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Short and longer-term psychological consequences of Operation Cast Lead: documentation from a mental health program in the Gaza Strip.
Llosa A., Casas G., Thomas H., Mairal A., Grais R., Moro M.-R.
Conflict and Health 6, 1 (2012) 8 - http://www.hal.inserm.fr/inserm-00749359
Short and longer-term psychological consequences of Operation Cast Lead: documentation from a mental health program in the Gaza Strip.
Augusto Llosa () 1, Germán Casas2, 3, Hélène Thomas4, Angels Mairal4, Rebecca Grais1, Marie-Rose Moro3, 5
1 :  Epicentre
8 rue Saint Sabin, Paris, 75011
2 :  School of Medicine
Los Andes University
Los Andes University, Carrera 7 N 116-05, Bogotá
3 :  LPCPP - Laboratoire de Psychologie Clinique et Psychopathologie, Psychanalyse
Médecins Sans Frontières – Université Paris V - Paris Descartes : EA4056 – la Maison de Solenn – Centre Henri Piéron – Institut de Psychologie
71 Avenue Edouard Vaillant 92100 Boulogne Billancourt Cedex
4 :  Médecins Sans Frontières
Médecins Sans Frontières
El Hajaj Ibn Youssuf Street, Shufat Main road, Jerusalem
5 :  Troubles du comportement alimentaire de l'adolescent
INSERM : U669 – Université Paris XI - Paris Sud – Université Paris V - Paris Descartes
Maison de Solene 97, Boulevard de Port Royal 75679 PARIS cedex 14
ABSTRACT: BACKGROUND: There is growing recognition of the psychological impact of adversity associated with armed conflict on exposed civilian populations. Yet there is a paucity of evidence on the value of mental health programs in these contexts, and of the chronology of psychological sequelae, especially in prolonged conflicts with repeated cycles of extreme violence. Here, we describe changes in the psychological profile of new patients in a mental health program after the military offensive Cast Lead, in the context of the prolonged armed conflict involving the Gaza Strip. METHODS: This study analyses routinely collected program data from a Medecins Sans Frontieres mental health program in the Gaza Strip spanning 2007--2011. Data consist of socio-demographic as well as clinical baseline and follow-up data on new patients entering the program. Comparisons were made through Chi square and Fisher's exact tests, univariate and multivariate logistic and linear regression. RESULTS: PTSD, depression and other anxiety disorders were the most frequent psychopathologies, with 21% having multiple diagnoses. With a median of nine sessions, clinical improvement was recorded for 83% (1122/1357), and more common for those with separation anxiety, acute and posttraumatic disorders as principal diagnosis (855/1005), compared to depression (141/183, p<0.01). Noted changes proximal to Operation Cast Lead were: a doubling in patient case load with a broader socio-economic background, shorter interval from an identified traumatic event to seeking care, and a rise in diagnoses of acute and posttraumatic stress disorders. Sustained changes included: high case load, more distal triggering events, and increase in diagnoses of other anxiety disorders (especially for children 15 years and younger) and depression (especially for patients 16 years and older). CONCLUSION: Evolving changes in patient volume, diagnoses and recall period to triggering events suggest a lengthy and durable effect of an intensified exposure to violence in a context of prolonged conflict. Our findings suggest that mental health related humanitarian relief in protracted conflicts might need to prepare for an increase in patients with changing profiles over an extended period following an acute flare-up in violence.
Sciences du Vivant/Santé publique et épidémiologie

Articles dans des revues avec comité de lecture
Conflict and Health
Publisher BioMed Central
ISSN 1752-1505 

Mental health – Psychological – PTSD – Internally displaced persons – Refugees – Conflict – War – Cast lead – Palestinian – Gaza
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