Journal Article > ResearchFull Text
BJPsych Open. 2023 May 17; Volume 9 (Issue 3); e83.; DOI:10.1192/bjo.2023.58
de Jong K, Martinmäki SE, te Brake H, Komproe IH, Kleber RJ, et al.
BJPsych Open. 2023 May 17; Volume 9 (Issue 3); e83.; DOI:10.1192/bjo.2023.58
BACKGROUND
Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues.
AIMS
To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy.
METHOD
Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data.
RESULTS
Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The ‘healthy/normative’ trajectory had the largest sample size for all health indicators (73–86%). A stable (moderate) ‘ill health’ trajectory was identified for all health indicators (7–17%), except anxiety. An ‘improving’ trajectory was found for PTSD and anxiety symptoms (5–14%). A minority of staff (4–15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the ‘healthy’ trajectory. Female biological sex was associated with higher odds of belonging to the ‘worsening’ depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the ‘worsening’ depressive symptoms trajectory.
CONCLUSION
Most iHAWs stayed healthy during their assignment; a stable ‘ill health’ trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the ‘healthy’ profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs’ ability to remain healthy under stress.
Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues.
AIMS
To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy.
METHOD
Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data.
RESULTS
Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The ‘healthy/normative’ trajectory had the largest sample size for all health indicators (73–86%). A stable (moderate) ‘ill health’ trajectory was identified for all health indicators (7–17%), except anxiety. An ‘improving’ trajectory was found for PTSD and anxiety symptoms (5–14%). A minority of staff (4–15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the ‘healthy’ trajectory. Female biological sex was associated with higher odds of belonging to the ‘worsening’ depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the ‘worsening’ depressive symptoms trajectory.
CONCLUSION
Most iHAWs stayed healthy during their assignment; a stable ‘ill health’ trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the ‘healthy’ profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs’ ability to remain healthy under stress.
Journal Article > ResearchFull Text
J Interpers Violence. 2023 February 7; Volume 38 (Issue 11-12); 7426-7456.; DOI:10.1177/08862605221145954
Martinmäki SE, de Jong K, Komproe IH, Boelen PA, Kleber RJ
J Interpers Violence. 2023 February 7; Volume 38 (Issue 11-12); 7426-7456.; DOI:10.1177/08862605221145954
To date, there have been no cohort studies of sexual harassment incidence and its relation to mental health within humanitarian field-workers. Research among numerous occupations suggests an association between workplace sexual harassment and several health complaints. This study examined the incidence and severity of sexual harassment and its association with changes in mental health in a cohort of international humanitarian aid field-workers (iHAWs). Four hundred and seventy-eight iHAWs filled in questionnaires about sexual harassment, depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) as part of a larger study on health and well-being. Six percent of male and 18% of female iHAWs reported experiencing sexual harassment during their latest field assignment, with most reporting low levels of nonphysical forms of sexual harassment. Sexual harassment was predictive of negative changes in both depression and anxiety symptom severity between before and after an assignment for females; for males, it predicted negative changes in PTSD symptom severity. Sexual harassment did not predict utilization of mental healthcare services within 2 months after the end of assignment. The current findings are the first figures derived from a representative sample of iHAWs on the incidence of sexual harassment during a field assignment and show sexual harassment to be a relatively common and present issue. The findings are mostly in line with the extant literature and underscore the importance of attending to the issue of sexual harassment in the humanitarian sector.
Journal Article > ResearchFull Text
PLOS One. 2022 November 16; Volume 17 (Issue 11); e0276727.; DOI:10.1371/journal.pone.0276727
de Jong K, Martinmäki SE, Brake HT, Kleber RJ, Haagen JFG, et al.
PLOS One. 2022 November 16; Volume 17 (Issue 11); e0276727.; DOI:10.1371/journal.pone.0276727
BACKGROUND
International humanitarian aid workers (iHAWs) are motivated strongly to travel abroad to help communities affected by war, famine, disaster and disease. They expose themselves to dangers and hardships during their field assignments. Despite working under such challenging circumstances, most workers remain healthy. The objective of the present study was to unravel the mechanism that enables workers to remain healthy under the same circumstances that affect these communities. We hypothesised that the different components of the Sense of Coherence (SOC) health mechanism mediate the relationship between field stressors and post-assignment health.
METHODS AND FINDINGS
The stress-health model was tested among 465 international aid workers using a longitudinal pre-post assignment study design and structural equation modelling for path analyses. The (health) outcome variables were PTSD, anxiety, depression, emotional exhaustion, and work engagement. Our findings highlight the importance of being healthy before aid assignment and the negative health impact of field stressors that were not potentially traumatic. The SOC components mediated the relationship between field stress and post-assignment health, with males and females using different SOC components to alleviate stress. Males are more likely trying to understand the nature of the stressor, whereas females mobilise their resources to manage stressors. In both groups, a high level of meaningfulness of the work was an important component in maintaining health. Regarding using the SOC concept for understanding the process of maintaining health, our findings indicated that SOC is best considered context-specific and multidimensional.
CONCLUSION
In addition to good pre-mission health, the SOC components help prevent field assignment-related negative health effects in iHAWs. Our findings support the idea to compose gender-balanced teams of iHAWs to maintain and promote health. The findings can be used to develop or refine health conversation tools and SOC based health interventions to promote health and wellbeing and prevent ill-health among aid workers and other stress-exposed populations.
International humanitarian aid workers (iHAWs) are motivated strongly to travel abroad to help communities affected by war, famine, disaster and disease. They expose themselves to dangers and hardships during their field assignments. Despite working under such challenging circumstances, most workers remain healthy. The objective of the present study was to unravel the mechanism that enables workers to remain healthy under the same circumstances that affect these communities. We hypothesised that the different components of the Sense of Coherence (SOC) health mechanism mediate the relationship between field stressors and post-assignment health.
METHODS AND FINDINGS
The stress-health model was tested among 465 international aid workers using a longitudinal pre-post assignment study design and structural equation modelling for path analyses. The (health) outcome variables were PTSD, anxiety, depression, emotional exhaustion, and work engagement. Our findings highlight the importance of being healthy before aid assignment and the negative health impact of field stressors that were not potentially traumatic. The SOC components mediated the relationship between field stress and post-assignment health, with males and females using different SOC components to alleviate stress. Males are more likely trying to understand the nature of the stressor, whereas females mobilise their resources to manage stressors. In both groups, a high level of meaningfulness of the work was an important component in maintaining health. Regarding using the SOC concept for understanding the process of maintaining health, our findings indicated that SOC is best considered context-specific and multidimensional.
CONCLUSION
In addition to good pre-mission health, the SOC components help prevent field assignment-related negative health effects in iHAWs. Our findings support the idea to compose gender-balanced teams of iHAWs to maintain and promote health. The findings can be used to develop or refine health conversation tools and SOC based health interventions to promote health and wellbeing and prevent ill-health among aid workers and other stress-exposed populations.
Journal Article > ResearchFull Text
J Clin Psychol. 2003 January 1; Volume 59 (Issue 1); DOI:10.1002/jclp.10118
Mooren TTM, de Jong K, Kleber RJ, Ruvic J
J Clin Psychol. 2003 January 1; Volume 59 (Issue 1); DOI:10.1002/jclp.10118
The efficacy of a community-based psychosocial program in Bosnia-Herzegovina during the war and immediate postwar years (1994-1999) was described in this article. Ten centers provided various kinds of psychological help in the besieged city of Sarajevo and the towns of Zenica, Travnik, and Vitez. Since 1994, an intensive monitoring system has documented data on clients, interventions, and outcomes. This study focused on the systematic evaluation of counseling interventions aimed to alleviate the distress in wartime. The sample consisted of 3,283 and 1,785 inhabitants of Sarajevo, Zenica, Travnik, and Vitez who filled out the GHQ-28 and IES respectively. Pre- and post-assessments were compared throughout consecutive years (1994-1999) and across age groups and both sexes. Outcomes of these scales reflected very high scores, especially among people between 30 and 40 years of age. Furthermore, intake scores increased in time rather than decreased. Differences between pre- and postmeasurements are highly significant--throughout the years. Analyses revealed substantial proportions of clinically recovered or generally improved individual functioning, although some clients revealed no improvement.
Journal Blog > Perspective
BMJ Opinion (blog). 2012 March 5
de Jong K
BMJ Opinion (blog). 2012 March 5
Journal Article > ResearchFull Text
PLOS One. 2016 June 17; Volume 11 (Issue 6); DOI:10.1371/journal.pone.0157474
de Jong K, Ariti C, van der Kam S, Mooren TTM, Shanks L, et al.
PLOS One. 2016 June 17; Volume 11 (Issue 6); DOI:10.1371/journal.pone.0157474
Existing tools for evaluating psychosocial interventions (un-validated self-reporting questionnaires) are not ideal for use in non-Western conflict settings. We implement a generic method of treatment evaluation, using client and counsellor feedback, in 18 projects in non-Western humanitarian settings. We discuss our findings from the perspective of validity and suggestions for future research. A retrospective analysis is executed using data gathered from psychosocial projects. Clients (n = 7,058) complete two (complaints and functioning) rating scales each session and counsellors rate the client's status at exit. The client-completed pre- and post-intervention rating scales show substantial changes. Counsellor evaluation of the clients' status shows a similar trend in improvement. All three multivariable models for each separate scale have similar associations between the scales and the investigated variables despite different cultural settings. The validity is good. Limitations are: ratings give only a general impression and clinical risk factors are not measured. Potential ceiling effects may influence change of scales. The intra and inter-rater reliability of the counsellors' rating is not assessed. The focus on client and counsellor perspectives to evaluate treatment outcome seems a strong alternative for evaluation instruments frequently used in psychosocial programming. The session client rated scales helps client and counsellor to set mutual treatment objectives and reduce drop-out risk. Further research should test the scales against a cross-cultural valid gold standard to obtain insight into their clinical relevance.
Journal Article > ResearchFull Text
J Health Psychol. 2007 May 1; Volume 12 (Issue 3); DOI:10.1177/1359105307076235
de Jong K, Kleber RJ
J Health Psychol. 2007 May 1; Volume 12 (Issue 3); DOI:10.1177/1359105307076235
Médecins Sans Frontières has been involved in emergency mental health or psychosocial programmes since 1990. In this article the intervention model developed for emergency settings is shared. Psychosocial programmes distinguish two elements. The 'psycho'-component facilitates the reconnection of the affected individual to his environment. The 'socio'-element aims to create an environment that facilitates the individual to re-integrate. The nature of mental health and psychosocial programmes requires a multidisciplinary approach. Emotional support can also be provided by regular medical staff and does not always require a specialist. The years ahead of us are important for the development of psychosocial interventions. Fundamental issues such as programme evaluation need systematic research.
Journal Article > CommentaryFull Text
Lancet. 2004 September 11; Volume 364 (Issue 9438); 1008.; DOI:10.1016/S0140-6736(04)17029-3
de Jong K, van der Kam S, Ford NP, Hargreaves S, van Oosten R, et al.
Lancet. 2004 September 11; Volume 364 (Issue 9438); 1008.; DOI:10.1016/S0140-6736(04)17029-3
Journal Article > ResearchFull Text
Confl Health. 2013 September 16; Volume 7 (Issue 1); DOI:10.1186/1752-1505-7-19
de Jong K, Shanks L, Ariti C, Denault M, Siddiqui R, et al.
Confl Health. 2013 September 16; Volume 7 (Issue 1); DOI:10.1186/1752-1505-7-19
Medecins Sans Frontieres (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes.
Journal Article > ReviewFull Text
Health (Irvine Calif). 2014 March 12; Volume 06 (Issue 06); 504-516.; DOI:10.4236/health.2014.66070
de Jong K, Knipscheer JW, Ford NP, Kleber RJ
Health (Irvine Calif). 2014 March 12; Volume 06 (Issue 06); 504-516.; DOI:10.4236/health.2014.66070
Compared to psychosocial programs implemented in post-conflict settings those executed in areas of ongoing conflicts may have different effects. Their evidence of efficacy has never been systematically reviewed. We searched PubMed, PsychInfo and the Dutch Tropical Institute Literature Portal from inception to31 January 2013 to identify studies on community-oriented psychosocial and psychiatric/clinical services for adults during ongoing man-made conflict or its direct aftermath.Of 6358 articles screened, 16 met our inclusion criteria. The interventions varied from psycho-educational to psychotropic drugs. The review is presented using outcome indicators such as PTSD, anxiety, depression, physical health, functioning and well being. A substantial improvement of some outcome was found though the small number of studies and their heterogeneity did not justify strong conclusions. PTSD symptoms improved significantly by treatments that included exposure (such as narrative exposure therapy). A number of studies (eight) showed notable improvement of the client’s functioning through counseling interventions. Depression and anxiety both improved considerably using that culturally adapted interventions (two studies), whereas non-culturalized interventions did not. We found a notable lack of studies on the efficacy of medication and on preferred western, evidence-based interventions for PTSD such Eye Movement Desensitization.To measure outcomes only two studies applied locally-developed diagnostic labels and validated instruments. Future research should encourage the use of robust research methods that are culturally valid, including mixed-methods research to combine measurable outputs with qualitative research aimed at improved understanding from the client’s perspective.