About the War
In the summer of 2021, the U.S military decided to end its 20 years presence in Afghanistan. The resurgence of Taliban during the end of deployment of the U.S military led to the world’s largest refugee crisis causing a forced displacement of more than 6 million people.
The Afghan Evacuee Response Resources
On average forced migrants typically suffer worse mental health than residents of the country they move to. That is a combination of the experiences which forced them to migrate and the difficulties of adjusting to a new country. Not every forced migrant has mental health difficulties, and the screening materials are intended to help identify those who do. Some forced migrants will have mental health problems as a result of trauma, for others homesickness, separation from friends and family and problems in the place they have settled (for instance with housing, lack of employment, difficulty in adjusting to a new environment) can lead to anxiety and depression even in those who are not traumatised.
When people experience psychological trauma the majority will experience a period of acute stress. This gradually reduces in many people over a period of a month to six weeks. However some traumatised people will have continuing stress problems which do not get better or even get worse and they should be assessed and, where necessary, offered treatment.
Below you will find a collection of materials which we hope professionals and third-sector volunteers working with Afghan refugees will find useful. There are three types of material:
- Materials for those helping refugees, both professionals and third sector volunteers, to understand how best to deal with people in acute distress immediately after a traumatic event.
- Materials that can be given to people affected by traumatic events to help them understand how they are feeling and things they can do themselves to help them feel better.
- Screening questionnaires. These are intended for use by health and social care professionals and others with experience in working with mental health problems and familiarity with common mental health problems to help identify those who need further assessment.
Educational Resources about Trauma and its Effects:
Psychological First Aid: Guide for Field Workers
This guide covers psychological resources focusing on humane, supportive, and practical aspects when working in a humanitarian setting. It is written for professionals to help those experiencing extremely distressing events.
Source: World Health Organisation. (2011, October 2). Psychological first aid: Guide for field workers.
Dealing with Trauma
Dealing with Trauma is a clear easy to read informational guide for people for people who have recently experienced a traumatic event. It is also very useful for those helping them because they give a clear explanation of how people react to traumatic experiences, common symptoms and when to refer on for further help. So they can be useful both to refugees and to those who are helping them.
Source: British Red Cross, Psychosocial and Mental Health Team. (2020, December 22). Coping after a traumatic event.
Doing what matters in times of stress: An illustrated guide
This is a stress management guide to help people with practical skills to help cope with stress. This guide can be used with anyone for a few minutes each day to practice some self-help strategies.
Source: Doing what matters in times of stress: an illustrated guide. Geneva: World Health Organization; 2020. License: CC BY-NC-SA 3.0 IGO.
How Trauma Can Affect You
How Trauma Can Affect You is a handout that covers information for children and young people focusing on normalising common reactions to traumatic events that includes anxiety, unwanted memories, nightmares, and poor sleep.
Source: Psychology Tools. (2020). How Trauma Can Affect You. Reading.
Reactions to Trauma
Reaction to Trauma is an information handout designed for adults. It describes symptoms after experiencing trauma – including re-experiencing symptoms, hyperarousal, and avoidance. It also gives helpful pointers about what to do to help someone who has experienced trauma.
Source: Psychology Tools. (2020). Reactions To Trauma. Reading.
Understanding Post-Traumatic Stress Disorder
Understanding Post-Traumatic Stress Disorder is a guide to help people with PTSD to learn more about their condition. This guide comprises a description of trauma, symptoms of PTSD, and effective treatments. Furthermore, the guide covers maintenance factors that include unprocessed memories, beliefs about trauma, and its consequences, and coping strategies.
Source: Psychology Tools. (2022). Understanding Post Traumatic Stress Disorder. Reading.
These resources are intended for mental health professionals and those with experience in identifying and managing common mental health problems. The resources are in English, Dari, Farsi, and Pashto where available. We have provided English versions where Dari, Farsi and Pashto versions are not available but we will add translations as soon as possible. If necessary they can be administered orally, via an interpreter since they are being used to screen not to make a diagnosis.
Trauma Screening Questionnaire (TSQ)
The TSQ is a 10-item symptoms screen for use with survivors of all sorts of traumatic events. It is short, easy to understand and quick and simple to use. It performs as well in practice as lengthier and more complicated screens. Its plain simple language is a particular advantage. Anyone scoring 6 or more “yes” responses should be referred on (if they are willing) for further specialist assessment. Where someone does not speak English and the scale has to be administered via an interpreter it would be prudent to reduce the threshold to 5 which increases sensitivity at the expense of reduced specificity. The questionnaire asks for the refugee to identify a traumatic event they have experienced and answer the questions with respect to that traumatic event. It is not a diagnostic test, diagnosis of post-traumatic stress disorder is by clinical interview.
Source: Brewin, C. R., Rose, S., Andrews, B., Green, J., Tata, P., McEvedy, C., Turner, S., and Foa, E. B. (2002). Brief screening instrument for post-traumatic stress disorder. The British Journal of Psychiatry, 181, 158-162.
The GAD-7 is a patient questionnaire which is used as a screening tool and severity measure for Generalised Anxiety Disorder (GAD). To download the questionnaire, click the language you would like it in below:
Source: Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.
The PHQ-9 is a multipurpose resource that helps screen, diagnose, monitor and measure the severity of depression. To download the PHQ-9, click the language you would like it in below:
Source: Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515. https://doi.org/10.3928/0048-5713-20020901-06
Children’s Impact of Event Scale
The Children’s Impact of Event Scale (CRIES-8) is one of the most widely used resources for measuring traumatic stress symptoms in children aged 8 and older. To download the Children’s Impact of Event Scale, click the language you would like it in below:
Source: Perrin, S., Meiser-Stedman, R., & Smith, P. (2005). The children’s revised impact of event scale (CRIES): Validity as a screening instrument for PTSD. Behavioural and Cognitive Psychotherapy, 33(4), 487–498.
Life Events Checklist for DSM-5 (LEC-5)
The Life Events Checklist for DSM-5 (LEC-5) is a self-report measure designed to screen for potentially traumatic events in a respondent’s lifetime. The LEC-5 assesses exposure to 16 events known to potentially result in PTSD or distress and includes one additional item assessing any other extraordinarily stressful event not captured in the first 16 items, click the language you would like it in below:
- LEC-5 (standard self-report) (English)
- LEC-5 (extended self-report) (English)
- LEC-5 Interview (with abuse ratings) (English)
Source: Gray, M., Litz, B., Hsu, J., & Lombardo, T. (2004). Psychometric properties of the Life Events Checklist. (PDF) Assessment, 11, 330-341. doi: 10.1177/1073191104269954 PILOTS ID: 26825
Links to Recordings for Symptom Management and Relaxation
A symptom management audio recording in English on guided imagery. Click the link below to listen:
Progressive muscle relaxation
A symptom management audio recording in Farsi or English on progressive muscle relaxation. Click the language you would like to listen to the recording in below:
Soothing breathing exercises
A symptom management audio recording in English or Farsi on soothing breathing exercises. Click the language you would like to listen to the recording in below:
A symptom management audio recording in Farsi on compassionate imagery relaxation. Click the link below to listen:
A very short introduction to grounding
An audio version of an exercise Touchstone IAPT use in Stabilisation treatment. Ideal for Farsi speaking people new to mindfulness, grounding and stabilisation techniques. Click the link below to listen:
Dropping the anchor ACT
An audio version of an exercise Touchstone IAPT use in Stabilisation treatment. Ideal for Farsi speaking people interested in mindfulness, grounding and stabilisation techniques. Click the link below to listen:
The 5-4-3-2-1 grounding technique
An audio version of an exercise Touchstone IAPT use in Stabilisation treatment. Ideal for Farsi speaking people wanting to learn mindful, grounding and stabilisation techniques. Click the link below to listen:
There are two videos on Diaphragmatic breathing, both in Farsi. Try both to find out which is most helpful to you. Click the links below to listen:
Links to Educational Films about Trauma and it’s Effects
Here are links to films that were produced for patients being seen in Woodfield Trauma Service, an NHS stepped care service for refugees and asylum seekers with PTSD.
A film for patients and carers about PTSD psychoeducation
A film for patients and carers PTSD symptoms and memory storage during trauma, available in English and English with Farsi Translation. Click the language you would like to watch the film in below:
A film for patients about basic sleep hygiene, available in English or English with Farsi translation. Click the language you would like to watch the film in below:
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