几十年人道主义危机后索马里的心理健康问题:对看法和经历的定性探索。

IF 3.6 Q1 TROPICAL MEDICINE
Md Manirul Islam, Abdiwali Ahmed Siyad, Sk Md Mamunur Rahman Malik
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引用次数: 0

摘要

背景:人道主义危机会增加出现心理健康问题的风险。三十多年来,索马里一直受到冲突、不安全和经济动荡以及气候冲击的影响。然而,80%-90% 有心理健康问题的索马里人都无法获得优质且负担得起的心理保健服务。为了制定一个以证据为基础的、有效的、公平的和人性化的心理健康计划,我们需要全面了解心理健康问题,以及与人们对心理健康的看法、经历和行为相关的护理:我们开展了一项定性研究,探讨索马里人对心理健康问题的看法和经历。我们进行了 3 次关键信息提供者访谈、2 次深入访谈、9 次焦点小组讨论、12 次在私营和公共医疗机构的观察以及超过 12 次非正式讨论。在讨论过程中,我们使用了翻译成索马里语的案例小故事。我们还研究了三个有心理健康问题经历的案例,以了解寻求护理的行为和获得服务的经历:索马里正在从传统的游牧生活方式向定居生活方式转变。社区中的氏族或家庭关系中存在着强大的非正式支持系统。经常发生在部族之间的武装冲突、自然灾害和阿拉伯茶的使用是影响心理健康的三个主要因素。精神问题的发生率可能比实际情况要高。据估计,约 95% 的精神疾病患者得不到适当的治疗。很少有人寻求精神健康方面的治疗,因为他们没有意识到这一点,也因为精神疾病被严重鄙视和忽视。由于文化和费用的原因,那些寻求治疗的人通常会去找传统的治疗师。用于心理健康护理的资源严重不足,劳动力有限,而且往往训练有素。心理健康护理至少存在两个层面的障碍,即个人/家庭层面(如对心理健康认识不足和成见)和服务提供者层面(如缺乏工作人员,诊断、治疗或转介有心理健康问题的人的能力有限和成见)。没有任何工具或循证方案可以解决这些障碍:结论:需要有更多训练有素的心理健康专业人员来实施一项以定性数据为导向的心理健康计划,以解决所有这些问题。鉴于人们对心理健康问题的成见,还需要一种工具来提高公众和卫生工作者对心理健康和心理保健重要性的认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mental health problems in Somalia after decades of humanitarian crises: a qualitative exploration of perceptions and experiences.

Background: Humanitarian crises increase the risk of mental health problems. Somalia has been affected by conflict, insecurity, and economic turmoil for over three decades, as well as climatic shocks. However, 80-90% of Somalis who have mental health problems do not have access to good-quality, and affordable mental health care. To develop an evidence-based, effective, equitable, and humane programme for mental health, we need to have a holistic understanding of mental health problems and care in relation to people's perceptions, experiences, and behaviour related to mental health.

Methods: We undertook a qualitative study to explore Somalis' perceptions and experiences of mental health problems. We conducted three key informant interviews, two in-depth interviews, nine focus group discussions, 12 observations in private and public health facilities and more than 12 informal discussions. We used case vignettes translated into Somali during our discussion. We also studied three cases with experience of mental health problems to understand care-seeking behaviour and the experiences with services available.

Results: Somalia has been moving from a traditional pastoral nomadic lifestyle to a settled one. A strong informal support system exists in the community within clans or family relations. Armed conflict often among clans, natural disasters, and khat use are the three main factors affecting mental health. The prevalence of mental problems is likely greater than is evident. It is perceived that about 95% of people suffering from mental illness remain outside of appropriate care. Few people seek care for mental health problems because they are not aware of it and because it is highly stigmatized and neglected. Those who do seek care usually go to traditional healers because of culture and cost. Resources for mental health care are grossly inadequate with a limited and often poorly trained workforce. At least two levels of barrier to mental health care exist, at the individual/family level (e.g. poor awareness of mental health and stigma) and service provider level (e.g. lack of staff and limited ability to diagnose, treat, or refer persons with mental health problems and stigma). No tool or evidence-based programme is available to address these barriers.

Conclusion: A qualitative data-driven mental health programme that addresses all these issues is needed with more trained mental health professionals. Given the stigma about mental health problems, there is also a need for a tool to raise awareness about mental health and the importance of mental health care among both the public and health workers.

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Tropical Medicine and Health
Tropical Medicine and Health TROPICAL MEDICINE-
CiteScore
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11 weeks
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