola is extremely contagious, the 2014 outbreak in West Africa was the worst to date. Many strategies were implemented for the containment and treatment of the disease, although some were limited by a lack of focus on social and behavioural factors. These factors must be taken into consideration during intervention development at the levels of individuals, communities and international networks to address issues that could block intervention success. Projects in which social and behavioural understandings are embedded can have long-lasting results not only within affected communities, but also within institutions, with key players, and at a broader level. Ultimately, removing the barriers to outbreak response strengthens health and social systems and could help to prevent EVD infection and reduce transmission worldwide. Key implications for practice

• Behaviour-based strategies should include communication through specific groups and subsets of people.
• This type of communication embedded with social and behavioural understanding can have long-lasting results not only within the community, but also in institutions, key players, and other communities and levels of society.
• Ultimately, removing the barriers to outbreak response strengthens health and social systems.
• Being aware of cultural norms and traditions at various levels (individual, community and international) could ultimately help prevent EVD infection and reduce transmission.

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The Ebola virus disease (EVD) epidemic killed almost 12,000 people across Sierra Leone, Liberia and Guinea, causing significant psychological distress and suffering. This paper describes International Medical Corps’ innovative and comprehensive model for integrating mental health and psychosocial support (MHPSS) considerations and activities into Ebola treatment units (ETUs) across Sierra Leone and Liberia. This includes staff capacity building as well as psychosocial considerations and activities to address needs and challenges at the ETUs. This model was aimed at reducing patient and family distress and promoting healthy behaviours and recovery. We also include data describing mental health-related symptoms reported by our ETU patients, as well as psychosocial support interventions utilised. We discuss recommendations and lessons learnt and conclude that in line with global guidelines, MHPSS considerations and activities should be integral to all aspects of EVD care. Key implications for practice

• Patients admitted to ETUs face several stressors and challenges related to the ETU environment and procedures, separation from families and effects of EVD
• Mental health and psychosocial support considerations should be an integral part of all aspects of care provided at the ETU
• Paraprofessional psychosocial support workers can play a key role in meeting patient needs at the ETU in line with global mental health and psychosocial support guidelines.

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Over 907,000 Rohingya refugees are currently living in mostly makeshift camps in Bangladesh with limited resources to address their psychosocial needs. Physical activity is a scalable, low-cost intervention effective for prevention and treatment of non-communicable diseases and mental health problems. Understanding community attitudes to physical activity and mental health is key to designing community endorsed and accessible interventions. We employed the ‘community readiness model’, a tool to assess community climate, needs and resources regarding physical activity as a community-driven psychosocial intervention. Fifteen Rohingya key informants were interviewed across multiple refugee camps in Cox’s Bazaar district in January 2019. Community readiness scores were calculated. Thematic analysis explored community-identified priorities. Community members strongly endorsed physical activity as an effective biopsychosocial strategy for relieving tension (a local idiom of distress). Despite leadership endorsement, space and resources to support community initiatives are extremely limited. For women, restrictions of movement were identified as barriers to participation. Physical activity is a feasible and acceptable community-identified strategy to promote psychosocial wellbeing among Rohingya refugees. Resources for physical activity programmes are extremely limited despite the identified social, mental and physical health benefits.
Key implications for practice

• Physical activity was identified as a psychosocial strategy by Rohingya refugees living in Cox’s Bazar, Bangladesh, which can help to relieve tension, which is a local idiom of distress.
• Resources (such as space and equipment) to support community-led physical activity initiatives are limited, despite support from community leadership.
• Access to physical activity is limited for women, due to security fears and cultural attitudes, as well as for people with disabilities and older people, due to overcrowding and lack of accessibility planning.

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Mental health disorders are common in low and middle-income countries (LMICs), creating vulnerability to adverse outcomes. Despite this, there is a gap in understanding the perspectives of people with psychosocial disability (PPSD). A mental health project from Afghanistan collected lived experience narratives through semi-structured interviews with PPSD and family members. The interviews focused on individual experiences of barriers and enablers to social inclusion. Four main barrier themes were elicited: symptoms of mental disorders interfering with social inclusion, unhelpful family attitudes and behaviour, unhelpful community attitudes and behaviours and lack of access to quality mental health services. Three prominent enabler themes were also identified: family support and understanding, access to quality mental health services and supportive community attitudes and behaviours. Connection to supportive community and support from family was a critical finding. These results reinforce the importance of hearing from lived experience to help shape both service and community development programmes. Key implications for practice

• Engaging with the lived experience of psychosocial disability is beneficial, necessary and possible in LMICs
• Understanding key, context-specific barriers and enablers for PPSD will improve wellness, recovery and inclusion
• In the Afghan context, working with families and communities to promote supportive environments towards mental health will improve social inclusion and access to services.

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COVID-19, a watershed moment in global health, has brought health inequalities into sharp focus exposing structural disadvantage and institutional discrimination experienced by disenfranchised populations. Focusing on urban refugees and asylum seekers in Malaysia who are deemed of irregular status under the law, this field report outlines the legal and policy responses of the government and the impact of COVID-19 on refugees. It also highlights the organisational response of an organisation working with refugees in the greater Kuala Lumpur area. As pandemics become a reality of our times, it is imperative that pandemic preparedness and mitigation strategies adopt inclusive and universal approaches that include migrant populations such as refugees and asylum seekers.

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As a consequence of prolonged exposure to the high levels of cumulative trauma such as war, gross human rights violations and traumatic loss, refugee adolescents are at significant risk of developing psychological and behavioural complications. During resettlement in Australia, they are often faced with social challenges. It is vital to provide support at this vulnerable stage to reduce future setbacks. In response to the high rates of truancy, challenging behaviour in school and negative relationship with teachers and peers, Capoeira Angola programme was implemented to help them better settle in school life, build resilience, using individual strengths and kinesthetic movement for personal growth and recovery. The main aim of this qualitative evaluation was to establish efficacy and ascertain the impact attributable to the programme on psychological and social issues. Positive changes were observed by participant and teacher’s accounts, demonstrating improvements in resilience, self-esteem, interpersonal relationships and school attendance. The significance and benefits of the programme was established and was endorsed its continuation.

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By learning to identify feelings and express emotions, children can better cope with the difficulties they face, as well as increase their personal resilience. As the Syrian crisis has entered its seventh year, it has had a negative effect on vulnerable populations, especially children. It should be noted that while not all children have been traumatised, many have experienced conflict and crisis, and in turn face challenges expressing and regulating their emotions and behaviour. The aim of the small study, described in this field report, is to explore the power of using drama and art as tools for Syrian children to help them learn to identify their emotions. The qualitative study was conducted at an informal education centre in southeast Turkey, with 10 children, over the course of five workshops. Basic drama and creative art skills were used to raise awareness about emotions as the first phase of emotion regulation.

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Introduction: This article outlines the results of a participatory action research project to (a) understand stigma experienced by family members of people with intellectual disabilities (IDs) in Kinshasa, Democratic Republic of the Congo and (b) identify strategies used by these family members to mitigate or cope with stigma. Methods: We conducted 20 semi-structured interviews with family members of people with ID. Results: All participants in this study discussed experiencing stigma. This stigma was most commonly felt when people directed negative looks, used negative language and names, or refused to touch their family member with ID. Stigma was also directed at the family members as being the ’cause’ of the ID. Family members noted engaging a range of coping mechanisms or strategies to minimise the stigma. Conclusion: Insight from this study could be used to develop interventions benefiting families affected by ID. A sample of suggested interventions include creating opportunities for targeted, local contact with stigmatised persons; reducing or eliminating use of negative and stigmatising names (e.g. kizengi) for people with ID; and promoting self-help and self-advocacy groups for people with ID and their families. Key implications for practice

• Families of people with intellectual disabilities in Kinshasa, Democratic Republic of the Congo experience personal and family-level stigma
• Family members use a range of coping strategies, such as referencing religion; educating others; and participating in self-help associations
• Future interventions might create opportunities for targeted, local contact with stigmatized persons; reduce or eliminate negative and stigmatizing names for people with ID; and promote self-help for people with ID and their families.

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The aim of this study is to assess the levels of anxiety, depression and post-traumatic stress disorder (PTSD) in national aid workers in Central African Republic as well as to evaluate the effectiveness of a stress management group in reducing those symptoms. Twenty-seven stress management groups were evaluated in two international non-governmental organisations in which 197 national humanitarian aid workers took part. There was a significant decrease in the intensity of every psychopathological variable tested despite a decrease in the sample between the pre- and post-tests. At post-test, 8.1, 5.1 and 11.1% of the participants had scores indicating anxiety, depression and PTSD compared to 25, 18.9 and 26% at pre-test. The group intervention has demonstrated to be a realistic, effective and cost-effective way to respond to mental health problems in national aid workers living in a context of ongoing violence and where access to specialised services is extremely limited. Key implications for practice

• Documenting the mental health of national humanitarian staff working in unsecure environment in Central African Republic
• A one session stress management group protocol can reduce the levels of anxiety, depression and PTSD in this population and hence demonstrating that it is feasible and cost-effective for organizations to honour their duty of care towards national humanitarian workers
• Further research is needed to confirm these preliminary results, especially in other cultural and humanitarian contexts.

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Yezidism arguably remains one of the most oppressed religions in Iraq, with the population historically confronted by many attempts at genocide. These atrocities have left many survivors displaced and affected by trauma, yet little research has been conducted on experiences of trauma among this population. In the context of an internal evaluation of the Free Yezidi Foundation’s mental health intervention in the Kurdistan Region of Iraq, 200 Yezidi women were screened at the beginning and end of a six-month mental health intervention using the World Health Organization (WHO)-5 well-being scale and the Harvard Trauma Questionnaire (HTQ). Qualitative data were obtained from sixteen focus group discussions (FGDs) among service users of the project as well as six in-depth qualitative interviews conducted with members of the project team. The results of the WHO-5 indicate a 74% increase in self-reported well-being among service users who completed the programme. According to the results of the HTQ, the baseline prevalence rate of posttraumatic stress disorder was 81.25%, which decreased to 45% upon completion of the programme. A qualitative analysis of interviews and FGDs highlighted that a significant impact on mental health were collective, multiple losses and separations (including family members who sought refuge abroad), the fact that not all Yezidi held in captivity have returned, fear of ongoing attacks and daily stressors related to poor living conditions. The results highlight the substantial impact of the political, legal and sociocultural environment on both the prevalence of trauma as well as processes of psychosocial rehabilitation. The implications for interventions include utilising socioecological frameworks for research and practice, engaging in advocacy and establishing agendas for mental health practice and psychosocial support that emphasises individual and collective self-determination.
Key implications for practice

• Utilising eco-social frameworks for research and practice
• Engaging in political advocacy as part of MHPSS interventions
• Establishing agendas for mental health practice that emphasise individual and collective self-determination
• Addressing the social, cultural and political perspectives of trauma as part of MHPSS interventions
• Implementing interdisciplinary approaches to rehabilitation from trauma.

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The internal conflict in Syria has displaced large numbers of the population into neighbouring countries since the uprising in 2011. The large influx of displaced people into Jordan poses great challenges to the international community as well as local authorities, with increasing competition for already scarce resources and services creating rising tensions between refugee and host communities. In this context, the non-governmental organisation, Action Contre la Faim, implemented a programme aimed at improving psychosocial well-being, fostering resilience and promoting positive interactions between the members of both communities. Through the participation of support groups within community-based organisations, dialogue was facilitated, and interactions took place in a safe and therapeutic environment. Participants reported improved perception of well-being and self confidence, as well as improved mutual understanding and communication, reduced isolation and the extension of social support, enhanced empathy and reduce prejudice.

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While there is growing evidence for the effectiveness of mental health interventions in low- and middle-income countries and humanitarian contexts, this is lacking for psychosocial programming. We aimed to summarise the evidence for psychosocial programming in these contexts through a systematic review (PROSPERO: CRD42017069066) of peer-reviewed and grey literature of programme evaluations. A total of n = 42,435 unique records were initially identified, with n = 211 records meeting full inclusion criteria. We identified 51 randomised controlled trials of 47 different interventions. The remaining studies used different evaluation methodology. Only three interventions had more than one experimental/quasi-experimental evaluation: Brief Intervention and Contact, Problem Management Plus and Child Friendly Spaces. While there are many studies of interventions, it was challenging to identify the same intervention across studies, leaving almost no interventions with more than one rigorous study supporting their use and many interventions that are poorly described. This makes it difficult to choose between them or even to implement them. Future research should focus on replication of well-described interventions in multiple different sites, to place future intervention selection on a more scientific basis. There is also a need to better understand the impact of psychosocial programmes in sectors other than health and protection, such as nutrition. These sectors may provide critical delivery mechanisms for psychosocial programming to broaden the reach of such interventions. Key implications for practice

• Efforts to build the evidence base for psychosocial programming in humanitarian settings are challenged by the breadth of programming delivered, populations served and outcomes targeted in this field, resulting in predominantly one-off studies of a wide range of interventions.
• To inform future intervention selection, research initiatives should focus on replication of well-described interventions in multiple contexts or stages of humanitarian response.
• Rigorous evaluation of community-focused psychosocial programmes is also needed.

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In humanitarian crises, such as the Rohingya situation in Bangladesh, maternal and child health may be strongly affected. Maternal mental health is a well-recognised key factor for child survival, development and health. Promoting maternal mental health during the perinatal period, especially in emergencies, contributes to the prevention of child mortality, morbidity and psychological distress. Despite this, few humanitarian psychosocial interventions have been evaluated to measure their effect on maternal mental health and child care. In 2012, Action Against Hunger in collaboration with the International Centre for Diarrhoeal Disease Research, Bangladesh, evaluated the effect of a psychosocial support groups intervention on 260 pregnant Rohingya women, living in the registered camps of Cox’s Bazar. A set of questionnaires (including MMSE, CES-D scale and Rosenberg’s Self-Esteem scale) was administered to participants to measure the improvement on mental health and childcare knowledge after a three-month psychosocial intervention. Maternal wellbeing and childcare knowledge improved significantly over the three months of intervention. Findings suggest psychosocial intervention can be effective despite the chronic stressful conditions of the refugees in the camps. This study reinforces the importance of community-based interventions promoting mental health in contexts of chronic crisis and contributes to the research discussion on the impact of maternal mental health and childcare promotion programming.
Key implications for practice

• Supporting maternal mental health during the perinatal period has a positive impact on women's wellbeing and is also a key factor for good childcare, children's wellbeing and early childhood development. In an emergency situation such as the Rohingya crisis in Bangladesh, promoting maternal mental health is an effective way of preventing difficulties during the perinatal period that may aggravate family, maternal and children's wellbeing.
• Psychosocial support groups appear to provide an effective methodology to work with refugees on mental health and childcare promotion, since refugees are often isolated, with disrupted social support and with limited access to external resources.
• Reinforcing women's internal and external resources through group support helps to improve their self-esteem, which is a key factor for general wellbeing.

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Socio-ecological interventions assume that there are ‘links’ between the individual process that determines disaster mental health and the social context one lives in. However, there is insufficient empirical basis for this claim. This paper summarises the main findings from a research programme, in which two advanced statistical techniques on data from two floods were applied, respectively Uttar Pradesh, India 2008 and Morpeth, England, 2008. By means of multilevel structural equation modelling it was found that individual psychosocial resources (coping behaviour and social support) are employed more parsimoniously and effectively when disaster affected individuals can rely on a trustworthy and effective social community. Additionally, using multilevel confirmatory factor analyses to address screening outcomes yielded two methodological problems: nested variance due to the disaster context and poor construct validity. These can be illustrated, but not dismissed without applying advanced statistical analyses. The findings strongly suggest that community interventions promoting social context and individual interventions not only share the same objective, but also impact mental health via the same individual mechanisms.

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This article explores the ongoing impact of the genocide in Rwanda on marital relationships. Its specific focus are genocide related factors that generate relational trauma and the consequences of this trauma for the everyday lives of spouses affected by it. The qualitative study that informs this article was conducted within the context of a community based sociotherapy programme. The factors found to be contributing to traumatic marital conflict are categorised as those related to genocide perpetration and its consequences, refugeehood, victimisation by genocidal violence and its consequences, intermarriages, and being a descendant of a genocide survivor or a genocide perpetrator. Study participants give a relative high prevalence to factors regarding genocide perpetration, while they assume that the prevalence of traumatic marital conflict among the second generation may continue unless sufficient preventive measures are taken.

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