Practice-Driven Evaluation of a Multi-layered Psychosocial Care Package for Children in Areas of Armed Conflict

Psychosocial and mental health service delivery frameworks for children in low-income countries are scarce. This paper presents a practice-driven evaluation of a multi-layered community-based care package in Burundi, Indonesia, Sri Lanka and Sudan, through a set of indicators; (a) perceived treatment gains; (b) treatment satisfaction; (c) therapist burden; (d) access to care; (e) care package costs. Across four settings (n = 29,292 children), beneficiaries reported high levels of client satisfaction and moderate post-treatment problem reductions. Service providers reported significant levels of distress related to service delivery. Cost analyses demonstrated mean cost per service user to vary from 3.46 to 17.32 € depending on country and specification of costs. The results suggest a multi-layered psychosocial care package appears feasible and satisfactory in reaching out to substantial populations of distressed children through different levels of care. Future replication should address therapist burden, cost reductions to increase sustainability and increase evidence for treatment efficacy

Reintegration of child soldiers in Burundi: A tracer study

Background Substantial attention and resources are aimed at the reintegration of child soldiers, yet rigorous evaluations are rare. Methods This tracer study was conducted among former child soldiers (N=452) and never-recruited peers (N=191) who participated in an economic support program in Burundi. Socio-economic outcome indicators were measured retrospectively for the period before receiving support (T1; 2005–06); immediately afterwards (T2; 2006–07); and at present (T3; 2010). Participants also rated present functional impairment and mental health indicators. Results Participants reported improvement on all indicators, especially economic opportunity and social integration. At present no difference existed between both groups on any of the outcome indicators. Socio-economic functioning was negatively related with depression- and, health complaints and positively with intervention satisfaction. Conclusion The present study demonstrates promising reintegration trajectories of former child soldiers after participating in a support program

Migrant mental health: A model for indicators of mental health and health care consumption

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups

Depressive symptomatology of post-menopausal breast cancer patients: a comparison of women recently treated by mastectomy or by breast-conserving therapy

The aim of this study was to detect differences in depressive symptomatology in post-menopausal breast cancer patients who had recently undergone either mastectomy or breast conserving therapy. We measured depressive symptoms shortly after diagnosis and surgery as well as 6 months later. There were no significant differences in mean scores and relative risk estimates between the two treatment groups at either time of measurement. From this study we conclude that women treated by breast-conserving therapy have comparable levels of depressive symptoms to women treated by mastectomy during the first 8 months after diagnosis. Breast-conserving therapy can have cosmetic and physical advantages, but requires as much psychological adjustment as mastectomy does