One in five people in post-conflict settings suffer from a mental health condition, three times the global estimate
One in five people living in areas affected by conflict have depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, or schizophrenia, new estimates from the World Health Organization (WHO) reveal. The findings, published in The Lancet, show that the impact of conflict on people’s mental health is considerably higher than previous estimates suggest.
According to an analysis of 129 studies published in The Lancet between 1980 and 2017, researchers estimated that approximately one in five people (22%) in post-conflict settings suffer from mental health conditions, and about 9% of conflict-affected populations have a moderate to severe mental health condition.
The figures are also substantially higher than the global estimate for these mental health conditions in the general population, which stands at one in 14 people, according to estimates in the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), which was published in The Lancet.
according to WHO. “Given that the prevalence of mental disorders was found to be very high, there is a need to make sustainable mental health care available in conflict-affected countries. This will require a focus on investment in leadership and governance for mental health and integrated and responsive mental health and social care services in community-based settings,” co-author of the study Dr. Mark van Ommeren, from the Department of Mental Health and Substance Abuse, WHO, Geneva, told MEA WorldWide (MEAWW).
He added: “We are confident that this study provides the most accurate estimates of the prevalence of mental health conditions in areas affected by conflict available today.”
Currently, according to the paper, there are major conflict-induced humanitarian crises in numerous countries, including Afghanistan, Iraq, Nigeria, Somalia, South Sudan, Syria, and Yemen. UN estimates suggest that more than 68.6 million people worldwide have been forcibly displaced by violence and conflict, the highest number of people affected since World War II.
Since current WHO estimates are more than a decade old, the researchers decided to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population.
The findings show that depression and anxiety appeared to increase with age in conflict settings, and depression was more common among women than men. The report states that past studies underestimated the burden of mental health conditions in conflict-affected areas - with higher rates of severe mental health conditions (5% at any one time in the new study compared to 3-4% over a 12-month-period in the 2005 estimates), and also of mild to moderate mental health conditions (17% at any one time in the new estimates compared to 15-20% over a 12-month period in previous estimates). Overall, the mean prevalence was highest for mild mental health conditions (13%), the prevalence for moderate was 4%, and it was 5% for severe conditions.
As health systems do not often function properly in conflict settings, Dr. Ommeren told MEAWW that agencies working in emergency situations should take practical steps to make sure that at any health service, whether primary health-care centers, general hospitals or emergency field hospitals, there is at least one health worker who is capable of assessing and managing mental health conditions.
“This can be done in two ways: by adding a mental health professional to the general health service team; or by training and supervising a generalist, such as a general practitioner or a nurse, in mental health care,” he said.
The revised estimates used research from 129 studies and data from 39 countries published between 1980 and August 2017, including 45 new studies published between 2013 and August 2017.
Settings that have experienced conflict in the last ten years were included. There was limited data for bipolar disorder and schizophrenia, so estimates for these conditions were based on global estimates and did not take into account any increased risk of these conditions in conflict settings. Cases were categorized as mild, moderate, or severe. Natural disasters and public health emergencies, such as Ebola, were not included.