Differences in mental health between younger and older adults in complex humanitarian settings in low-income and middle-income countries: retrospective analysis from Médecins Sans Frontières-supported mental health services, 2019-2024.
IF 6.1 2区 医学Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Elburg van Boetzelaer, Raghda Sleit, Erickmar Rodriguez, Germando Kagomba Barathi, Favila Escobio, Joyce L Browne, Umberto Pellecchia, Judith van de Kamp, Martins Dada, Marion Staunton, Agirdo David Akaso, Nicole Wasara, Oscar Franco, Nadia Fredj, Grazia Caleo, Patrick Keating
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引用次数: 0
Abstract
Background: Humanitarian emergencies increase the risk of development or exacerbation of mental health conditions. This study documents how mental health differs between younger and older adults to inform adapted mental health services in humanitarian settings.
Methods: This multicountry study includes adults who accessed Médecins Sans Frontières-supported mental health services in humanitarian settings across 20 low-income and middle-income countries between July 2019 and July 2024. Mental health symptoms and precipitating events were compared between younger (20-49 years old) and older adults (50 years or older) adjusting for sex and displacement status using logistic regression analyses.
Findings: Data of 177 228 adults were included. Adults most frequently presented at mental health services with anxiety-related (44%; 70 496/158 665) and mood-related symptoms (26%; 41 732/158 665). Older adults had higher odds of reporting symptoms related to ageing (adjusted Odds Ratio (aOR)=4.44; 95% CI 3.84 to 5.14), physical complaints (aOR=2.74; 95% CI 2.65 to 2.83), social functioning (aOR=1.12; 95% CI 1.03 to 1.23) and neuro-psychiatry (aOR=1.09; 95% CI 1.02 to 1.17), and lower odds of reporting symptoms related to anxiety (aOR=0.68; 95% CI 0.66 to 0.70), mood (aOR=0.64; 95% CI 0.62 to 0.67) and behaviour (aOR=0.57; 95% CI 0.52 to 0.61), with variation by sex and displacement status. Compared with younger women, older women had higher odds of reporting violence, socioeconomic functioning and displacement, with variation by displacement status. Compared with younger men, older men had higher odds of reporting medical illness.
Interpretation: Significant differences in mental health symptoms were identified between younger and older adults, with variations by sex and displacement status. Older adults were more likely than younger adults to present symptoms related to ageing. Compared with their younger counterparts, older women were more likely to report experiences of violence, and older men were more likely to report medical illness. These findings underscore the need for age-sensitive and sex-sensitive mental health services in humanitarian settings, including staff training on age-related mental health presentations.
背景：人道主义紧急情况增加了精神健康状况发展或恶化的风险。本研究记录了年轻人和老年人之间的心理健康差异，为人道主义环境中适应的心理健康服务提供信息。方法：这项多国研究包括在2019年7月至2024年7月期间在20个低收入和中等收入国家的人道主义环境中获得无国界医生组织支持的心理健康服务的成年人。使用逻辑回归分析对年轻人（20-49岁）和老年人（50岁或以上）的心理健康症状和突发事件进行了比较，调整了性别和流离失所状况。结果：纳入了177228名成年人的数据。在精神卫生服务机构就诊的成年人最常出现焦虑相关症状（44%;70 496/158 665）和情绪相关症状（26%;41 732/158 665）。老年人报告与衰老相关症状的几率更高(调整后的优势比(aOR)=4.44；95% CI 3.84至5.14)、身体症状（aOR=2.74; 95% CI 2.65至2.83）、社会功能（aOR=1.12; 95% CI 1.03至1.23）和神经精神病学（aOR=1.09; 95% CI 1.02至1.17），以及与焦虑（aOR=0.68; 95% CI 0.66至0.70）、情绪（aOR=0.64; 95% CI 0.62至0.67）和行为（aOR=0.57; 95% CI 0.52至0.61）相关的较低报告几率，存在性别和流离失所状况的差异。与年轻妇女相比，老年妇女报告暴力、社会经济功能和流离失所的几率更高，因流离失所状况而异。与年轻男性相比，老年男性报告患病的几率更高。解释：在年轻人和老年人之间发现了心理健康症状的显著差异，并因性别和流离失所状况而异。老年人比年轻人更有可能出现与衰老有关的症状。与年轻女性相比，年长女性更有可能报告遭受暴力，而年长男性更有可能报告患有疾病。这些调查结果强调，需要在人道主义环境中提供对年龄和性别敏感的心理健康服务，包括对工作人员进行与年龄有关的心理健康介绍方面的培训。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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