This study will examine patterns of care and management of mental illness among displaced persons in the Republic of Georgia, with a focus on decision-making about care- seeking and types of informal strategies and services used. The study will take a mixed methods approach with semi-structured interviews leading to instrument development. Background: There is limited research on mental health concerns or access to mental health care in low and middle income countries, including among displaced populations. Care-seeking to mental health services is impeded by limited access and stigma of mental illness. The Republic of Georgia is a country in political and economic transition that has experienced significant displacement within its borders. Available research on the displaced population in Georgia suggests that they experience higher rates of psychological disorders and chronic disease. It is not clear how mental health problems among the displaced are conceptualized, addressed, and managed. There is a need to study care-seeking behavior to formal services, as well as to informal services and within social support structures. Available literature on mental health services does not clearly delineate care-seeking and management processes to informal services. Understanding such care-seeking will inform the development of prevention and service delivery interventions. A mixed methods approach allows for in-depth exploration and the development of an instrument that can be adapted to different programmatic settings with migrant and displaced populations. Methods: The study site is Zugdidi, an urban center in northwestern Georgia. The study population is protracted, internally displaced persons (IDPs) ages 18 and over residing in the community. In-depth, qualitative interviews will be carried out with 30-45 IDPs and will include modules on migration history, problem recognition, perceived need, and care-seeking behavior. Interview data will be used to construct an instrument to measure patterns of care and management. The instrument will be pilot tested with 165 IDP households. Local service organizations will be partnered with for future validation studies and hypothesis testing.

Public Health Relevance

Thousands of people are displaced within the borders of the Republic of Georgia, a strategically important country in the Southern Caucasus. Internally Displaced Persons (IDPs) in Georgia lack access to adequate health and mental health care. We know little about their care-seeking behavior to formal and informal mental health services. This study will examine care-seeking to mental health services among Georgian IDPs through qualitative interviews and the development of a scale.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZMH1-ERB-E (02))
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Hill, Lauren D
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Singh, Namrita S; Jakhaia, Nino; Amonashvili, Nino et al. (2016) ""Finding a way out"": Case histories of mental health care-seeking and recovery among long-term internally displaced persons in Georgia. Transcult Psychiatry 53:234-56