Background
Children and adolescents exposed to armed conflict are at high risk of developing mental health problems. To date, a range of psychosocial approaches and clinical/psychiatric interventions has been used to address mental health needs in these groups.
Aims
To provide an overview of peer-reviewed psychosocial and mental health interventions designed to address mental health needs of conflict-affected children, and to highlight areas in which policy and research need strengthening.
Methods

This editorial proposes a shift in emphasis in the field of mental health epidemiology in conflict-affected settings. After a brief summary of the nature of contemporary armed conflicts, we consider the current and potential roles that epidemiology can play with regard to: (1) establishing the burden of mental disorders; (2) identifying risk and protective factors; and (3) intervention research.

Mental health in low- and middle income countries has received increasing attention. This attention has shifted focus, roughly moving from demonstrating the burden of mental health problems, to establishing an evidence base for interventions, to thinking about care delivery frameworks. This paper reviews these trends specifically for humanitarian settings and discusses lessons learned.

Wietse Tol and colleagues discuss some of the key challenges for implementation of new WHO guidelines for stress-related mental health disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary.

Background
Major gaps remain – especially in low- and middle-income countries – in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations’ mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development.
Case description

The mental health needs of people affected by emergencies are significant, but often overlooked by health-care providers. The world is facing an unprecedented number of humanitarian emergencies arising from conflict and disasters. In 2014, nearly 60 million people were forcibly displaced due to conflict, the highest number on record. Climatic and geological hazards continue to take their toll, as seen recently following the devastating earthquake in Nepal, cyclone in Vanuatu and flooding in China, Malawi and Myanmar.

Aims. To discuss the potential usefulness of a public health approach for ‘mental health and psychosocial support’ (MHPSS) interventions in humanitarian settings.

Objective: We examined the prevalence of mental health problems in refugees living in camps that emerged in Tanzania during the Rwanda crisis that started in 1994.
Method: Using the 28-item version of the General Health Questionnaire (GHQ-28), we examined two samples: a random sample (n=854) and a sample of clients of a psychosocial support programme in these camps (n=23). Sensitivity, specificity and positive- and negative predictive values were estimated for several cut-off scores of the GHQ-28.

Context Uncertainties continue about the roles that methodological factors and key risk factors, particularly torture and other potentially traumatic events (PTEs), play in the variation of reported prevalence rates of posttraumatic stress disorder (PTSD) and depression across epidemiologic surveys among postconflict populations worldwide.
Objective To undertake a systematic review and meta-regression of the prevalence rates of PTSD and depression in the refugee and postconflict mental health field.

People with severe mental disorders are a neglected and vulnerable group in complex emergencies. Here, we describe field experiences in establishing mental health services in five humanitarian settings. We show data to quantify the issue, and suggest reasons for this neglect. We then outline the actions needed to establish services in these settings, including the provision of practical training, medication, psychosocial supports, and, when appropriate, work with traditional healers.