Anxiety Disorders: Ventevogel P

Eisenman D, Weine S, Green B, de Jong J, Rayburn N, Ventevogel P, Keller A, Agani F. · RAND, Santa Monica, California and David Geffen School of Medicine, UCLA, USA. · J Trauma Stress. · Pubmed #16568460 No free full text.

Abstract: Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.

Ventevogel P, De Vries G, Scholte WF, Shinwari NR, Faiz H, Nassery R, van den Brink W, Olff M. · HealthNet TPO, Mental Health Programme, Jalalabad, Afghanistan. · Soc Psychiatry Psychiatr Epidemiol. · Pubmed #17370049 No free full text.

Abstract: BACKGROUND: Recent epidemiological studies in Afghanistan using mental health questionnaires yielded high prevalence rates for anxiety and depression. OBJECTIVES: To explore the validity in the Afghan cultural context of two mental health questionnaires, the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire-20 (SRQ-20). METHODS: The two mental health questionnaires were compared against a 'gold standard' semi-structured psychiatric interview, the Psychiatric Assessment Schedule (PAS). All instruments were administered to a sample of 116 Pashto-speaking patients (53 men, 63 women) attending primary health care facilities in Eastern Afghanistan. RESULTS: Both HSCL-25 and SRQ-20 had modest properties to correctly identify mental disorders, with an AUC (area under the curve) of 0.73 and 0.72 respectively. The optimal cut-off points for this population are different from those often used in transcultural research. For women the optimal cut-off points are higher than usual (2.25 for the HSCL-25 and 17 for the SRQ-20). For men the cut-off point for the HSCL-25 is lower than usual (1.50) and for the SRQ-20 it was 10). CONCLUSIONS: This study underlines the necessity of validating instruments along with cultural context and gender. Earlier studies in Afghanistan may have overestimated the prevalence of mental disorders among women and underestimated the prevalence in men.

Scholte WF, Olff M, Ventevogel P, de Vries GJ, Jansveld E, Cardozo BL, Crawford CA. · Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands. · JAMA. · Pubmed #15292084 links to  free full text

Abstract: CONTEXT: Decades of armed conflict, suppression, and displacement resulted in a high prevalence of mental health symptoms throughout Afghanistan. Its Eastern province of Nangarhar is part of the region that originated the Taliban movement. This may have had a distinct impact on the living circumstances and mental health condition of the province's population. OBJECTIVES: To determine the rate of exposure to traumatic events; estimate prevalence rates of symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety; identify resources used for emotional support and risk factors for mental health symptoms; and assess the present coverage of basic needs in Nangarhar province, Afghanistan. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional multicluster sample survey of 1011 respondents aged 15 years or older, conducted in Nangarhar province during January and March 2003; 362 households were represented with a mean of 2.8 respondents per household (72% participation rate). MAIN OUTCOME MEASURES: Posttraumatic stress disorder symptoms and traumatic events using the Harvard Trauma Questionnaire; depression and general anxiety symptoms using the Hopkins Symptom Checklist; and resources for emotional support through a locally informed questionnaire. RESULTS: During the past 10 years, 432 respondents (43.7%) experienced between 8 and 10 traumatic events; 141 respondents (14.1%) experienced 11 or more. High rates of symptoms of depression were reported by 391 respondents (38.5%); anxiety, 524 (51.8%); and PTSD, 207 (20.4%). Symptoms were more prevalent in women than in men (depression: odds ratio [OR], 7.3 [95% confidence interval [CI], 5.4-9.8]; anxiety: OR, 12.8 [95% CI, 9.0-18.1]; PTSD: OR, 5.8 [95% CI, 3.8-8.9]). Higher rates of symptoms were associated with higher numbers of traumas experienced. The main resources for emotional support were religion and family. Medical care was reported to be insufficient by 228 respondents (22.6%). CONCLUSIONS: In this survey of inhabitants of Nangarhar province, Afghanistan, prevalence rates of having experienced multiple traumatic events and having symptoms of anxiety, depression, and PTSD were high. These findings suggest that mental health symptoms in this region should be addressed at the population and primary health care level.