title: Mental health problems among conflict-affected adults in Grozny, Chechnya: a qualitative study.
abstract: BACKGROUND
  A decade of conflict in Chechnya destroyed infrastructure and resulted in widespread exposure to violence. Amidst substantial reconstruction, periodic violence has contributed to an ongoing atmosphere of insecurity. We conducted a qualitative study to understand the mental health and psychosocial problems affecting adult Chechens in this context to inform development of assessment tools for an evaluation study related to individual counseling.
  
  
  METHODS
  Data were collected in July 2014. A convenience sample of 59 Chechen adults was asked to Free List all problems affecting people in the area. Four problems were explored further in 19 Key Interviewee (KI) interviews, with respondents identified using snowball sampling. Data analysis was conducted in Russian by the Chechen interviewers.
  
  
  RESULTS
  Multiple mental health and psychosocial problems emerged, including 'bad psychological health', 'depression', 'stress and nervous people', and 'problems in the family'. Aggression, 'emotional blowing', and 'not adequate' behavior were frequently reported indicators of these problems, with negative effects on the whole family. Chechens reported seeking help through informal social networks, psychiatric and psychological services, and Islamic Centers.
  
  
  CONCLUSIONS
  Chechens reported mental health and psychosocial problems similar to those experienced in other post-conflict settings. The description of 'emotional blowing' mirrored prior findings in Chechen asylum seekers and fits within a cluster of cultural concepts of distress featuring anger that has been identified in other conflict-affected populations. Further exploration of the nature and prevalence of this construct, as well as evaluations of interventions aimed at reducing these symptoms, is warranted.
authors.affiliation: Department of Mental Health, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Nguyen
authors.affiliation: Médecins Sans Frontières, Moscow, Russia.
authors.forename: Concetta
authors.initials: C
authors.lastname: Feo
authors.affiliation: Department of Psychiatry, Chechen State University, Grozny, Chechen Republic Russian Federation.
authors.forename: Kyuri
authors.initials: K
authors.lastname: Idrisov
authors.affiliation: Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pintaldi
authors.affiliation: Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands.
authors.forename: Annick
authors.initials: A
authors.lastname: Lenglet
authors.affiliation: Médecins Sans Frontières, Moscow, Russia.
authors.forename: Zalina
authors.initials: Z
authors.lastname: Tsatsaeva
authors.affiliation: Department of Mental Health, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA ; Center for Refugee and Disaster Response, Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Bolton
authors.affiliation: Department of Mental Health, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA ; Center for Refugee and Disaster Response, Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Bass
keywords: Aggression; Chechnya; Depression; Mental health; Psychosocial