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  • The findings of Peck and colleagues are

    2019-06-12

    The findings of Peck and colleagues are in major ways expected and apply to many developing countries. However, the quest for solutions must integrate many other important questions. To what extent is the report by Peck and colleagues specific for NCDs and not only a reflection of an overall non-optimum health system? Answering this question will help to segregate solutions into those targeting an overall improvement in the health system, and those specifically addressing NCDs. Tanzania has had Standard Treatment Guidelines since 1991 in the form of a combined document that covers the disorders researched by Peck and colleagues. The guidelines are a national policy that health workers in the country are expected to implement. If the absence of guidelines referred to by Peck and colleagues also extends to the Tanzanian Standard Treatment Guidelines, then wide dissemination of this document as opposed to concentrating on NCD-specific guidelines will probably have a huge effect.
    In their Article in , Derrick Silove and colleagues describe how different forms of recurrent political violence have affected mental health in Timor-Leste. The paper establishes several advances in epidemiological studies of mental health in conflict-affected populations. One of the most important is ache inhibitor of high-quality epidemiological sampling and validated mental health measures with information about relevant social conditions, a good qualitative grounding, personally meaningful experience, and local historical context. Epidemiological studies that measure potentially traumatic events and post-traumatic stress disorder in low-income countries have been criticised as deficient in culturally salient meaning and relevance to interventions. By contrast, culturally informed epidemiological studies integrate anthropological methods of in-depth interviews and qualitative fieldwork to identify local idioms of distress, illness experiences, and sociocultural context to form the basis for relevant and valid research questions. Epidemiological articles are generally terse—journalistic styles are often used—so in assessing the qualitative basis for a transcultural epidemiological study, principle of segregation is important to recognise substantial qualitative research that might be published in journals of different specialties. For example, the study by Silove and colleagues was informed by previous qualitative research of East Timorese people living in Australia, which showed that trauma was a historical process of collective suffering imbued with meaning in relation to a struggle for justice. Silove and colleagues also noted the personal and social importance of trauma experienced as human rights violations, and the relevance of mental health care for recovery from political trauma. The identification of trauma events as human rights violations is being increasingly noted in epidemiological studies of conflict-affected populations. By recognising moral, legal, and political links between trauma, perpetrators, and social context, the adverse effects can be better linked to means of personal and social recovery and resilience. In this study and others, traumatic experiences, post-traumatic stress disorder, and depression have been associated with several factors that can affect a country\'s chances of peace and security after conflict: unresolved injustice, desire for revenge, attitudes to legal redress, and whether violence or non-violence is considered a means to peace. Silove and colleagues used a longitudinal study design identifying historical eras, rather than the typical cross-sectional design measuring generic cumulative trauma. As a result, they were able to assess the effects of repeated armed conflict and violent social turmoil, showing the importance of social stabilisation and successful peace processes for the prevention of, and recovery from, individual and social disability, distress, and impairment. They also investigated the contribution of poverty to the development of mental distress—poverty often accompanies sustained armed conflict and is associated with distress and mental illness.