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Women in post-trafficking services in Moldova: diagnostic interviews over two time periods to assess returning women's mental health.

Ostrovschi NV, Prince MJ, Zimmerman C, Hotineanu MA, Gorceag LT, Gorceag VI, Flach C, Abas MA - BMC Public Health (2011)

Bottom Line: Trafficking in women is a widespread human rights violation commonly associated with poor mental health.We compared diagnoses at the patient level between the two time points by tabulating the diagnoses and carrying out a kappa test of agreement and the Stuart-Maxwell test for marginal homogeneity (an extension of the McNemar test to kxk table). 120/176 (68%) eligible women participated.Women found to have co-morbid PTSD or other forms of anxiety and depression immediately post-return should be offered evidenced-based mental health treatment for at least the standard 12-month period of rehabilitation.

View Article: PubMed Central - HTML - PubMed

Affiliation: N Testemitanu Medical and Pharmaceutical University, Chisinau, Moldova. melanie.abas@kcl.ac.uk

ABSTRACT

Background: Trafficking in women is a widespread human rights violation commonly associated with poor mental health. Yet, to date, no studies have used psychiatric diagnostic assessment to identify common forms of mental distress among survivors returning to their home country.

Methods: A longitudinal study was conducted of women aged 18 and over who returned to Moldova between December 2007 and December 2008 registered by the International Organisation for Migration as a survivor of human trafficking. Psychiatric diagnoses in women at a mean of 6 months after return (range 2-12 months) were made by a trained Moldavian psychiatrist using the Structured Clinical Interview for DSM-IV, and compared with diagnoses recorded in the same women within 5 days of return. We described the socio-demographic characteristics of the women in the sample including both pre and post-trafficking information. We then described the distribution of mental health diagnoses recorded during the crisis intervention phase (1-5 days after return) and the re-integration phase (2-12 months after return). We compared diagnoses at the patient level between the two time points by tabulating the diagnoses and carrying out a kappa test of agreement and the Stuart-Maxwell test for marginal homogeneity (an extension of the McNemar test to kxk table).

Results: 120/176 (68%) eligible women participated. At 2-12 months after their return, 54% met criteria for at least one psychiatric diagnoses comprising post-traumatic stress disorder (PTSD) alone (16%); co-morbid PTSD (20%); other anxiety or mood disorder (18%). 85% of women who had been diagnosed in the crisis phase with co-morbid PTSD or with another anxiety or mood disorder sustained a diagnosis of any psychiatric disorder when followed up during rehabilitation.

Conclusions: Trafficked women returning to their country of origin are likely to suffer serious psychological distress that may endure well beyond the time they return. Women found to have co-morbid PTSD or other forms of anxiety and depression immediately post-return should be offered evidenced-based mental health treatment for at least the standard 12-month period of rehabilitation.

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Related in: MedlinePlus

Study Flow chart.
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Figure 1: Study Flow chart.

Mentions: During the study period, between December 2007 and December 2008, 178 women aged 18 and over were registered with IOM and participated in crisis assessment. See Figure 1. Social workers were subsequently able to trace 150 of these women, of whom two were excluded because of on-going severe physical illness. Of the 176 eligible, nine declined to be approached by the research team, 19 declined to give informed consent after being approached by the research team, and 28 we were unable to trace. Follow-up assessments were ultimately completed for 120 of the 176 women. More than a third (40%) of the interviews took place at the IOM Rehabilitation Center and the majority (60%) took place at various locations chosen by the women, e.g. their home, nearest hospital or the regional social work office. The mean time for the follow-up interview was 6 months after the crisis interview with 65% of women interviewed between 3 and 8 months.


Women in post-trafficking services in Moldova: diagnostic interviews over two time periods to assess returning women's mental health.

Ostrovschi NV, Prince MJ, Zimmerman C, Hotineanu MA, Gorceag LT, Gorceag VI, Flach C, Abas MA - BMC Public Health (2011)

Study Flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104951&req=5

Figure 1: Study Flow chart.
Mentions: During the study period, between December 2007 and December 2008, 178 women aged 18 and over were registered with IOM and participated in crisis assessment. See Figure 1. Social workers were subsequently able to trace 150 of these women, of whom two were excluded because of on-going severe physical illness. Of the 176 eligible, nine declined to be approached by the research team, 19 declined to give informed consent after being approached by the research team, and 28 we were unable to trace. Follow-up assessments were ultimately completed for 120 of the 176 women. More than a third (40%) of the interviews took place at the IOM Rehabilitation Center and the majority (60%) took place at various locations chosen by the women, e.g. their home, nearest hospital or the regional social work office. The mean time for the follow-up interview was 6 months after the crisis interview with 65% of women interviewed between 3 and 8 months.

Bottom Line: Trafficking in women is a widespread human rights violation commonly associated with poor mental health.We compared diagnoses at the patient level between the two time points by tabulating the diagnoses and carrying out a kappa test of agreement and the Stuart-Maxwell test for marginal homogeneity (an extension of the McNemar test to kxk table). 120/176 (68%) eligible women participated.Women found to have co-morbid PTSD or other forms of anxiety and depression immediately post-return should be offered evidenced-based mental health treatment for at least the standard 12-month period of rehabilitation.

View Article: PubMed Central - HTML - PubMed

Affiliation: N Testemitanu Medical and Pharmaceutical University, Chisinau, Moldova. melanie.abas@kcl.ac.uk

ABSTRACT

Background: Trafficking in women is a widespread human rights violation commonly associated with poor mental health. Yet, to date, no studies have used psychiatric diagnostic assessment to identify common forms of mental distress among survivors returning to their home country.

Methods: A longitudinal study was conducted of women aged 18 and over who returned to Moldova between December 2007 and December 2008 registered by the International Organisation for Migration as a survivor of human trafficking. Psychiatric diagnoses in women at a mean of 6 months after return (range 2-12 months) were made by a trained Moldavian psychiatrist using the Structured Clinical Interview for DSM-IV, and compared with diagnoses recorded in the same women within 5 days of return. We described the socio-demographic characteristics of the women in the sample including both pre and post-trafficking information. We then described the distribution of mental health diagnoses recorded during the crisis intervention phase (1-5 days after return) and the re-integration phase (2-12 months after return). We compared diagnoses at the patient level between the two time points by tabulating the diagnoses and carrying out a kappa test of agreement and the Stuart-Maxwell test for marginal homogeneity (an extension of the McNemar test to kxk table).

Results: 120/176 (68%) eligible women participated. At 2-12 months after their return, 54% met criteria for at least one psychiatric diagnoses comprising post-traumatic stress disorder (PTSD) alone (16%); co-morbid PTSD (20%); other anxiety or mood disorder (18%). 85% of women who had been diagnosed in the crisis phase with co-morbid PTSD or with another anxiety or mood disorder sustained a diagnosis of any psychiatric disorder when followed up during rehabilitation.

Conclusions: Trafficked women returning to their country of origin are likely to suffer serious psychological distress that may endure well beyond the time they return. Women found to have co-morbid PTSD or other forms of anxiety and depression immediately post-return should be offered evidenced-based mental health treatment for at least the standard 12-month period of rehabilitation.

Show MeSH
Related in: MedlinePlus