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Philippe Laramee - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness of nalmefene added to Psychosocial Support for the reduction of alcohol consumption in alcohol dependent patients with high very high drinking risk levels a microsimulation model
Journal of Studies on Alcohol and Drugs, 2017Co-Authors: Aurélie Millier, Philippe Laramee, Nora Rahhali, Jürgen Rehm, Jean-bernard Daeppen, Samuel Aballea, Mondher ToumiAbstract:Objective:A microsimulation model was adapted to evaluate the cost-effectiveness of nalmefene combined with Psychosocial Support (NMF + PS) versus Psychosocial Support alone (PS). The economic impact of alcohol reduction using nalmefene treatment was not evaluated.Method:The model simulates patient-level alcohol consumption over a 5-year time horizon across different treatment cohorts. Study outcomes included probabilities of alcohol-attributable diseases and injuries as well as deaths from these events. The approach used nalmefene clinical trial data, a time horizon of 1 and 5 years, and a U.K. societal perspective. Extensive deterministic and probabilistic sensitivity analyses were conducted.Results:Compared with the PS strategy, NMF + PS was associated at Year 5 with a gain of 0.047 quality-adjusted life years (QALYs) and an additional £503, leading to an incremental cost-effectiveness ratio (ICER) of £10,613 per QALY gained. When compared with the strategy without treatment, NMF + PS was associated wi...
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the cost effectiveness of the integration of nalmefene within the uk healthcare system treatment pathway for alcohol dependence
Alcohol and Alcoholism, 2016Co-Authors: Philippe Laramee, Melissa Bell, Adam Irving, Thorhenrik BrodtkorbAbstract:Aims To assess the cost-effectiveness of integrating nalmefene within the treatment pathway for alcohol dependence recommended by the National Institute for Health and Care Excellence in the UK. Methods A Markov model, taking a UK NHS perspective, followed a cohort with alcohol dependence and high/very high drinking risk levels (HVHDRLs), who do not require immediate detoxification and who continue at HVHDRLs after initial assessment, for 5 years. Costs and quality-adjusted life years (QALYs) from treatment with nalmefene plus Psychosocial Support versus Psychosocial Support alone were modelled. The consequent incidence of alcohol-attributable harmful events and disease progression, with the possibility of requiring other options or recurrent treatment, were captured. Results Nalmefene plus Psychosocial Support dominated Psychosocial Support alone, with lower costs and increased QALYs after 5 years. Savings are driven by the higher response to nalmefene, and the subsequent lower cost accumulation for alternatives. Conclusions Nalmefene represents a highly cost-effective treatment option in this population. The analysis shows that integrating nalmefene within the current UK clinical treatment pathway for alcohol dependence could reduce the economic burden on the NHS by limiting harmful events and disease progression.
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the cost effectiveness of nalmefene for reduction of alcohol consumption in alcohol dependent patients with high or very high drinking risk levels from a uk societal perspective
CNS Drugs, 2016Co-Authors: Thorhenrik Brodtkorb, Adam Irving, Melissa Bell, Philippe LarameeAbstract:Aim To evaluate costs and health outcomes of nalmefene plus Psychosocial Support, compared with Psychosocial intervention alone, for reducing alcohol consumption in alcohol-dependent patients, specifically focusing on societal costs related to productivity losses and crime.
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the cost effectiveness and public health benefit of nalmefene added to Psychosocial Support for the reduction of alcohol consumption in alcohol dependent patients with high very high drinking risk levels a markov model
BMJ Open, 2014Co-Authors: Philippe Laramee, Nora Rahhali, Clement Francois, Jean-bernard Daeppen, Mondher Toumi, Thorhenrik Brodtkorb, Chris Knight, Carolina Barbosa, Jürgen RehmAbstract:Objectives To determine whether nalmefene combined with Psychosocial Support is cost-effective compared with Psychosocial Support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Design Decision modelling using Markov chains compared costs and effects over 5 years. Setting The analysis was from the perspective of the National Health Service (NHS) in England and Wales. Participants The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. Data sources We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. Main outcome measures We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Results Nalmefene in combination with Psychosocial Support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20 000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus Psychosocial Support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to Psychosocial Support alone over the course of 5 years. Conclusions Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits. Trial registration numbers This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).
Martin Harter - One of the best experts on this subject based on the ideXlab platform.
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unmet needs for information and Psychosocial Support in relation to quality of life and emotional distress a comparison between gynecological and breast cancer patients
Patient Education and Counseling, 2017Co-Authors: Hermann Faller, Joachim Weis, Elmar Brahler, Martin Harter, Monika Keller, Holger Schulz, Karl Wegscheider, Anna Boehncke, Katrin Reuter, Matthias RichardAbstract:Abstract Objective We compared gynecological and breast cancer patients regarding their needs for information and Psychosocial Support, quality of life (QoL), and emotional distress and the relationship among these constructs. Methods In a multicenter, cross-sectional study in Germany, we evaluated 1214 female cancer patients (317 with gynecological cancer, 897 with breast cancer). We obtained self-reports of unmet needs, using a self-developed measure. We measured QoL with the EORTC QLQ-C30, symptoms of depression with the Patient Health Questionnaire (PHQ-9), and symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7). Results Compared to breast cancer patients, gynecological cancer patients felt less informed about several aspects of their disease, particularly regarding psychological Support (p Conclusion Compared to breast cancer, gynecological cancer patients were less satisfied with the information received and reported lower levels of QoL. Practice implications Both clinicians and policy makers should take efforts to address the higher needs of gynecological cancer patients.
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perceived need for Psychosocial Support depending on emotional distress and mental comorbidity in men and women with cancer
Journal of Psychosomatic Research, 2016Co-Authors: Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brahler, Martin Harter, Monika Keller, Holger Schulz, Karl Wegscheider, Anna Boehncke, Bianca HundAbstract:Abstract Objective Although elevated levels of distress are supposed to constitute a need for Psychosocial Support, the relation between elevated distress and need for Support does not appear to be straightforward. We aimed to determine cancer patients' perceived need for Psychosocial Support, and examine the relation of need to both self-reported emotional distress and the interview-based diagnosis of a mental disorder. Methods In a multicenter, cross-sectional study in Germany, 4020 cancer patients (mean age 58 years, 51% women) were evaluated. We obtained self-reports of need for Psychosocial Support. We measured distress with the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) and depressive symptoms with the Patient Health Questionnaire (PHQ-9). In a subsample, we evaluated the presence of a mental disorder using the Composite International Diagnostic Interview (CIDI). Results 32.1% (95%-CI 30.6 to 33.6) of patients perceived a need for Psychosocial Support. Younger age, female sex, and higher education were associated with more needs, being married and living with a partner with fewer needs, respectively. While up to 51.2% of patients with elevated distress levels reported a need for Psychosocial Support, up to 26.1% of those without elevated distress levels perceived such a need. Results were similar across distress assessment methods. Conclusion Our findings emphasize that the occurrence of mental distress is one important but not an exclusive factor among different motives to report the need for Psychosocial Support. We should thus consider multifaceted perspectives, facilitators and barriers when planning and implementing patient-centered Psychosocial care services.
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prevalence of mental disorders Psychosocial distress and need for Psychosocial Support in cancer patients study protocol of an epidemiological multi center study
BMC Psychiatry, 2012Co-Authors: Anja Mehnert, Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brahler, Monika Keller, Holger Schulz, Karl Wegscheider, Martin HarterAbstract:Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement Psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and Psychosocial Support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany. In this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and Wurzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and Psychosocial Support needs as well as quality of life. Epidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of Psychosocial Support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and Psychosocial distress, specific Supportive care needs and use of Psychosocial Support offers.
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prevalence of mental disorders Psychosocial distress and need for Psychosocial Support in cancer patients study protocol of an epidemiological multi center study
BMC Psychiatry, 2012Co-Authors: Anja Mehnert, Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brahler, Monika Keller, Holger Schulz, Karl Wegscheider, Martin HarterAbstract:Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement Psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and Psychosocial Support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany.
Thorhenrik Brodtkorb - One of the best experts on this subject based on the ideXlab platform.
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the cost effectiveness of the integration of nalmefene within the uk healthcare system treatment pathway for alcohol dependence
Alcohol and Alcoholism, 2016Co-Authors: Philippe Laramee, Melissa Bell, Adam Irving, Thorhenrik BrodtkorbAbstract:Aims To assess the cost-effectiveness of integrating nalmefene within the treatment pathway for alcohol dependence recommended by the National Institute for Health and Care Excellence in the UK. Methods A Markov model, taking a UK NHS perspective, followed a cohort with alcohol dependence and high/very high drinking risk levels (HVHDRLs), who do not require immediate detoxification and who continue at HVHDRLs after initial assessment, for 5 years. Costs and quality-adjusted life years (QALYs) from treatment with nalmefene plus Psychosocial Support versus Psychosocial Support alone were modelled. The consequent incidence of alcohol-attributable harmful events and disease progression, with the possibility of requiring other options or recurrent treatment, were captured. Results Nalmefene plus Psychosocial Support dominated Psychosocial Support alone, with lower costs and increased QALYs after 5 years. Savings are driven by the higher response to nalmefene, and the subsequent lower cost accumulation for alternatives. Conclusions Nalmefene represents a highly cost-effective treatment option in this population. The analysis shows that integrating nalmefene within the current UK clinical treatment pathway for alcohol dependence could reduce the economic burden on the NHS by limiting harmful events and disease progression.
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the cost effectiveness of nalmefene for reduction of alcohol consumption in alcohol dependent patients with high or very high drinking risk levels from a uk societal perspective
CNS Drugs, 2016Co-Authors: Thorhenrik Brodtkorb, Adam Irving, Melissa Bell, Philippe LarameeAbstract:Aim To evaluate costs and health outcomes of nalmefene plus Psychosocial Support, compared with Psychosocial intervention alone, for reducing alcohol consumption in alcohol-dependent patients, specifically focusing on societal costs related to productivity losses and crime.
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the cost effectiveness and public health benefit of nalmefene added to Psychosocial Support for the reduction of alcohol consumption in alcohol dependent patients with high very high drinking risk levels a markov model
BMJ Open, 2014Co-Authors: Philippe Laramee, Nora Rahhali, Clement Francois, Jean-bernard Daeppen, Mondher Toumi, Thorhenrik Brodtkorb, Chris Knight, Carolina Barbosa, Jürgen RehmAbstract:Objectives To determine whether nalmefene combined with Psychosocial Support is cost-effective compared with Psychosocial Support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Design Decision modelling using Markov chains compared costs and effects over 5 years. Setting The analysis was from the perspective of the National Health Service (NHS) in England and Wales. Participants The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. Data sources We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. Main outcome measures We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Results Nalmefene in combination with Psychosocial Support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20 000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus Psychosocial Support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to Psychosocial Support alone over the course of 5 years. Conclusions Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits. Trial registration numbers This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).
Uwe Koch - One of the best experts on this subject based on the ideXlab platform.
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perceived need for Psychosocial Support depending on emotional distress and mental comorbidity in men and women with cancer
Journal of Psychosomatic Research, 2016Co-Authors: Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brahler, Martin Harter, Monika Keller, Holger Schulz, Karl Wegscheider, Anna Boehncke, Bianca HundAbstract:Abstract Objective Although elevated levels of distress are supposed to constitute a need for Psychosocial Support, the relation between elevated distress and need for Support does not appear to be straightforward. We aimed to determine cancer patients' perceived need for Psychosocial Support, and examine the relation of need to both self-reported emotional distress and the interview-based diagnosis of a mental disorder. Methods In a multicenter, cross-sectional study in Germany, 4020 cancer patients (mean age 58 years, 51% women) were evaluated. We obtained self-reports of need for Psychosocial Support. We measured distress with the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) and depressive symptoms with the Patient Health Questionnaire (PHQ-9). In a subsample, we evaluated the presence of a mental disorder using the Composite International Diagnostic Interview (CIDI). Results 32.1% (95%-CI 30.6 to 33.6) of patients perceived a need for Psychosocial Support. Younger age, female sex, and higher education were associated with more needs, being married and living with a partner with fewer needs, respectively. While up to 51.2% of patients with elevated distress levels reported a need for Psychosocial Support, up to 26.1% of those without elevated distress levels perceived such a need. Results were similar across distress assessment methods. Conclusion Our findings emphasize that the occurrence of mental distress is one important but not an exclusive factor among different motives to report the need for Psychosocial Support. We should thus consider multifaceted perspectives, facilitators and barriers when planning and implementing patient-centered Psychosocial care services.
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prevalence of mental disorders Psychosocial distress and need for Psychosocial Support in cancer patients study protocol of an epidemiological multi center study
BMC Psychiatry, 2012Co-Authors: Anja Mehnert, Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brahler, Monika Keller, Holger Schulz, Karl Wegscheider, Martin HarterAbstract:Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement Psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and Psychosocial Support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany. In this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and Wurzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and Psychosocial Support needs as well as quality of life. Epidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of Psychosocial Support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and Psychosocial distress, specific Supportive care needs and use of Psychosocial Support offers.
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prevalence of mental disorders Psychosocial distress and need for Psychosocial Support in cancer patients study protocol of an epidemiological multi center study
BMC Psychiatry, 2012Co-Authors: Anja Mehnert, Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brahler, Monika Keller, Holger Schulz, Karl Wegscheider, Martin HarterAbstract:Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement Psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and Psychosocial Support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany.
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psychological comorbidity and health related quality of life and its association with awareness utilization and need for Psychosocial Support in a cancer register based sample of long term breast cancer survivors
Journal of Psychosomatic Research, 2008Co-Authors: Anja Mehnert, Uwe KochAbstract:Abstract Objective Psychosocial comorbidity and quality of life (QOL) and its association with knowledge, utilization, and need for Psychosocial Support have been studied in long-term breast cancer survivors. Methods One thousand eighty-three patients were recruited through a population-based cancer registry an average of 47 months following diagnosis (66% response rate). Self-report measures (e.g., Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist—Civilian Version, and Short-Form Health Survey) were used. Results Thirty-eight percent of patients had moderate to high anxiety, and 22% had moderate to high depression; posttraumatic stress disorder was observed in 12%. The overall psychological comorbidity was 43% and 26% for a possible and probable psychiatric disorder. Disease progress, detrimental interactions, less social Support, a lower educational level, and younger age were predictors of psychological comorbidity (P Conclusion Findings show the long-term impact of breast cancer and indicate need for patient education, screening for Psychosocial distress, and implementation of psychological interventions tailored in particular for older women.
Wietse A Tol - One of the best experts on this subject based on the ideXlab platform.
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a call for greater conceptual clarity in the field of mental health and Psychosocial Support in humanitarian settings
Epidemiology and Psychiatric Sciences, 2021Co-Authors: Kenneth E Miller, Wietse A Tol, Mark J D Jordans, A GalappattiAbstract:Aims When the Interagency Standing Committee (IASC) adopted the composite term mental health and Psychosocial Support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. Methods We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. Results Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. Conclusions Greater attention to the ‘why’ of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the ‘how’), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
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ethical standards for mental health and Psychosocial Support research in emergencies review of literature and current debates
Globalization and Health, 2017Co-Authors: Anna Chiumento, Atif Rahman, Lucy Frith, Leslie Snider, Wietse A TolAbstract:Research in emergencies is needed to understand the prevalence of mental health and Psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and Psychosocial Support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.
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mental health and Psychosocial Support for south sudanese refugees in northern uganda a needs and resource assessment
Conflict and Health, 2016Co-Authors: Alex Adaku, James Okello, Blakeley Lowry, Jeremy C Kane, Stephen Alderman, Seggane Musisi, Wietse A TolAbstract:Since December 2013, an armed conflict in South Sudan has resulted in the displacement of over 2.2 million people, more than 270,000 of whom are presently in refugee settlements located throughout Uganda. Existing literature suggests that refugees are at increased risk for a range of mental health and Psychosocial problems. There is international consensus on the importance of needs and resource assessments to inform potential mental health and Psychosocial Support (MHPSS) interventions. We conducted a MHPSS needs and resource assessment in Rhino Camp refugee settlement in northern Uganda, between June and August 2014. We followed World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) guidelines for MHPSS needs assessments in humanitarian settings. The assessment used a range of methodologies including: 1) a desk (literature) review to understand the context for mental health service provision; 2) an analysis of data from existing health information systems (HIS); 3) an assessment of the current infrastructure for service provision using a shortened version of a Who does What Where until When (4Ws); and 4) semi-structured individual and group interviews (total n = 86) with key informants (n = 13) and general community members (individual interviews n = 28, four focus groups with n = 45). Data from the HIS indicated that visits to health centers in refugee settlements attributable to psychotic disorders, severe emotional disorders, and other psychological complaints increased following the refugee influx between 2013 and 2014, but overall help-seeking from health centers was low compared to estimates from epidemiological studies. In semi-structured interviews the three highest ranked mental health and Psychosocial problems included “overthinking”, ethnic conflict, and child abuse. Other concerns included family separation, drug abuse, poverty, and unaccompanied minors. The 4Ws assessment revealed that there were very limited MHPSS services available in Rhino Camp. The types of MHPSS problems among South Sudanese refugees in northern Uganda are diverse and the burden appears to be considerable, yet there are currently few available services. The assessment indicates the need for a range of services addressing social concerns as well as varied types of mental conditions. The idiom of “overthinking” may form a useful starting point for intervention development and mental health communication.
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mental health and Psychosocial Support in humanitarian settings a public mental health perspective
Epidemiology and Psychiatric Sciences, 2015Co-Authors: Wietse A Tol, Marianna Purgato, Judith K Bass, A Galappatti, W EatonAbstract:Aims. To discuss the potential usefulness of a public health approach for ‘mental health and Psychosocial Support’ (MHPSS) interventions in humanitarian settings. Methods. Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for Supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries. Results. A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between ‘mental health’ and ‘Psychosocial’ practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology. Conclusions. The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.
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sexual and gender based violence in areas of armed conflict a systematic review of mental health and Psychosocial Support interventions
Conflict and Health, 2013Co-Authors: Wietse A Tol, Vivi Stavrou, Claire M Greene, Christina Mergenthaler, Mark Van Ommeren, Claudia Garcia MorenoAbstract:Sexual and other forms of gender-based violence are common in conflict settings and are known risk factors for mental health and Psychosocial wellbeing. We present findings from a systematic review of the academic and grey literature focused on the effectiveness of mental health and Psychosocial Support interventions for populations exposed to sexual and other forms of gender-based violence in the context of armed conflicts. We searched the Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PubMed/ Medline, psycINFO, and PILOTS, as well as grey literature to search for evaluations of interventions, without date limitations. Out of 5,684 returned records 189 full text papers were assessed for eligibility. Seven studies met inclusion criteria: 1 non-randomized controlled study; 3 non-controlled pre- post-test designs; 1 retrospective cohort with a matched comparison group; and 2 case studies. Studies were conducted in West and Central Africa; Albania; UK and USA, included female participants, and focused on individual and group counseling; combined psychological, medical, social and economic interventions; and cognitive behavioral therapy (two single case studies). The seven studies, while very limited, tentatively suggest beneficial effects of mental health and Psychosocial interventions for this population, and show feasibility of evaluation and implementation of such interventions in real-life settings through partnerships with humanitarian organizations. Robust conclusions on the effectiveness of particular approaches are not possible on the basis of current evidence. More rigorous research is urgently needed.