Competency-based training and supervision: development of the WHO-UNICEF Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) initiative.

Globally, there has not been a standardised approach to ensure that the growing number of people who are not licensed clinicians but are delivering psychological interventions and mental health services have the competencies to deliver those interventions and services safely. Therefore, WHO and UNICEF developed Ensuring Quality in Psychosocial and Mental Health Care (EQUIP). EQUIP is a free resource with a digital platform that can be used to guide competency assessment.

Perspectives on competency-based feedback for training non-specialists to deliver psychological interventions: multi-site qualitative study of the EQUIP competency-based approach.

Background: The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care.

Aims: For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems.

Mother, child and adolescent health outcomes in two long-term refugee camp settings at the Thai-Myanmar border 2000-2018: a retrospective analysis.

Aim: The study assessed mothers, children and adolescents' health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.

Background: Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.

Ambiguous loss of home: Syrian refugees and the process of losing and remaking home.

This constructivist-interpretive study examines social-relational dimensions of change and loss following experiences of political terror, war and forced migration from the perspective of Syrian refugee men and women who were presently living in Jordan (n=31). A process model derived from the analysis theorizes four dimensions of ambiguous loss (safety and security, social connections and identities, connection to place, and dreams and imagined future) and to capture the cyclical process of losing and remaking a sense of home in displacement. Our findings underscore a more complex set of processes that remain outside the array of supports and services provided by many current practices and policies with displaced populations generally, and Syrian refugees specifically.

The network structure of posttraumatic stress symptoms in war-affected children and adolescents.

Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents.

Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict.

Associations between gender, torture, and health: A 5-year retrospective cohort analysis.

Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort.

The effect of group support psychotherapy on adherence to anti-retroviral therapy and viral suppression among HIV positive young people: Study protocol for a pilot randomized controlled trial.

Background: Several studies have demonstrated an association between psychological risk factors and HIV disease progression. However, there is limited information on the use of psychological interventions to improve HIV treatment outcomes in young people living with HIV.

Objective: This pilot trial aims to evaluate the feasibility, acceptability and preliminary effectiveness of group support psychotherapy in improving adherence to anti-retroviral therapy and viral suppression in young people living with HIV in Uganda.

Long-Term Effect of Group Support Psychotherapy on Depression and HIV Treatment Outcomes: Secondary Analysis of a Cluster Randomized Trial in Uganda.

Objective: We aimed to determine the effect of group support psychotherapy (GSP) compared with group HIV education (GHE) on depression and HIV treatment outcomes 24 months after treatment. We further aimed to investigate the mediating role of depression and antiretroviral therapy (ART) adherence in the relationship between GSP and viral load suppression.

Methods: Thirty HIV clinics across three districts were randomly assigned to deliver either GSP or GHE for depression.

Perception, practice and proximity. Qualifying threats as psychological torture in international law.

Background: International law prohibits threats made by state officials when amounting to torture or other forms of ill-treatment (hereafter "ill-treatment"). Yet, there remains a pressing need to better distinguish in practice the threatening acts which amount to torture or illtreatment (and as prohibited) from acts which fall short. Responding to this need, this article reviews the literature and offers a discussion towards functionally conceptualising and, in turn, qualifying threats as torture or ill-treatment.

A network analysis of posttraumatic stress symptoms among help-seeking refugees in Kenya.

We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses.

The complex care of a torture survivor in the United States: The case of Joshua.

Introduction: Torture is an assault on the physical and mental health of an individual, impacting the lives of survivors and their families.The survivor's interpersonal relationships, social life, and vocational functioning may be affected, and spiritual and other existential questions may intrude. Cultural and historical context will shape the meaning of torture experiences and the aftermath.

Effectiveness and cost-effectiveness of group support psychotherapy delivered by trained lay health workers for depression treatment among people with HIV in Uganda: a cluster-randomised trial.

Background: WHO recommends the use of psychological interventions as first-line treatment for depression in low-income and middle-income countries. However, evaluations of the effectiveness and cost-effectiveness of such interventions among people with HIV are scarce. Our aim was to establish the effectiveness of group support psychotherapy (GSP) delivered by lay health workers for depression treatment among people living with HIV in a rural area of Uganda on a large scale.

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial.

Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression.

Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU).

Organizational development with torture rehabilitation programs.

Torture rehabilitation has emerged as a field over the past several decades and much of the literature has focused on clinical interventions, related evaluation, and documentation of torture. Less discussed are organizational development initiatives that seek to strengthen organizational effectiveness in order to improve mental health outcomes for torture survivors. Based on applied experience in organizational development with torture rehabilitation programs in post-conflict contexts, the authors explore key organizational development needs in the field of torture rehabilitation, areas of future consideration for international agency donors, and additional future considerations for torture rehabilitation programs themselves.

Sleep deprivation does not work: Epidemiology, impacts and outcomes of incidental and systematic sleep deprivation in a sample of Palestinian detainees.

Background: Sleep deprivation (SD) is a method used in the context of interrogations aimed to obtain submission, information and confessions. Its impact on producing false confessions has been documented. Even information obtained is true, it will be unreliable as it cannot be separated with what has been suggested by interrogators.

Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy.

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC.

Recruitment and Baseline Characteristics of Participants in the Social, Emotional, and Economic Empowerment Through Knowledge of Group Support Psychotherapy Study (SEEK-GSP): Cluster Randomized Controlled Trial.

Background: Psychosocial characteristics, including self-esteem, perceived social support, coping skills, stigma, discrimination, and poverty, are strongly correlated with depression symptoms. However, data on the extent of these correlations among persons living with HIV and the associations between psychosocial characteristics and HIV treatment outcomes are limited in sub-Saharan Africa.

Objective: This paper aims to describe the recruitment process and baseline characteristics associated with depression in a sample of HIV-positive people in a cluster randomized trial of group support psychotherapy (GSP) for depression delivered by trained lay health workers (LHWs).

Defining effective care coordination for mental health referrals of refugee populations in the United States.

Refugee populations arriving to the United States report high rates of exposure to trauma and associated psychiatric distress that may necessitate referrals to mental health services. Although refugee arrivals receive a voluntary health screening, mental health screening is not routine. Public health providers report that one barrier to mental health screening concerns uncertainty about how to connect refugee patients to mental health services.

Psychological capital and life satisfaction of refugees in Canada: Evidence from a community-based educational support program.

Drawing on a 2-year community-based participatory research project, and grounded in the theories of positive psychology, this article examines the effects of targeted educational support on refugee participants' psychological capital (PsyCap)-hope, self-efficacy, resilience, and optimism-as well as life satisfaction. Two groups of participants attended a 14-week trauma-informed, educational support program in 2 consecutive sessions. The program was designed in collaboration with George Brown College, the Centre for Addiction and Mental Health, Wellesley Institute, and the Canadian Centre for Victims of Torture.

The Effect of Group Support Psychotherapy Delivered by Trained Lay Health Workers for Depression Treatment Among People with HIV in Uganda: Protocol of a Pragmatic, Cluster Randomized Trial.

Background: There is limited information on the effectiveness of task shifting of mental health services in populations with HIV.

Objective: This trial aims to evaluate the effectiveness of group support psychotherapy delivered by trained lay health workers to persons living with HIV (PLWH) with depression in primary care.

Methods: Thirty eligible primary care health centers across three districts were randomly allocated to have their lay health workers trained to deliver group support psychotherapy (intervention arm) or group HIV education and treatment as usual (control arm) to PLWH with depression.

The Development and Implementation of a Multi-Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo.

In this article, we present development and feasibility of implementation of a multi-couple group for use with torture-surviving couples. The model was developed in the Democratic Republic of the Congo in a community that experienced widespread torture during the wars from 1998 to 2004. The Torture-Surviving Couple Group model is a short-term intervention designed to use few human resources to address relational difficulties resulting from exposure to traumatic stressors.

The Interplay Between Housing Stability and Child Separation: Implications for Practice and Policy.

Greater understanding of how residential stability affects child separation and reunification among homeless families can guide both child welfare and homeless policy and practice. This article draws upon two longitudinal studies examining services and housing for homeless families and their relationship to family and housing stability. Both studies were conducted in the same state at roughly the same time with similar instruments.

A systematic review of physical activity policy recommendations and interventions for people with mental health problems in Sub-Saharan African countries.

Introduction: There is a need for interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Implementation of physical activity (PA) within the rehabilitation of people with mental health problems (PMHP) could reduce the burden and facilitate recovery. The objective of the current review was to explore (1) the role of PA within mental health policies of SSA countries, and (2) the current research evidence for PA to improve mental health in SSA.