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The influence of humanitarian crises on social functioning among civilians in low- and middle-income countries: A systematic review.

ABSTRACT: Our aim was to systematically review how social functioning is measured, conceptualised, impacted, and associated with mental disorders in populations affected by humanitarian crises. Quantitative studies conducted with civilian populations affected by humanitarian crises in low- and middle-income countries with outcomes of social functioning were examined up to 2014. Data sources included Medline, Embase, PsycInfo, and Global Health, and 8 grey literature sources, yielding 14,350 records, of which 20 studies met inclusion criteria. A descriptive synthesis analysis was used, and the final selected studies assessed for quality using a modified Newcastle-Ottawa Scale. In the 20 studies, social functioning was conceptualised in 6 categories: family functioning, friendship quality, functional impairment, overall social functioning, social adaptation, and social relations. Seventeen studies were cross-sectional, two were cohort, and one a controlled trial. The quality of the studies was generally moderate. The limited evidence suggests that social functioning is a relevant variable. Greater crisis exposure is associated with more severe depression and lower social functioning. The protective role of familial and social resources for social functioning is highlighted in different crisis settings. However, greater research on social functioning and mental health is required.

SUBMITTER: Lahiri S

PROVIDER: S-EPMC5638016 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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The influence of humanitarian crises on social functioning among civilians in low- and middle-income countries: A systematic review.

Lahiri Shaon S van Ommeren Mark M Roberts Bayard B

Global public health 20160310 12

Our aim was to systematically review how social functioning is measured, conceptualised, impacted, and associated with mental disorders in populations affected by humanitarian crises. Quantitative studies conducted with civilian populations affected by humanitarian crises in low- and middle-income countries with outcomes of social functioning were examined up to 2014. Data sources included Medline, Embase, PsycInfo, and Global Health, and 8 grey literature sources, yielding 14,350 records, of wh ...[more]

PMID: 26963867

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Project description:BackgroundPublished by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations.MethodsSeven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov . We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed.ResultsWe identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies.ConclusionAlthough results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis.Trial registrationPROSPERO registration number: CRD42017058287 .

Project description:ImportanceEndorsement of global humanitarian interventions is based on either proven cost-effectiveness or perceived public health benefits. The cost-effectiveness and long-term benefits of global humanitarian pediatric cardiac surgery are unknown, and funding for this intervention is insufficient.ObjectivesTo determine the cost-effectiveness of the intervention (multiple 2-week-long humanitarian pediatric cardiac surgery program assistance trips to various low- and middle-income countries [LMICs]) and to produce a measure of the long-lasting effects of global humanitarian programs.Design, setting, and participantsInternational, multicenter cost-effectiveness analysis of a cohort of children (aged <16 years) undergoing surgical treatment of congenital heart disease during 2015 in LMICs, including China, Macedonia, Honduras, Iran, Iraq, Libya, Nigeria, Pakistan, Russia, and Ukraine. The study also assessed estimated improvement in the United Nations Human Development Indicators (life expectancy, years of schooling, and gross national income) for each individual survivor, as a proxy for long-term benefits of the intervention.Main outcomes and measuresThe primary outcome was cost-effectiveness of the intervention. The secondary outcomes were potential gains in life expectancy, years of schooling, and gross national income per capita for each survivor.ResultsDuring 2015, 446 patients (192 [43%] female; mean [SD] age, 3.7 [5.4] years) were served in 10 LMICs at an overall cost of $3 210 873. Of them, 424 were children. The cost-effectiveness of the intervention was $171 per disability-adjusted life-year averted. Each survivor in the cohort (390 of 424) potentially gained 39.9 disability-adjusted life-years averted, 3.5 years of schooling, and $159 533 in gross national income per capita during his or her extended lifetime at purchasing power parity and 3% discounting.Conclusions and relevanceHumanitarian pediatric cardiac surgery in LMICs is highly cost-effective. It also leaves behind a lasting humanitarian footprint by potentially improving individual development indices.

Project description:INTRODUCTION:There is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC). METHODS AND ANALYSIS:Qualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis. ETHICS AND DISSEMINATION:Findings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users. PROSPERO REGISTRATION NUMBER:CRD42017058287.

Dataset Information

The influence of humanitarian crises on social functioning among civilians in low- and middle-income countries: A systematic review.

Publications

The influence of humanitarian crises on social functioning among civilians in low- and middle-income countries: A systematic review.

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