Preventing Mental Disorders Among Women Internally Displaced by War in Ukraine: The SHAWL Trial

项目总结 乌克兰战争引发了目前世界上最大的人道主义流离失所事件：自2022年2月以来， 三分之一的乌克兰人被迫离开家园，导致国内超过700万人流离失所 流离失所的人。乌克兰大多数流离失所者是妇女，其中近一半人报告说 心理健康是受战争影响最大的生活领域。大约五分之一的人受到 冲突会发展成精神障碍，特别是抑郁和焦虑障碍。因此，防止流离失所 女性摆脱精神疾病的负担是至关重要的。这一点尤其重要，因为女性会有困难 在乌克兰获得循证精神卫生保健，如果早期症状发展为完全障碍的话。我们 建议采用以社区为基础的接受和承诺疗法(ACT)干预，以预防 因乌克兰战争而流离失所的妇女的精神障碍。ACT是一种基于证据的干预措施， 使用接受、正念和行为改变过程来提高心理灵活性。我们的 由社区合作伙伴、心理健康专家和行为临床试验组成的跨国多学科团队 科学家们对乌克兰受战争影响的人群进行了研究，并成功地使用ACT 改善东欧弱势群体的健康行为。该项目在以下方面具有创新性 人道主义背景：ACT只是作为一项心理健康预防战略在 在乌克兰，还没有被评估为流离失所的人口，也没有被评估为单一的- 会话干预。然而，关于ACT作为一种预防策略的现有证据表明，采用ACT 在乌克兰境内因战争而流离失所的妇女中使用具有很强的潜力，可长期降低风险 对心理健康的不利影响。以社区成员的洞察力和生活经验为指导，包括 对于乌克兰流离失所的妇女，我们将与我们的社区合作伙伴 公共卫生联盟(“联盟”，乌克兰领先的非政府组织，服务于 全国各地的弱势群体)，以及乌克兰领先的精神卫生专家。作为一种直接 由于战争的结果和流离失所人口的需求，该联盟正在为受影响的人提供保健需求 通过移动医疗车进入社区。我们将评估经过调整的单次ACT小组干预 乌克兰西部。作为通过流动货车提供的服务的一部分，我们将使用我们 以前被验证可以筛查和招募被确认为抑郁症和焦虑症风险的女性。我们的 中心假设是，在人道主义背景下提供的ACT干预将帮助流离失所的妇女 学习提高心理灵活性的技能，从而减少抑郁和焦虑的症状 预防精神障碍的发生。这一奖项的预期结果是一个潜在有效、可扩展、 以及低强度干预，可以创造超出规划拨款的能力，并在规模上防止 受乌克兰人道主义危机影响的流离失所妇女精神障碍的发展情况。

PROJECT SUMMARY The war in Ukraine has provoked the world’s current largest humanitarian displacement: since February 2022, one-third of Ukrainians have been forced to leave their homes, resulting in upwards of 7 million internally displaced persons. Most of Ukraine’s displaced persons are women, and nearly half of them reported that mental health is the area of life most impacted by the war. Approximately one in five persons affected by conflict will develop mental disorders, notably depressive and anxiety disorders. Thus, preventing displaced women from the burden of mental disease is critical. This is particularly significant as women will have difficulty accessing evidence-based mental health care in Ukraine, if early symptoms develop into full disorders. We propose to adapt a community-based Acceptance and Commitment Therapy (ACT) intervention to prevent mental disorders among women displaced by the war in Ukraine. ACT is an evidence-based intervention that uses acceptance, mindfulness, and behavior change processes to improve psychological flexibility. Our transnational, multidisciplinary team of community partners, mental health experts, and behavioral clinical trial scientists has conducted studies with war-affected populations in Ukraine and successfully used ACT to improve health behaviors among disadvantaged populations in Eastern Europe. This project is innovative in the humanitarian context: ACT is only being newly evaluated as a mental health prevention strategy among displaced populations, has not yet been evaluated as such in Ukraine, and has not been evaluated as a single- session intervention. However, existing evidence on ACT as a prevention strategy suggests that adapting ACT for use among women internally displaced by war in Ukraine has strong potential to reduce risks for long-term adverse mental health effects. Guided by insights and lived experience of community members including displaced women in Ukraine, we will adapt and implement the intervention with our community partner, the Alliance for Public Health (“Alliance,” a leading non-governmental organization in Ukraine that serves vulnerable populations across the country), as well as leading mental health experts in Ukraine. As a direct result of the war and the needs of displaced populations, the Alliance is serving the health needs of impacted communities via mobile medical vans. We will evaluate an adapted, single-session ACT group intervention in Western Ukraine. As part of the services offered through the mobile vans, we will use instruments we previously validated to screen and enroll women identified as at risk for depressive and anxiety disorders. Our central hypothesis is that an ACT intervention delivered in a humanitarian context will help displaced women learn skills to improve psychological flexibility, thereby decreasing symptoms of depression and anxiety and preventing onset of mental disorders. The expected outcome of this award is a potentially effective, scalable, and low-intensity intervention that could create capacity beyond this planning grant and prevent at scale the development of mental disorders among displaced women affected by the humanitarian crisis in Ukraine.