Bulletin of the World Health Organization
Volume 93, Number 12, December 2015, 817-892
http://www.who.int/bulletin/volumes/93/12/en/

.
EDITORIALS
Learning from Ebola: readiness for outbreaks and emergencies
Margaret Chan
doi: 10.2471/BLT.15.165720
.

Research
Improving outcomes for caregivers through treatment of young people affected by war: a randomized controlled trial in Sierra Leone
Ryan K McBain, Carmel Salhi, Katrina Hann, Jim Kellie, Alimamy Kamara, Joshua A Salomon, Jane J Kim & Theresa S Betancourt
Abstract
Objective
To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living in a war-affected area.
Methods
Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention – a cognitive–behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems – in Freetown, Sierra Leone. Overall, 436 participants aged 15–24 years were randomized to receive the intervention (n = 222) or care as usual (n = 214). Household caregivers for the participants in the intervention arm (n = 101) or control arm (n = 103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later in a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional impairment. The caregivers’ mental health – i.e. internalizing, externalizing and prosocial behaviour – was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects.
Findings
Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions in emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026–0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012–0.486) between the two surveys.
Conclusion
A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers.

.

PERSPECTIVES
Including migrant populations in health impact assessments
Lara Miramontes, Kevin Pottie, Maria Benkhalti Jandu, Vivian Welch, Keith Miller, Megan James & Janet Hatcher Roberts
doi: 10.2471/BLT.14.142315
Bulletin of the World Health Organization 2015;93:888-889. doi: http://dx.doi.org/10.2471/BLT.14.142315

In 2010, there were 214 million international migrants worldwide, a number that is projected to double by 2050.1 Migrants’ motives for leaving their countries of origin include employment and education opportunities, escape from conflict and discrimination and the desire to raise families in economically and politically stable environments.
New migrants are often healthier than the general population on arrival, but their health may deteriorate after settlement,2 due to unfamiliar social conditions, infectious diseases, or restricted access to health services. Cultural and linguistic barriers may contribute to poor delivery of health services. The 61st World Health Assembly called on all Member States to “promote migrant-sensitive health policies”.3 Some subgroups – especially refugees – have a greater burden of infectious diseases and mental disorders than the indigenous population.4 Guidelines have been developed to assist health workers in the clinical management of migrating populations.4 However, there are no explicit decision-support tools for policy-makers to ensure health equity for migrants. Here we discuss how health impact assessment can account for the needs of migrant populations…