Takemi Program in International Health
The Takemi Program in International Health seeks to improve health and health systems around the world by welcoming mid-career health professionals and scholars to the Harvard T. H. Chan School of Public Health to conduct path breaking research and develop their leadership skills.
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Mental Health Literacy among Populations in and from War and Conflict Zones
A Narrative Review
Fareeda Abo-Rass 1 and Bizu Gelaye 2
¹ Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA
² Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
Study Context
Mental health literacy (MHL) is vital for enhancing mental health behaviors and outcomes, especially among vulnerable populations. However, there has been limited attention to examining MHL among populations affected by war and political conflict, leaving the field relatively unclear. This is surprising given that these populations often face unique mental health challenges and have limited access to mental health services.
Additionally, with the increasing number of war zones worldwide and the growing number of refugees and immigrants originating from these areas, it is crucial to understand what is currently known about MHL in these contexts and identify future research directions. Addressing this gap can inform the development of targeted interventions and support strategies tailored to the unique needs of these populations.
Aims
This review gathered, synthesized, and summarized existing literature on MHL among individuals in ongoing political conflict or war zones, and refugees specifically from these areas worldwide. The focus was on the studies and populations characteristics, MHL tools and correlates, and examinations related to war.
Methodology
- Databases: This review utilized four databases: Medline, PsycINFO, CINAHL, and Web of Science, in accordance with PRISMA guidelines, and included articles published from January 1997 to December 2024.
- Inclusion criteria: Studies examining populations in ongoing political conflict areas or refugees from these regions; studies on MHL defined by established criteria; and English-language studies encompassing both peer-reviewed and grey literature.
- Exclusion criteria: Studies not adhering to an MHL framework; studies irrelevant to political conflicts; and incomplete protocols.
Study Selection
The selection process yielded 35 studies: 26 on residents in conflict zones and 11 on refugees and immigrants from these areas.
Key Findings
Five key themes aligned with our review’s objectives were identified. For each theme, data from the 35 included studies were systematically extracted and synthesized, highlighting crucial patterns and summarizing the findings descriptively for each study group.
Table 1: Summary of findings by population in and from war and conflict zones
| Theme | Studies of Populations Residing in War and Conflict Zones | Studies of Refugees and Immigrants from War and Conflict Zones |
|---|---|---|
| 1. Study Characteristics | Limited Geographical Scope and Predominantly Quantitative Methods Most studies from four countries used quantitative designs, prioritizing measurement over exploration. | Few Studies and Only Quantitative Methods Research was limited, primarily quantitative, and conducted in only four countries, despite including diverse immigrant and refugee populations. |
| 2. Population Characteristics | Diverse Samples with Limited Gender, Educational, and Clinical Variations Despite diverse populations, studies generally had female-majority samples and limited variations in clinical characteristics. | Limited Sociodemographic Characteristics with High Clinical Characteristics Samples included only adults, with gender-balanced representation, and populations studied showed high levels of PTSD and depression. |
| 3. Measures and Frameworks | Narrow Range of Assessment Instruments and Framework Most research used a few validated tools, like the MHLS and vignette-based measures, mainly assessing general MHL. | Limited Instruments with Emphasis on PTSD and Depression Studies utilized a small range of tools, with several focusing on examining MHL related to PTSD and depression. |
| 4. MHL Levels and Correlates | Surprising Levels Amid Familiar Patterns MHL was moderate to high, with gender, age, and education frequently correlating positively with MHL. | Predominantly Low to Moderate with Expected Correlates MHL was generally low to moderate, with higher education and longer host-country residence related to higher MHL. |
| 5. War and Conflict Related Discussions | Unexamined Relationships Studies did not explore how conflict and war contexts might influence MHL, and only a few acknowledged the sociopolitical background of the samples. | Acknowledged War Context without Explicit Analytical Integration Although the impact of war-related trauma on mental health was frequently noted, direct analytical linkage to MHL was notably absent. |
Conclusions
- The review revealed considerable variability in MHL levels among conflict-affected populations and refugees, highlighting the need for research approaches that better account for sociocultural and political contexts.
- Despite involving diverse populations, most studies featured predominantly female samples with limited variation in clinical characteristics, potentially affecting the generalizability of findings.
- The majority of the studies employed quantitative cross-sectional designs, offering limited qualitative insights into lived experiences and contextual factors. Incorporating qualitative methods would enhance the contextual relevance of findings.
- Insufficient integration of war-related contexts in MHL analyses limits understanding of conflict-specific influences. A nuanced approach that incorporates conflict and sociopolitical factors into MHL studies is essential for more relevant and effective interventions.