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

项目概要 乌克兰战争引发了全球目前最大规模的人道主义流离失所：自 2022 年 2 月以来， 三分之一的乌克兰人被迫离开家园，导致超过 700 万人流离失所 流离失所者。大多数乌克兰流离失所者是妇女，其中近一半报告说 心理健康是受战争影响最严重的生活领域。大约五分之一的人受到影响 冲突会导致精神障碍，特别是抑郁症和焦虑症。因此，防止流离失所 女性摆脱精神疾病的负担至关重要。这一点尤其重要，因为女性会遇到困难 如果早期症状发展为完全疾病，则在乌克兰获得基于证据的精神卫生保健。我们 建议采用基于社区的接受和承诺疗法（ACT）干预措施来预防 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，并成功利用 ACT 改善东欧弱势群体的健康行为。该项目的创新之处在于 人道主义背景：ACT 仅作为一项心理健康预防策略被重新评估 乌克兰尚未对流离失所人口进行过此类评估，也没有将其视为单一流离失所者 会话干预。然而，关于 ACT 作为预防策略的现有证据表明，调整 ACT 用于乌克兰境内因战争而流离失所的妇女，具有降低长期风险的巨大潜力 不良的心理健康影响。以社区成员的见解和生活经验为指导，包括 在乌克兰流离失所的妇女中，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，为 全国各地的弱势群体），以及乌克兰领先的心理健康专家。作为直接 由于战争和流离失所者的需求，该联盟正在满足受影响人群的健康需求 通过移动医疗车的社区。我们将评估经过调整的单次 ACT 小组干预 乌克兰西部。作为通过移动货车提供的服务的一部分，我们将使用我们的仪器 此前已验证用于筛查和招募被确定有抑郁症和焦虑症风险的女性。我们的 中心假设是，在人道主义背景下实施的 ACT 干预措施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。该奖项的预期成果是一个潜在有效的、可扩展的、 和低强度干预，可以创造超出本规划拨款的能力，并防止大规模 受乌克兰人道主义危机影响的流离失所妇女出现精神障碍。

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.