Flora Cohen

Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies...

Background: Armed conflicts and natural disasters can cause significant psychological and social challenges for affected populations. Displaced populations are extremely heterogeneous in terms of culture, language, and experiences of crises. Current diagnostic criteria is insufficient when evaluating the symptoms and treatment of mental health issues across contexts. Aim: This scoping review presents information about cultural idioms of distress across displaced populations. The review includes aspects of etiology, symptomology, and proposed intervention methods. Methods: I conducted a Boolean search of academic and grey literature for studies that described cultural idioms of distress among displaced populations. Results were analyzed using thematic analysis and grounded theory. Results: A shared sense of injustice, spirit possession, and karma are common etiologies for mental distress among displaced populations. Symptoms include somatic complaints, ‘thinking a lot’, and interpers...

Individuals from conflict-affected countries, such as Iraq, face formidable challenges when they resettle in the United States. Drawing from intersectionality theory, we explore the lived experiences of adolescent boys and girls from Iraq who have resettled in Texas and Virginia. In this qualitative study, we focus on the school as an institution that is positioned to enforce, or to combat, systemic and interpersonal inequalities among young refugees, especially in terms of gender and race. Our thematic analysis identifies the ways their interactions with teachers, peers, and family in the school context have shaped the socialization of these adolescent boys and girls from Iraq. The study findings reflect the importance of understanding how education settings can affect the intersectional experiences of conflict-affected youth who have resettled in the United States.

Supplemental material, sj-pdf-1-irp-10.1177_2633489521998790 for Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM by Flora Cohen and Lauren Yaeger in Implementation Research and Practice

Experiences of intimate partner violence (IPV) victimization have well-established associations with poor mental health. There is also burgeoning evidence regarding the association between IPV perpetration and mental health in a small number of countries. However, there is a paucity of data about the gendered differences for these IPV experiences within sub-Saharan African. This study examines the association between IPV victimization, perpetration, and mental health outcomes for male and female adolescents and young adults in Uganda. Data on IPV perpetration were available for a nationally representative sample of 1,373 males and 2,022 females in Uganda. Observations were weighted to be representative of 13- to 24-year-olds in Uganda. Study procedures used multivariate logistic regression models to examine associations between ever-perpetration of IPV and four self-reported mental health variables: severe sadness, feelings of worthlessness, suicide ideation, and alcohol abuse. Mode...

There is substantial evidence linking stressful life events (SLEs) in childhood to poor mental health later in life, but few studies explore how various types of SLEs differentially impact mental health. The purpose of this study is to assess associations between SLEs and psychosocial outcomes in a diverse adolescent population in the USA and to examine whether and how these relationships are gendered. The sample comprises 181 high school students ages 13–21 years in Harrisonburg, Virginia. This study analyzed associations between 12 SLEs and eight psychosocial outcomes using ordinary least-squares and logistic regressions. Relationships were estimated for the full sample and for males and females, separately. For boys, having ever been forced to leave one’s family was associated with declines in resilience (B = − 4.646; 95% CI (− 8.79, − 0.50)) and increases in externalizing symptoms (B = 0.392; 95% CI (0.15, 0.63)). Furthermore, boys who experienced a drastic change in their family reported lower levels of school belonging (B = − 9.272; 95% CI (− 17.45, − 1.09)). For girls, having ever been forced to leave one’s family was associated with decreases in depressive (B = − 0.961; 95% CI (− 1.88, − 0.05)) and anxiety symptomology (B = − 0.868; 95% CI (− 1.68, − 0.06)). Overall, students who experienced a life-threatening emergency exhibited greater depressive (B = 0.445; 95% CI (0.15, 0.74)) and anxiety symptoms (B = 0.287; 95% CI (0.05, 0.52)), and depressive symptomology was also associated with having ever been physically hurt by someone (B = 0.224; 95% CI (0.01, 0.44)). Findings provide insights into how exposures might engender different mental health processes and outcomes, and how these processes may manifest differently across gender.

Mental and substance use disorders are leading causes of disability worldwide. Yet only 10% of individuals globally receive treatment for such disorders, with an even higher treatment gap in low- and middle-income countries (LMIC). Serious mental illnesses (SMI), defined as a mental, behavioral, or emotional disorders resulting in serious functional impairment, primarily including bipolar disorder and schizophrenia spectrum disorder, remain misunderstood in countries with limited infrastructure (financial and human capital). This study explores the lived experiences, social ecologies, and political framework for the treatment of individuals living with serious mental illness in Uganda. This scoping review identified relevant publications using (1) a Boolean search, (2) manual screening of eligible publications, (3) identification of additional peer-reviewed articles and grey literature by hand searching the final list of included records, (4) thematic analysis and grounded theory to categorize studies into representative aspects of compiled literature, based on emerging themes of people with serious mental illnesses (PWSMI) ecologies, and (5) rigorous data extraction and analysis, guided by a comprehensive exclusion strategy for eligibility. The 41 eligible articles included aspects of prevalence, comorbidities, caregiver involvement, and treatment pathways (traditional healers, community healthcare workers, primary care clinics, and national referral hospitals) for PWSMI in Uganda. Due to a lack of community mental health literacy, there are barriers to accessing high-quality, holistic mental healthcare for afflicted individuals. People seek care wherever they can find it, and if they believe their symptoms align with the treatment modalities. For example, beliefs in spirit possession may lead a PWSMI to visit the neighborhood traditional healer before the more distant national referral hospital. Research further illustrated a direct link between the aforementioned ecologies and a decreased quality of life in caregivers due to the economic loss, erratic behaviors of the afflicted, and the strain of caring for PWSMI when interfacing with allopathic medicine. Stock-outs in health facilities and limited human resources cause overburdened health systems and the utilization of less efficacious psychotropic medications inconsistently. Additionally, misdiagnoses are common due to the lack of service oversight, and PWSMI often endure severe untreated side-effects from both traditional and allopathic medicine providers. While this study outlines the current pathways to care, there is room for improvement, including lessons for improving mental health policy and the implementation of appropriate community-based mental health practices. PWSMI are often left with low-quality choices to access care. This study suggests that, by critically analyzing community needs and complimentary programs, the livelihoods of people with serious mental illness and their caregivers can be vastly improved. Although PWSMI struggle with mental, physical, and social concerns, they are largely undervalued in the Ugandan context and isolated from society. Their pathways to recovery are wrought with frustrating encounters with peers and painful side-effects of treatment.

Background Youth resettling to the U.S. from conflict-affected countries in the Middle East and North Africa (MENA) face countless challenges. As they cope with their experiences of armed conflict and forced migration, these girls and boys must also adjust to the language and social norms of their new society, often encountering prejudice and discrimination along the way. Previous studies indicate that schools can play a central role in facilitating this adjustment while also promoting mental health and psychosocial wellbeing. This qualitative study aims to understand the lived experiences of MENA newcomers resettled in Austin, Texas and Harrisonburg, Virginia and to assess how schools, families, and communities support their mental and psychosocial wellbeing. Methods We held six focus group discussions across the two cities with a total of 30 youths (13–23 years) from Iraq, Syria, and Sudan. We also conducted semi-structured interviews with 30 caregivers and 27 key informants, incl...

Background: Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context. Methods: This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these inter...

Background Child psychological distress in refugee settings is a significant public health concern, which is exacerbated by poor caregiver mental health and functioning. However, there are limited studies about effective interventions to improve caregiver mental health in support of child wellbeing. The objective of the current study is to evaluate the effectiveness and implementation of the Journey of Life (JoL) intervention to improve caregiver mental health in a refugee camp in Western Uganda. Methods A waitlist-control quasi-experimental design is being implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was selected as the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule, (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Pare...