Yaghi Mohammad, Chatterjee Sudipto, Alissawi Fouad, Daher Mahmoud, Khader Yehia, Abu Shawish Mohammad, Imad Osama
WHO, occupied Palestinian territory, Gaza.
WHO, occupied Palestinian territory, Gaza.
Lancet. 2021 Jul;398 Suppl 1:S52. doi: 10.1016/S0140-6736(21)01538-5.
There is an absence of mental health services within general hospitals in Gaza. As part of the Ministry of Health plan to develop mental health liaison services, a cross-sectional survey of the prevalence of and risk factors for psychological distress in attendees at two general hospitals was undertaken to estimate and highlight the need for establishing such services.
20 volunteers aged 24-30 years with a degree in psychological or social science from a university accredited by the Palestinian Ministry of Education and Higher Education, and with experience in field data collection for studies in mental health, were selected and trained in the use of the Arabic version of the 12-item General Health Questionnaire (GHQ-12), an internationally and well validated tool for measuring psychological distress in adults. The volunteers were supervised as they screened adult attendees at emergency rooms, inpatient wards and outpatient departments, and women attending the maternity units at two of the largest general hospitals in Gaza (Nasser and Indonesian) over seven consecutive days (March 18-23, 2018). Attendees at emergency and outpatient departments were included if they were on repeat visits with medically unexplained somatic complaints, if they attended with complaints resulting from any kind of social problem, physical or sexual violence, or had a history of any kind of chronic disease. All patients from the internal medicine and inpatient departments were included. The data from the questionnaires were collated and analysed with descriptive and inferential statistics.
1789 attendees (791 men and 998 women) were screened using the GHQ-12. Of these attendees, 23·8% (426 of 1789) had a GHQ-12 score of 6 or 7, indicating the presence of significant psychological distress with a high possibility of caseness (ie, meeting the diagnostic threshold for clinical depression). 36·2% (648 of 1789) scored 8 or above, indicating the presence of moderate to severe depression or anxiety disorders that require immediate clinical intervention. For all of the hospital departments surveyed, individuals with scores of 6 or greater made up a large proportion of the attendees (385 of 660 [58·3%] in emergency rooms, 197 of 306 [64·4%] in inpatient wards, 430 of 711 [60·5%] in outpatient departments, and 62 of 112 [55·4%] in maternity units), in both hospitals. In addition, a set of risk factors were found to be significantly associated with GHQ-12 scores of 6 or greater. These were being a woman (p=0·020), living in villages adjoining the most conflict prone areas (p<0·0001), no or low formal education (p<0·0001), being divorced (p<0·001) or widowed (p<0·0001), being unemployed (p<0·0001), and low family income (monthly income of <1000 ILS; p<0·0001). On further stepwise regression analysis, unemployment and low family income were found to be the most important risk factors associated with GHQ-12 scores of 6 or greater.
In general hospital attendees there was a very high rate of significant psychological distress. Given the absence of mental health services within general hospitals in Gaza, the findings indicate an urgent need to make mental health interventions routinely available through general hospital liaison units in Gaza. The risk factors that were identified indicate that psychosocial interventions and access to developmental support are key components of such clinical services, and will be required to reduce the very large, and mostly unmet, population burden of mental health problems in Gaza.
WHO, occupied Palestinian territory, as part of the EU project "Building Palestinian resilience: improving psychosocial and mental health responses in emergency".
加沙地带的综合医院缺乏心理健康服务。作为卫生部发展心理健康联络服务计划的一部分，对两家综合医院就诊者的心理困扰患病率及风险因素进行了横断面调查，以评估并凸显建立此类服务的必要性。
选取了20名年龄在24至30岁之间的志愿者，他们拥有巴勒斯坦教育和高等教育部认可大学的心理学或社会科学学位，且有心理健康研究领域数据收集经验。对他们进行培训，使其使用阿拉伯语版的12项一般健康问卷（GHQ - 12），这是一种在国际上经过充分验证的用于测量成年人心理困扰的工具。在连续七天（2018年3月18日至23日）里，志愿者在加沙最大的两家综合医院（纳赛尔医院和印度尼西亚医院）的急诊室、住院病房、门诊部门以及产科病房对成年就诊者进行筛查，并接受监督。如果急诊和门诊部门的就诊者因医学上无法解释的躯体不适前来复诊，如果他们因任何社会问题、身体或性暴力导致的不适前来就诊，或者有任何慢性病病史，则纳入调查。内科和住院部的所有患者都被纳入。对问卷数据进行整理，并采用描述性和推断性统计方法进行分析。
使用GHQ - 12对1789名就诊者（791名男性和998名女性）进行了筛查。在这些就诊者中，23.8%（1789人中的426人）的GHQ - 12得分达到6或7，表明存在显著的心理困扰，很有可能符合病例标准（即达到临床抑郁症的诊断阈值）。36.2%（1789人中的648人）得分在8分及以上，表明存在中度至重度抑郁或焦虑障碍，需要立即进行临床干预。在接受调查的所有医院科室中，得分6分及以上的个体在就诊者中占很大比例（急诊室660人中的385人[58.3%]，住院病房306人中的197人[64.4%]，门诊部门711人中的430人[60.5%]，产科病房112人中的62人[55.4%]），两家医院皆是如此。此外，还发现了一组与GHQ - 12得分6分及以上显著相关的风险因素。这些因素包括女性（p = 0.020）、居住在最易发生冲突地区附近的村庄（p < 0.0001）、未接受正规教育或接受的正规教育程度低（p < 0.0001）、离婚（p < 0.001）或丧偶（p < 0.0001）、失业（p < 0.0001）以及家庭收入低（月收入低于1000以色列新谢克尔；p < 0.0001）。进一步的逐步回归分析发现，失业和家庭收入低是与GHQ - 12得分6分及以上相关的最重要风险因素。
在综合医院就诊者中，显著心理困扰的发生率非常高。鉴于加沙地带的综合医院缺乏心理健康服务，研究结果表明迫切需要通过加沙的综合医院联络单位常规提供心理健康干预措施。所确定的风险因素表明，社会心理干预和获得发展支持是此类临床服务的关键组成部分，对于减轻加沙地带非常大且大多未得到满足的心理健康问题人群负担而言是必要的。
世界卫生组织，巴勒斯坦被占领土，作为欧盟项目“增强巴勒斯坦复原力：改善紧急情况下社会心理和心理健康应对措施”的一部分。
