Trauma and mental health of medics in eastern Myanmar’s conflict zones: a cross-sectional and mixed methods investigation

Conflict and Health

Douglas P Jutte⁴  Eh Kalu Shwe Oo²  Lawrence Stock³  Andrew George Lim¹ 

[1] Present address: 2550 Ninth St., Suite III, Berkeley, CA 94110, USA;Karen Department of Health and Welfare, 9/164 Soi 3 Mae Sot Villa, Intarakiri Rd., Mae Sot, Tak 63110, Thailand;David Geffen School of Medicine at the University of California, Los Angeles, 924 Westwood Blvd., Suite 300, Los Angeles, CA 90024, USA;UC Berkeley-UCSF Joint Medical Program at the University of California, Berkeley School of Public Health, 570 University Hall #1190, Berkeley, CA 94720, USA

关键词: Vicarious traumatization;    Burnout;    Depression;    Anxiety;    Medics;    Healthworkers;    Conflict;    PTSD;    Mental health;    Trauma;    Myanmar;    Burma;   

Others  :  804555
DOI  :  10.1186/1752-1505-7-15

 received in 2013-01-14, accepted in 2013-07-21,  发布年份 2013

【 摘 要 】

Background

In conflict and disaster settings, medical personnel are exposed to psychological stressors that threaten their wellbeing and increase their risk of developing burnout, depression, anxiety, and PTSD. As lay medics frequently function as the primary health providers in these situations, their mental health is crucial to the delivery of services to afflicted populations. This study examines a population of community health workers in Karen State, eastern Myanmar to explore the manifestations of health providers’ psychological distress in a low-resource conflict environment.

Methods

Mental health screening surveys were administered to 74 medics, incorporating the 12-item general health questionnaire (GHQ-12) and the posttraumatic checklist for civilians (PCL-C). Semi-structured qualitative interviews were conducted with 30 medics to investigate local idioms of distress, sources of distress, and the support and management of medics’ stressors.

Results

The GHQ-12 mean was 10.7 (SD 5.0, range 0–23) and PCL-C mean was 36.2 (SD 9.7, range 17–69). There was fair internal consistency for the GHQ-12 and PCL-C (Cronbach’s alpha coeffecients 0.74 and 0.80, respectively) and significant correlation between the two scales (Pearson’s R-correlation 0.47, P<0.001). Qualitative results revealed abundant evidence of stressors, including perceived inadequacy of skills, transportation barriers, lack of medical resources, isolation from family communities, threats of military violence including landmine injury, and early life trauma resulting from conflict and displacement. Medics also discussed mechanisms to manage stressors, including peer support, group-based and individual forms of coping.

Conclusions

The results suggest significant sources and manifestations of mental distress among this under-studied population. The discrepancy between qualitative evidence of abundant stressors and the comparatively low symptom scores may suggest marked mental resilience among subjects. The observed symptom score means in contrast with the qualitative evidence of abundant stressors may suggest the development of marked mental resilience among subjects. Alternatively, the discrepancy may reflect the inadequacy of standard screening tools not validated for this population and potential cultural inappropriateness of established diagnostic frameworks. The importance of peer-group support as a protective factor suggests that interventions might best serve healthworkers in conflict areas by emphasizing community- and team-based strategies.

【 授权许可】

   
2013 Lim et al.; licensee BioMed Central Ltd.

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