Attitudes towards people with mental health illness in the Kurdistan region of Iraq: a quantitative study.

People with mental health illnesses are exposed to rejection by community members because of the negative attitudes from people towards them. This study assesses undergraduates' attitudes towards people with mental health illness in the Kurdistan region of Iraq and compares their attitudes with socio-demographic characteristics such as age, gender and academic field of study. A quantitative descriptive study design has been used for this research. A multistage cluster sampling was used for data collection between May to June 2019 from a sample of 361 undergraduate students. A modified version of the British Market Research Bureau (BMRB) questionnaire was used for data collection. Undergraduate students from various fields of study have had different attitudes towards people with mental illnesses. Medical students have better understanding and more positive attitudes than students of the other fields. Male students showed more negative attitudes compared to female students. Furthermore, younger students had more negative attitudes than older students.

Mental health status of internally displaced persons in the Garmian region of Kurdistan, Iraq: a cross-sectional survey.

There are an estimated 4 million internally displaced persons (IDPs) in Iraq, mainly settled in the Kurdistan Region of Iraq, and yet few studies have documented the mental health of IDPs in the region. The aims of this study were (1) to assess the prevalence of mental health disorders and trauma experiences amongst IDPs and (2) to explore associations between prior displacement and years living in the camp and mental health disorders. A cross-sectional survey was conducted with adults (N = 100) from March - July 2018. Structured surveys were used to collect sociodemographic information, and adapted measures included the Harvard Trauma Questionnaire (HTQ), Post-traumatic Stress Disorder Inventory (PTSD-8), Hopkins Symptoms Checklist-25 (HSCL-25) and the Post-Migration Living Difficulties Checklist (PMLD). The average number of traumatic events experienced was 4.43 (SD = 2.63). The most commonly reported traumatic events included oppression due to ethnicity, religion or sect (92%) and exposure to combat situations (83%). Nearly half of the participants had experienced ill health without access to medical care, 44% lack of shelter and 43% lack of food or clean water. Thirty-two percent of respondents witnessed someone being murdered. There is a critical need for quality mental health services for IDPs in KR.

Assessment of Perinatal Depression Risk among internally displaced Yazidi Women in Iraq: a descriptive cross-sectional study.

BACKGROUND: Yazidi survivors of a 2014 genocidal attack by the self-proclaimed Islamic State of Iraq and Syria (ISIS) have complex medical and mental health needs in the perinatal and postpartum period. Few studies have assessed perinatal mental health needs for this population of women who are living in camps for Internally Displaced Persons (IDP) in the Kurdistan Region of Iraq (KRI). METHODS: The specific aim of this formative cross-sectional study was to assess the prevalence of perinatal depressive symptoms, specifically the risk of perinatal depression symptoms, among a purposive sample of Yazidi women living in camps for internally displaced persons in the Kurdistan region of Iraq. One hundred twenty-two pregnant and recently postpartum (<1 year) Yazidi women completed a Kurdish-language version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Pregnant and postpartum participants' responses were analyzed together, in order to assess an overall combined risk of perinatal mental health issues for the study population. Logistic regression analyses were used to measure the association of participant characteristics with an elevated risk of perinatal depressive symptoms. RESULTS: Participants were 17-45 years of age (mean 32 years, SD 7.63) Among the 122 women, 67.2% (n=82) were pregnant and 32.8% (n=40) were <1 year postpartum. Overall, 78% (n=95) of participants were at an elevated risk of depression (EPDS >10), and 53% (n=65) of all participants were at risk of moderate to severe depression (EPDS >12). Thoughts of self-harm (EPDS item 10) were reported among 97% (n=118) of participants. Logistic regression analysis indicated that increased risk of perinatal depressive symptoms was significantly associated with reports of health problems during pregnancy (OR=3.22, 95% [CI]:1.08-9.61) and marital status (OR=16.00; 95% [CI]: 0.42-0.50). Age (OR= 0.84; 95% [CI]: 0.75-0.94) and level of education (OR=0.15; 95% [CI]: 0.42-0.50) had protective effects. CONCLUSIONS: Rates of perinatal depressive symptoms risk among internally displaced Yazid pregnant and postpartum women are higher than the general Kurdish-speaking population in Iraq (28.4%). Culturally responsive trauma informed perinatal and postpartum care services, which include both community-based and clinical strategies for perinatal depressive symptoms and suicide prevention for this population, are critically needed.

Applying Cognitive Behavioral Therapy and Thought Field Therapy in Kurdistan region of Iraq: A retrospective case series study of mental-health interventions in a setting of political instability and armed conflicts.

BACKGROUND: Mass violence, atrocities, and political upheavals have affected the prosperity and psychological health of the people of Iraq. Those living in the Garmian region of the Kurdistan Region of Iraq are among those most affected. While there is an urgent need for mental health interventions in this region, mental health resources are scarce, and only a small percentage of the population in need receive mental health care. Despite the high burden of mental illness, and the general demand by the community and local authorities for social and psychological services, effective validated cost-effective interventions tailored to address the cultural and social problems are scarce. This retrospective case series study, which is based on the lead author's experiences in the Garmian region, aims to describe the results of using two mental health interventions, cognitive behavioral therapy and thought field therapy. METHODS AND FINDINGS: The files of 31 clients that met criteria of the study were selected using purposive sampling. The results showed that, of the 13 clients who received Cognitive Behavioral Therapy, one improved and others showed either no change in symptoms, deterioration of symptoms, or dropped out of treatment. All 11 clients who received only Thought Field Therapy, showed improvement in their symptoms. Seven clients who received Cognitive Behavioral Therapy and showed no improvement received Thought Field Therapy, and showed improvement finally. While the results of preliminary experience with Thought Field Therapy in the Garmian community is encouraging, conducting randomized controlled trials with follow-ups, and comparing Thought Field Therapy with other therapeutic approaches is needed to substantiate these findings. CONCLUSION: We found that Thought Field Therapy had positive results in reducing anxiety disorders and trauma related symptoms, as compared to Cognitive Behavioral Therapy.

Sexual violence against women and girls in South Sudan.

This Letter to the Editor is in reference to the article by Murphy M, Ellsberg M and Contreras-Urbina M, "Nowhere to go: disclosure and help-seeking behaviors for survivors of violence against women and girls in South Sudan," published on 12 February 2020. The authors have to be lauded to study this important topic in South Sudan where data are scarce and the problem is less understood. In such a context, actions by various actors to address sexual violence, a major public health concern and a serious international humanitarian law and human rights violation, must be well thought of to avoid causing more harm and compound the suffering of survivors.

Environmental health in forced displacement: A systematic scoping review of the emergency phase.

There are 70.8 million forcibly displaced people worldwide, including internally displaced persons, refugees, and asylum seekers. Since mortality rates are highest in the first six months of displacement, the provision of adequate services and infrastructure by relief organizations is critical in this "emergency phase." Environmental health provisions such as adequate water supply, excreta management, solid waste management, and vector control measures are among those essential services. We conducted a systematic scoping review of environmental health in the emergency phase of displacement (the six months following first displacement). A total of 122 publications, comprising 104 peer-reviewed and 18 grey literature publications, met the inclusion criteria. We extracted data relating to environmental health conditions and services, associated outcomes, and information concerning obstacles and recommendations for improving these conditions and services. Despite the fact that most displaced people live outside of camps, publications largely report findings for camps (n = 73, 60%). Water supply (n = 57, 47%) and excreta management (n = 47, 39%) dominate the literature. Energy access (n = 7, 6%), exposure to harsh weather from inadequate shelter (n = 5, 4%), food hygiene and safety (n = 4, 3%), indoor air quality (n = 3, 3%), menstrual hygiene management (n = 2, 2%), dental hygiene (n = 2, 2%), and ambient air quality (n = 1, 1%) are relatively understudied. The most common health outcome attributed to inadequate environmental conditions in the included publications is diarrhea (n = 43, 35%). We found that organizations and governments often embrace their own standards, however we call for policymakers to adopt standards no less rigorous than Sphere for the emergency phase of displacement. Although other reviews examine water, sanitation, and hygiene interventions in emergencies, this is the first systematic review of environmental health more broadly in the first six months of displacement.

Quality healthcare in extreme adversity: Developing a framework for action.

Quality issue: Improving quality of care has become a global health priority to improve health outcomes and strengthen health systems, particularly in the context of achieving universal health coverage. Initial assessment: The delivery of quality essential health services in settings of extreme adversity, such as fragile, conflict-affected, vulnerable or disaster contexts, has been identified as a high priority globally to address the massive level of need. Choice of solution: This paper provides an action framework to systematically address the quality of health services for state and non-state actors working in such settings. The framework is designed to be practical, comprehensible and simple in adoption and implementation. It describes challenges, a set of medical needs and population priorities, a menu of quality-related interventions, and a hierarchy of health system levels defining the roles and responsibilities of key actors. Conclusion: Optimizing the use of limited resources in delivering the best quality possible in 'the hardest of the hard settings' is imperative.

Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters.

Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

Psychometric properties of the Kurdish version of Pittsburgh Sleep Quality Index.

BACKGROUND: The Pittsburgh Sleep Quality Index (PSQI) is a standardized questionnaire that used for subjective assessment of sleep quality. It has been translated into several languages and is widely used in clinical research settings. Since there is no sleep-related scale standardized in the Kurdish language, the present study aimed to translate and validate the PSQI into Kurdish. METHODS: First, the PSQI was successfully translated into Kurdish then back-translated into English by independent professional bilingual translators. The translated version of PSQI was tested with 230 participants, 150 healthy subjects, 40 subjects with insomnia, and 40 subjects with physical symptoms. Internal consistency was calculated by the Cronbach Alpha method using SPSS-20 software. Spearman correlation via a test-retest process was used for reliability. The General Health Questionnaire (GHQ28) was used to analyze criterion validity. The construct validity of the scale was tested by exploratory factor analysis (EFA). Factor weight was checked by confirmatory factor analysis (CFA) using LISREL software version 8.8. RESULTS: The internal consistency and reliability for PSQI global score was acceptable (Cronbach's alpha = 0.70). The result showed a strong correlation between test and retest after six weeks (r = 0.83). Correlations between the global score and components of the PSQI with the GHQ28 were all statistically significant (r = 0.23-0.72, p < 0.05). Exploratory factor analysis revealed three factors with a significant correlation between the PSQI global score and these factors. All factor weights were above 0.40. CONCLUSION: The results of this study support the PSQI's validity and reliability. This study offers a foundation for further studies in Kurdish populations.