Mental Disorders in War Affected Populations

Transcription

1 Mental Disorders in War Affected Populations Nino Makhashvili 1, Ivdity Chikovani 2, Natia Rukhadze 2 ; Martin McKee 3, Vikram Patel 3, Jonathan Bisson4, Bayard Roberts 3 1 Ilia State University, Tbilisi; Global Initiative on Psychiatry Tbilisi; 2 Curatio International Foundations, Tbilisi. 3 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine 4. Cardiff University, School of Medicine and Cardiff and Vale University Health Board, UK

2 BACKGROUND Civil conflicts over separatist areas of Abkhazia and South Ossetia in the 1990s. Conflict with Russia over South Ossetia (2008) IDPs reach almost 6% of Georgia s total population Limited quantitative data on mental ill health among conflict-affected groups.

3 Internally Displaced Persons (IDPs) and Returnees Old IDPs app. 250,000 persons displaced from Abkhazia and South Ossetia (mid 90 s) New IDPs around 36,000 persons (2008) Returnees - 99,500 former IDPs returned to their home villages, across the border

4 The specific objectives of the study To examine the patterns of mental disorders and functional disability among conflictaffected populations in Georgia. To measure the prevalence of PTSD, depression, anxiety and their co-morbidity;

5 Methods (1) A cross-sectional design and multi-stage random sampling Stratification by region and displacement status A total sample size of to meet the statistical requirements 1200 respondents from the 3 main population groups of interest ( Old & New IDPs, Returnees )

6 Methods (2) A range of questions on exposure to violent and traumatic events and demographic and socioeconomic characteristics All respondents provided informed consent Ethics approval - by the National Council on Bioethics of Georgia and the London School of Hygiene and Tropical Medicine

7 Instruments PTSD -Trauma Screening Questionnaire (TSQ); 10 items on PTSD symptoms over the past 1 week Depression - Patient Health Questionnaire (PHQ- 9); 9 questions on depression symptoms over the last 2 weeks Anxiety - Generalised Anxiety Disorder (GAD-7); 7 questions on anxiety symptoms over the last 2 weeks Functional disability - WHO Disability Assessment Schedule (WHODAS-2); 12 items on six activity domains (cognition, mobility, self-care, getting along, life activities, participation) - a recall period of the previous 30 days

8 Analysis Descriptive analysis on levels of mental disorders Multivariate logistic regression analysis Test for instruments reliability and validity, including test-retest mini survey TSQ, PHQ-9, GAD-7, and WHODAS-2 all showed good internal reliability, with alpha scores of 0.86, 0.86, 0.90, and 0.91 respectively

9 Some results (N=3,600) 35% 30% 30% 25% 24% 20% 15% 10% 5% 14% 11% 6% 0% At least one disorder PTSD Depression Anxity All three conditions

10 Proportion of total respondents with single conditions and with comorbidity

11 % with the mental health condition(s) Distribution of mental health conditions for respondents reporting any mental health condition (N=1086) PTSD only PTSD, depression and anxiety PTSD and depression only Depression only PTSD and anxiety only Anxiety only Depression and anxiety only

12 Significantly higher levels of MH disorders for IDPs than Returnees 40% 35% 34% 30% 27% 25% 20% 22% 18% 18% 15% 10% 13% 8% 8% 5% 0% At least one disorder PTSD Depression Anxity IDPs Returnee

13 Factors significantly associated with mental disorders and their co-morbidity greater frequency of exposure to traumatic events; female gender, older age, displacement status; low levels of neighbourhood support, poor community conditions, and a bad economic situation. All 3 disorders significantly influenced functional disability.

14 Functional Disability (FD) 14% increase in FD related to PTSD, 20% increase related to depression, 19% related to anxiety, 14% for any of the conditions. Women were significantly more likely to report higher disability scores than men

15 Discussion High prevalence of MH disorders in war affected populations High co-morbidity of PTSD, Depression and Anxiety Risk factors: Age; Gender; Exposure Strong association between post-conflict socio-economic hardships and increased prevalence of MH disorders High burden of MH disorders (depression and PTSD) on functional disability

16 Contribution Discussion The first nationally representative data on patterns of mental disorders among IDPs in Georgia. Highlights levels of comorbidity of common mental disorders. Highlights the role of community-level factors on mental disorders. Highlights positive influence of return to home areas. Policy implications Trauma-informed mental health policy Trauma-informed services

17 Thank you for your attention!