Journal Article > ResearchFull Text
BMC Psychiatry. 2017 January 18; Volume 17 (Issue 1); 28.; DOI:10.1186/s12888-016-1154-5
Llosa AE, van Ommeren M, Kolappa K, Ghantous Z, Souza R, et al.
BMC Psychiatry. 2017 January 18; Volume 17 (Issue 1); 28.; DOI:10.1186/s12888-016-1154-5
BACKGROUND
Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting.
METHODS
Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010.
RESULTS
The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity.
CONCLUSIONS
Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.
Time and resource efficient mental disorder screening mechanisms are not available to identify the growing number of refugees and other forcibly displaced persons in priority need for mental health care. The aim of this study was to identify efficient screening instruments and mechanisms for the detection of moderate and severe mental disorders in a refugee setting.
METHODS
Lay interviewers applied a screening algorithm to detect individuals with severe distress or mental disorders in randomly selected households in a Palestinian refugee camp in Beirut, Lebanon. The method included household informant and individual level interviews using a Vignettes of Local Terms and Concepts for mental disorders (VOLTAC), individual and household informant portions of the field-test version of the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) and the WHO Self Reporting Questionnaire (SRQ-20). A subset of participants were then reappraised utilizing the Mini International Neuropsychiatric Interview (MINI), WHO Disability Assessment Schedule II, and the Global Assessment of Functioning. The study constitutes a secondary analysis of interview data from 283 randomly selected households (n = 748 adult residents) who participated in a mental health disorders prevalence study in 2010.
RESULTS
The 5-item household informant portion of WASSS was the most efficient instrument among those tested. It detected adults with severe mental disorders with 95% sensitivity and 71% specificity (Area Under Curve (AUC) = 0.85) and adults with moderate or severe mental disorder with 85.1% sensitivity and 74.8% specificity (AUC = 0.82). The complete screening algorithm demonstrated 100% sensitivity and 58% specificity.
CONCLUSIONS
Our results suggest that a two phase, screen-confirm approach is likely a useful strategy to detect incapacitating mental disorders in humanitarian contexts where mental health specialists are scarce, and that in the context of a multi-step screen confirm mechanism, the household informant portion of field-test version of the WASSS may be an efficient screening tool to identify adults in greatest need for mental health care in humanitarian settings.
Journal Article > CommentaryAbstract
Lancet. 2013 May 11; Volume 381 (Issue 9878); DOI:10.1016/S0140-6736(12)62191-6
Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, et al.
Lancet. 2013 May 11; Volume 381 (Issue 9878); DOI:10.1016/S0140-6736(12)62191-6
Journal Article > ResearchFull Text
Int Health. 2016 September 12; Volume 8 (Issue 5); 336-344.; DOI:10.1093/inthealth/ihw032
Weintraub AC, Garcia MG, Birri E, Severy N, Ferir MC, et al.
Int Health. 2016 September 12; Volume 8 (Issue 5); 336-344.; DOI:10.1093/inthealth/ihw032
BACKGROUND
Severe mental disorders are often neglected following a disaster. Based on Médecins Sans Frontières' (MSF) experience of providing mental health (MH) care after the 2013 typhoon in the Philippines, we describe the monthly volume of MH activities and beneficiaries; characteristics of people seeking MH care; profile and outcomes of people with severe mental disorders; prescription of psychotropic medication; and factors facilitating the identification and management of individuals with severe mental disorders.
METHODS
A retrospective review of programme data was carried out.
RESULTS
In total, 172 persons sought MH care. Numbers peaked three months into MSF's intervention and decreased thereafter. Of 134 (78%) people with complete data, 37 (28%) had a severe mental disorder, often characterised by psychotic symptoms (n=24, 64%) and usually unrelated to the typhoon (n=32, 86%). Four people (11%) were discharged after successful treatment, two (5%) moved out of the area, 20 (54%) were referred for follow-up on cessation of MSF activities and 10 (27%) were lost-to-follow-up. Psychotropic treatment was prescribed for 33 (75%) people with mental disorders and for 11 with non-severe mental disorders.
CONCLUSIONS
This study illustrates how actors can play an important role in providing MH care for people with severe mental disorders in the aftermath of a disaster.
Severe mental disorders are often neglected following a disaster. Based on Médecins Sans Frontières' (MSF) experience of providing mental health (MH) care after the 2013 typhoon in the Philippines, we describe the monthly volume of MH activities and beneficiaries; characteristics of people seeking MH care; profile and outcomes of people with severe mental disorders; prescription of psychotropic medication; and factors facilitating the identification and management of individuals with severe mental disorders.
METHODS
A retrospective review of programme data was carried out.
RESULTS
In total, 172 persons sought MH care. Numbers peaked three months into MSF's intervention and decreased thereafter. Of 134 (78%) people with complete data, 37 (28%) had a severe mental disorder, often characterised by psychotic symptoms (n=24, 64%) and usually unrelated to the typhoon (n=32, 86%). Four people (11%) were discharged after successful treatment, two (5%) moved out of the area, 20 (54%) were referred for follow-up on cessation of MSF activities and 10 (27%) were lost-to-follow-up. Psychotropic treatment was prescribed for 33 (75%) people with mental disorders and for 11 with non-severe mental disorders.
CONCLUSIONS
This study illustrates how actors can play an important role in providing MH care for people with severe mental disorders in the aftermath of a disaster.