Short and longer-term psychological consequences of Operation Cast Lead: documentation from a mental health program in the Gaza Strip
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- 作者：Augusto E Llosa (1)
Germán Casas (2) (3)
Hélène Thomas (4)
Angels Mairal (4)
Rebecca F Grais (1)
Marie-Rose Moro (3) (5) - 关键词：Mental health ; Psychological ; PTSD ; Internally displaced persons ; Refugees ; Conflict ; War ; Cast lead ; Palestinian ; Gaza
- 刊名：Conflict and Health
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：6
- 期：1
- 全文大小：196KB
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Germán Casas (2) (3)
Hélène Thomas (4)
Angels Mairal (4)
Rebecca F Grais (1)
Marie-Rose Moro (3) (5)
1. Epicentre, 8 rue Saint Sabin, Paris, 75011, France
2. School of Medicine, Los Andes University, Carrera 7, N 116-05, Bogotá, Colombia
3. Médecins Sans Frontières, 8 rue Saint Sabin, Paris, 75011, France
4. Medecins Sans Frontieres, El Hajaj Ibn Youssuf Street, Shufat Main road, Kragujevac, Jerusalem
5. Cochin Hospital, Université Paris Descartes, Unité INSERM 669, Paris, 75014, France
文摘
Background There is growing recognition of the psychological impact of adversity associated with armed conflict on exposed civilian populations. Yet there is a paucity of evidence on the value of mental health programs in these contexts, and of the chronology of psychological sequelae, especially in prolonged conflicts with repeated cycles of extreme violence. Here, we describe changes in the psychological profile of new patients in a mental health program after the military offensive Cast Lead, in the context of the prolonged armed conflict involving the Gaza Strip. Methods This study analyses routinely collected program data from a Médecins Sans Frontières mental health program in the Gaza Strip spanning 2007-011. Data consist of socio-demographic as well as clinical baseline and follow-up data on new patients entering the program. Comparisons were made through Chi square and Fisher’s exact tests, univariate and multivariate logistic and linear regression. Results PTSD, depression and other anxiety disorders were the most frequent psychopathologies, with 21% having multiple diagnoses. With a median of nine sessions, clinical improvement was recorded for 83% (1122/1357), and more common for those with separation anxiety, acute and posttraumatic disorders as principal diagnosis (855/1005), compared to depression (141/183, p<0.01). Noted changes proximal to Operation Cast Lead were: a doubling in patient case load with a broader socio-economic background, shorter interval from an identified traumatic event to seeking care, and a rise in diagnoses of acute and posttraumatic stress disorders. Sustained changes included: high case load, more distal triggering events, and increase in diagnoses of other anxiety disorders (especially for children 15 years and younger) and depression (especially for patients 16 years and older). Conclusion Evolving changes in patient volume, diagnoses and recall period to triggering events suggest a lengthy and durable effect of an intensified exposure to violence in a context of prolonged conflict. Our findings suggest that mental health related humanitarian relief in protracted conflicts might need to prepare for an increase in patients with changing profiles over an extended period following an acute flare-up in violence.