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

项目摘要 乌克兰的战争引发了世界上目前最大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700多万人在国内流离失所。 流离失所者。乌克兰的流离失所者大多数是妇女，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 冲突会导致精神障碍，特别是抑郁症和焦虑症。因此，防止流离失所 妇女摆脱精神疾病的负担是至关重要的。这一点尤其重要，因为妇女将很难 在乌克兰，如果早期症状发展成全面疾病，就可以获得循证精神卫生保健。我们 建议采用以社区为基础的接受和承诺疗法（ACT）干预，以防止 乌克兰因战争而流离失所的妇女中的精神障碍。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 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 科学家对乌克兰受战争影响的人口进行了研究，并成功地利用ACT 改善东欧弱势群体的健康行为。该项目具有创新性， 人道主义背景：ACT只是作为一种心理健康预防战略， 流离失所的人口，在乌克兰尚未得到评估，也没有被评估为一个单一的- 会话干预。然而，关于ACT作为一种预防战略的现有证据表明， 在乌克兰因战争而流离失所的妇女中使用， 对心理健康的不良影响。以社区成员的见解和生活经验为指导，包括 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”，乌克兰一个主要的非政府组织， 全国各地的弱势群体），以及乌克兰领先的心理健康专家。直接 由于战争的结果和流离失所人口的需要，联盟正在满足受影响人口的健康需求。 社区通过移动的医疗车。我们将评估一个适应性的，单次ACT组干预， 乌克兰西部。作为通过移动的货车提供的服务的一部分，我们将使用我们 以前验证的筛选和登记妇女确定为抑郁症和焦虑症的风险。我们 核心假设是，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， 预防精神疾病的发生。该奖项的预期成果是一个潜在的有效，可扩展， 和低强度干预，可以创造超出这一规划赠款的能力，并防止大规模的 在乌克兰受人道主义危机影响的流离失所妇女中，

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.