Mental health of refugees, asylum seekers and migrants: An overview of challenges and good practice examples

U poslednjih nekoliko godina, broj izbeglica, migranata i tražilaca azila dramatično je porastao širom sveta. Srbija, kao glavna tranzitna zemlja, trenutno je domaćin za preko 6,000 novih tražilaca azila i izbeglica, za preko 26,200 izbeglica i 198,500 interno raseljenih lica iz regiona bivše Jugoslavije, kao i za 1,950 osoba pod rizikom od gubitka države. Migranti su često pod akutnim i hroničnim stresom. Mnogi od njih traumatizovani su u svojim domovinama i tokom puta, usled progona, nasilja, povreda ljudskim prava, i suočeni su sa stalnim stresorima u zemljama egzila. Obimna istraživanja pokazala su povećane stope i znatnu varijabilnost u prevalenciji kratkoročnih i dugoročnih problema mentalnog zdravlja među izbeglicama, tražiocima azila i migrantima. Najprevalentniji psihijatrijski poremećaji su depresija, anksioznost, prolongirano tugovanje, somatoformni poremećaji, psihoze, zloupotreba supstanci, kao i poremećaji specifično povezani sa stresom, posebno posttraumatski stresni poremećaj. Hitno je potrebno ponuditi sistematične i održive solucije za zaštitu mentalnog zdravlja, kako bi se smanjili sa traumom povezani problemi mentalnog zdravlja i prevenirale dogoročne posledice. Multisektorni, na dokazima zasnovan, multidisciplinarni pristup, prepoznat je kao krucijalni u prepoznavanju potreba ovih populacija i omogućavanju adekvatne zaštite njihovog mentalnog zdravlja i psihosocijalnog blagostanja.In the past few years the number of refugees, migrants and asylum seekers worldwide has increased dramatically. Serbia, as a mainly transit country currently hosts over 6,000 new asylum-seekers and refugees, over 26.200 refugees and 198.500 internally displaced persons from the ex-Yugoslavia region, and 1.950 persons at risk of statelessness. Migrants are often under acute and chronic stress. Many of them were traumatized in their homelands and during their journey , due to persecution, violence, and human right violations, and they are confronted with ongoing stressors in the exile countries. Extensive research has shown increased rates and substantial variability in the prevalence of short-term and long-term mental health problems among refugees, asylum seekers and migrants. The most prevalent psychiatric disorders are depression, anxiety, prolonged grief, somatoform disorders, psychosis, substance use disorders, and disorders specifically related to stress, particularly posttraumatic stress disorder. It's urgent to offer a systemic and sustainable solutions for mental health protection, in order to reduce trauma related mental health problems and prevent long-term consequences. Multisectoral, evidence-based and multidisciplinary approach is recognized as crucial in identifying needs of these populations and enabling proper protection of their mental health and psychosocial wellbeing

Posttraumatic stress disorder - predictors of development and of recovery

Uvod: Posttraumatski stresni poremećaj (PTSP) predstavlja multiuzročni fenomen, odnosno, poremećaj koji nastaje kombinacijom velikog broja različitih uzročnika. Izloženost potencijalno traumatskim događajima može dovesti do razvoja posttraumatskog stresnog poremećaja a njegova životna prevalenca u opštoj populaciji u Evropi iznosi 2-6%, dok prevalenca aktuelnog PTSP-a iznosi 1%. U Americi je ovaj procenat veći te je životna prevalenca PTSP-a između 5- 10% a aktuelnog 1-5%. Prema istraživanjima, približno 25-40% osoba koje su iskusile traumatski događaj razvije PTSP, dok je razlog zašto ostatak populacije ne razvije ovaj poremećaj predmet brojnih debata. Ciljevi: Utvrditi potencijalne prediktore razvoja PTSP-a u inicijalnoj fazi istraživanja, kao i potencijalne prediktore ishoda PTSP-a nakon godinu dana od inicijalne faze u opštoj populaciji u Srbiji. Metod: Uzorak sačinjava 640 osoba u inicijalnoj fazi i 120 u fazi praćenja nakon godinu dana. Procena je obavljena pomoću sledećih intrumenata: Međunarodni neuropsihijatrijski intervju (Mini–International Neuropsychiatric Interview (M.I.N.I.), Revidirana lista životnih stresora (Life Stressor Checklist Revised, LSC-R), Kratak inventor simptoma (The Brief Symptom Inventory, BSI), Upitnik za procenu kvaliteta života (Manchester Short Assessment of Quality of Life, MANSA). Rezultati: Starije životno doba, nizak obrazovni nivo i niži mesečni prihodi mogu predvideti aktuelni PTSP, kao i nizak nivo kvaliteta života, psihijatrijski komorbiditet i visok nivo ličnog distresa. Urbana populacija, bolji kvalitet života i mali broj stresora, vode oporavku od PTSP-a. Zaključak: Utvrđivanje faktora rizika kao i rezilijentnosti koji utiču na razvoj PTSP-a, neophodno je za prevenciju i tretman ovog mentalnog poremećaja koji može imati ozbiljne posledice po pojedinca, porodicu i društvenu zajednicu.Background: Posttraumatic stress disorder (PTSD) is a `multicausal` phenomenon, meaning that it is the product of the combination of a number of potential causes. Exposing to potentially traumatic events can develop posttraumatic stress disorder and lifetime prevalence rate of PTSD in general European population is 2-6% and 1% of current PTSD. Epidemiological studies on posttraumatic stress disorder in the United States show a lifetime prevalence rate of 5-10% and a current prevalence of 1-5% in adult population. According to studies, 25-40% persons who have experienced traumatic event develop PTSD, but why the rest of people do not is the metter of huge disscussion. Aims: To examine the predictors of development and of recovery of PTSD in general adult Serbian population at 1-year follow up period. Method: The sample consisted of 640 subjects in the initial phase and 120 in the follow up. Assessment has been carried out by the following instruments: Mini–International Neuropsychiatric Interview (M.I.N.I.), Life Stressor Checklist Revised, LSC-R, The Brief Symptom Inventory, BSI, Manchester Short Assessment of Quality of Life, MANSA. Results: Older age, low education, lower monthly income can predict current PTSD as also, low quality of life, psychiatric comorbidity and higher personal distress. Urban population, higher quality of life, small number of stressors and lower personal distress leads to recovery of PTSD. Conclusions: Distinguishing risk and resiliency factors which could have influence on development of PTSD, it is necessary for prevention and treatment this mental disorder which has a serious consequences for person, family and whole community

Sex steroid hormones status influence on antidepressant pharmacotherapy effect in male and female patients

Depression causes immense burden on health care systems worldwide with two time s higher prevalence in women. However, both male and female patients are treated with antidepressants under same protocols. As it was demonstrated that estrogen has a prodepressant and testosterone an antidepressant affect, it is reasonable to assume that pharmacotherapeutic effect might depend also on sex hormones status. The aim of this pilot study was to explore hormonal status of female and male patients upon hospitalization on occurrence of depressive episode and to correlate it with pharmacotherapy effect after four weeks of therapy. Subjects were 42 patients, 14 males, 14 females in the first (follicular) phase of menstrual cycle and 14 females in the second (luteal) phase of menstrual cycle upon hospitalization. The Hamilton scale was used to determine degree of depressive state upon hospitalization an after 28 days. At both time points, blood was sampled and level of testosterone and estrogen for male and estrogen, progesterone and testosterone for female patients was analysed. Results of the study showed that antidepressant effect calculated as a difference in Hamilton scale was highest in male group of patients and significantly higher than in women in the second phase of the cycle (10.4 vs 8.1). This correlated with increase of testosterone in male patients during four weeks treatment (12.08 vs. 9.46), while there was no significant change in the level of testosterone in both female groups of patients. Furthermore, in female patients in the luteal phase of the cycle, with lowest response to antidepressants, both estrogen and progesterone were significantly reduced during four weeks of treatment. In conclusion, results of our pilot study suggest sex differences in response to antidepressant therapy and level of hormonal status should be evaluated for better personalized pharmacotherapy.The Biochemistry Global Summit, 25th IUBMB Congress, 46th FEBS Congress, 15th PABMB Congress, July 9–14, 2022, Lisbon, Portuga

BURNOUT SYNDROME AMONG PHYSICIANS – THE ROLE OF PERSONALITY DIMENSIONS AND COPING STRATEGIES

Background: Burnout syndrome (BS) and stress-related disorders are frequent among medical specialists, but it has been suggested that some health workers are more prone to the BS than others. This study assessed the intensity of the BS among 3 groups of physicians: psychiatrists, general practitioners and surgeons and examined correlation both between the intensity of BS and physicians` personality dimensions as well as between the level of BS and stress coping strategies. Subjects and methods: The sample consisted of 160 physicians (70 general practitioners, 50 psychiatrists, 40 surgeons). The assessment was carried out by the Maslach Burnout Inventory, The Temperament and Character Inventory and Manual for the Ways of Coping Questionnaire. Results: Dimension of emotional exhaustion was the most prominent in general practitioners (F=5.546, df1=2, df2=156, p<0.01), while dimension of depersonalization was highest in surgeons (F=15.314, df1=2, df2=156, p<0.01), as well as lack of personal accomplishment (F=16.079, df1=2, df2=156, p<0.01). We found that the Harm Avoidance has lead to development of BS while Self-directedness and Cooperativeness were prominent in physicians with low level of BS. The escape-avoidance was in correlation with high depersonalization and lack of personal accomplishment while self-control was prominent in physicians with lower BS. Conclusion: The BS affects personal well-being and professional performance. It is important to identify individuals with a tendency towards its development, in order to undertake preventive measures such as stress management and improvement of the stress coping strategies

Suicide during years of stress: Serbian experience

Suicide is a global, ubiquitous phenomenon and one of the major causes of death at all ages and wide range of possible risk factors. Suicide and stress are intimately related, ranging from everyday life stressors, through global socioeconomic crises and economical disadvantages to major stressors such as natural or man made disasters. There is a strong association between suicidality and mental disorders, particularly depression and posttraumatic stress disorder (PTSD). Physicians should be alert to potential suicidal ideation when the history reveals risk factors for suicide, such as depression, PTSD, other psychiatric disorder, prior attempted suicide, recent divorce, separation, unemployment and bereavement. Dealing with consequences of stress, particularly suicidality, is a challenge to mental health professionals whose work during the years of stress has to be outside of their traditional roles. It is necessary to develop preventive strategies on high-risk population groups

Longitudinal Study of Posttraumatic Stress Disorder in the Community Risk and Recovery Factors

Posttraumatic stress disorder (PTSD) is a multicausal phenomenon and a final end point of the combination of a number of potential causes. Our study aimed to examine potential risk and recovery factors of PTSD in general adult population at 1-year follow-up period. The sample consisted of 640 subjects in the initial phase, chosen by random walk technique in five regions of the country, and 100 in the follow-up. The assessment has been carried out by the following instruments: Mini-International Neuropsychiatric Interview, Life Stressor Checklist-Revised, Brief Symptom Inventory, and Manchester Short Assessment of Quality of Life Scale. Older age, low education, and lower monthly income are potential risk factors for current PTSD, as well as decreased quality of life, psychiatric comorbidity, and higher personal distress. Urban population, higher quality of life, smaller number of stressors, and lower personal distress contributed to recovery of PTSD. It is essential to know the risk and resilience factors that contribute to the development and recovery of PTSD, which is important for prevention and treatment of this disorder

Analysis of the Relationship between Higher-Order Factor Structure of Personality Disorders and the Five-Factor Model of Personality

The growing body of evidence on the dimensional classification of personality disorders (PD) has resulted in its acceptance in the ICD-11 classification, which abolished categories and retains only a general description of PD. Specifying the type of PD is optional, and the suggested domains represent maladaptive variants of the five-factor model of personality (FFM). The aim of our study was to explore the existence of a joint structure between maladaptive and normal personality traits, and to investigate how these structures are integrated. The study included 223 patients who had been diagnosed with PD and completed the Structured Clinical Interview for DSM-5 Personality Disorders and the NEO Personality Inventory-Revised (NEO-PI-R). To determine the degree of overlap between PD domains and NEO PI–R scales, a canonical analysis of covariance was conducted. Our findings showed a relationship between the internalizing PD spectrum (consisting of avoidant, dependent, and borderline traits with detached and anankastic traits) and high neuroticism, low conscientiousness, and moderately low agreeableness and extroversion, suggesting the existence of a broad personality disorder factor. However, the internalizing dimensions exhibited a more pronounced effect within this construct. Furthermore, we identified a second function that demonstrated a link between the externalizing PD spectrum (including narcissistic, histrionic, and antisocial traits) and high extraversion, high openness, and low agreeableness, suggesting the existence of an externalizing factor. Overall, our findings provide evidence for a joint structure of maladaptive and normal personality traits in a sample of personality disorders and emphasize the importance of integrating the FFM model in PD evaluation in clinical practice, suggesting that differentiating between major subgroups could assist in adjusting therapeutic approaches

Determinants of quality of life among individuals seeking mental health care after termination of state of emergency due to the coronavirus disease 2019 pandemic

Prompted by the need to measure the impact of the coronavirus disease 2019 on main areas of quality of life related to mental health (MH), the COV-19-impact on quality of life (COV19-QoL) scale has been developed recently. We measured how patients seeking face-to-face MH care perceived the coronavirus disease 2019 impact on QoL and how socio-demographic factors, stress, and personality contributed to QoL in this diagnostically diverse population. Patients aged 18 to 65 years (n = 251) who came for the first time to the outpatient units during the 6-week index-period (May 21-July 1, 2020) were included. The cross-sectional assessment involved sociodemographic variables, working diagnosis, personality traits (7-dimension model, including HEXACO and DELTA), stress (list of threatening experiences and proximity to virus), and COV19-QoL. The perceived impact of the pandemic on QoL was above the theoretical mean of a 5-point scale (COV19-Qol = 3.1 +/- 1.2). No association between total COV19-QoL score, sociodemographic parameters, and working diagnoses was found in the present sample. After testing whether positional (threatening experiences), or dispositional (personality) factors were predominant in the perceived impact of COV-19 on QoL, significant predictors of the outcome were personality traits Disintegration (B = 0.52; P lt .01) and Emotionality (B = 0.18; P lt .05). It seems that pervasiveness and uncertainty of the pandemic threat triggers-especially in those high on Disintegration trait-a chain of mental events with the decrease of QoL as a final result. Present findings could be used to establish a profile of MH help seeking population in relation to this biological disaster, and to further explore QoL and personality in different contexts

Prescribing practices in Southeastern Europe – focus on benzodiazepine prescription at discharge from nine university psychiatric hospitals

There is much concern about the widespread long-term use of benzodiazepines. Our manuscript addressed its use in the region of Southeastern Europe, which seems extensive, but insufficiently explored. At nine university psychiatric hospitals (Croatia, Macedonia and Serbia), we retrospectively analyzed discharge summary documents to find the prevalence of discharge benzodiazepine prescriptions and the prescribed benzodiazepine doses. This study included 1047 adult subjects and showed that 81.9% of them had benzodiazepines prescribed in the discharge summary document, with high mean daily dose of around 5 mg lorazepam equivalents. Factors associated with the prescriptions were exclusively clinical factors (diagnosis of schizophrenia spectrum disorders, more lifetime hospitalizations, psychiatric comorbidity, co-prescription of antidepressant or mood stabilizer, shorter duration of the hospitalization), while socio-demographic factors were not found to influence benzodiazepine discharge prescriptions. Similarly, factors which influenced the prescription of higher daily benzodiazepine dose were more lifetime psychiatric hospitalizations and co-prescription of antidepressant or mood stabilizer, as well as the diagnosis of mental/behavioral disorders due to substance use and co-prescribed antipsychotic. Our data are emphasizing an urgent need for guidelines and improved education of both health care professionals and patients, in order to prevent long term benzodiazepine (mis)use and related side-effects