Mental illness in Afghanistan
When 66% of the population suffers from a mental illness (1), what are the country’s two psychiatrists (2) to do?
According to a 2006 WHO report on mental health in Afghanistan, as of that year the country’s mental health services were provided by just two psychiatrists, 61 other doctors, 37 nurses, and 40 other mental health workers. For a country whose population in that year was over 31 million (3), these numbers are woefully low, especially given the impact of decades of conflict on the population’s mental health.
According to a study conducted by the U.S. Centers for Disease Control and Prevention in 2002, after the fall of the Taliban government in Kabul, 42% of Afghans suffered from PTSD (Post-traumatic stress disorder) (4). Measurements of PTSD were made using the Harvard Trauma Questionnaire (HTQ) (5), for which 16 of the 30 trauma symptoms it probes for are derived from the DSM-IIIR/IV’s criteria for PTSD (the remaining symptom items relate specifically to refugee trauma) (6). The HTQ is meant to be administered by a mental health care professional, and is not designed to be a self-report questionnaire. Research on the HTQ’s reliability in South Africa has indicated strong test-retest reliability for this measure (7), indicating that this PTSD prevalence rate of 42% is likely accurate.
Given the high rates of PTSD, low numbers of mental health care providers (HCPs), and continuing instability in the country, it is crucial to conduct research on effective PTSD treatment for populations who are at high risk of being exposed to future traumatic stressors. One Afghan psychiatrist, Dr. Nader Alemi, does not shy away from treating Taliban members for mental illness, even though this presents a challenge present in many unstable clinical contexts: His patients keep leaving (8). Whether it is being called off on a mission every three months or fleeing renewed sectarian violence in one’s region, mental HCPs are limited in their ability to provide therapy. Treatments that can ameliorate PTSD symptoms, such as Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), require regular appointments so that patients can create a “trauma narrative” and then undergo a graded exposure to this narrative, and therefore to the events that brought about the stress disorder. But what if the patients cannot commit to regular appointments, and are likely to face new traumatic stressors within the week?
Since peaceful, stable settings are often unavailable in the places where treatment needs are highest, further research into new, innovative therapies needs to be conducted in order to address these pressing health concerns.
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(1) http://news.bbc.co.uk/2/mobile/south_asia/7838270.stm
(2) www.who.int/mental_health/evidence/Afghanistan_WHO_AIMS_Report.pdf
(3) http://www.indexmundi.com/g/g.aspx?c=af&v=21
(4) http://foreignpolicy.com/2012/08/13/ptsdland/
(5) http://www.ncbi.nlm.nih.gov/pubmed/15292083
(6) http://hprt-cambridge.org/screening/harvard-trauma-questionnaire/
(7) http://www.ajol.info/index.php/jcamh/article/view/72614
(8) http://www.bbc.com/news/magazine-29944329
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