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Soller B, Goodkind JR, Greene RN, Browning CR, Shantzek C. Ecological Networks and Community Attachment and Support Among Recently Resettled Refugees. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:332-343. [PMID: 29577334 PMCID: PMC7592197 DOI: 10.1002/ajcp.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Interventions aimed at enhancing mental health are increasingly centered around promoting community attachment and support. However, few have examined and tested the specific ecological factors that give rise to these key community processes. Drawing from insights from the ecological network perspective, we tested whether spatial and social overlap in routine activity settings (e.g., work, school, childcare) with fellow ethnic community members is associated with individuals' attachment to their ethnic communities and access to social resources embedded in their communities. Data on routine activity locations drawn from the Refugee Well-Being Project (based in a city in the Southwestern United States) were used to reconstruct the ecological networks of recently resettled refugee communities, which were two-mode networks that comprise individuals and their routine activity locations. Results indicated that respondents' community attachment and support increased with their ecological network extensity-which taps the extent to which respondents share routine activity locations with other community members. Our study highlights a key ecological process that potentially enhances individuals' ethnic community attachment that extends beyond residential neighborhoods.
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Affiliation(s)
- Brian Soller
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | | | - R Neil Greene
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | | | - Cece Shantzek
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
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Reliability, Validity, and Factor Structure of the Hopkins Symptom Checklist-25: Population-Based Study of Persons Living with HIV in Rural Uganda. AIDS Behav 2018; 22:1467-1474. [PMID: 28667469 DOI: 10.1007/s10461-017-1843-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression and anxiety are highly comorbid among people living with HIV (PLHIV), but few instruments for screening or measurement have been validated for use in sub-Saharan Africa. The objective of this study was to determine the reliability, validity, and factor structure of the 25-item Hopkins Symptom Checklist (HSCL) in a population-based sample of PLHIV in rural Uganda. This study was nested within an ongoing population-based cohort of all residents living in Nyakabare Parish, Mbarara District, Uganda. All participants who identified as HIV-positive by self-report were included in this analysis. We performed parallel analysis on the scale items and estimated the internal consistency of the identified sub-scales using ordinal alpha. To assess construct validity we correlated the sub-scales with related constructs, including subjective well being (happiness), food insecurity, and health status. Of 1814 eligible adults in the population, 158 (8.7%) self-reported being HIV positive. The mean age was 41 years, and 68% were women. Mean HSCL-25 scores were higher among women compared with men (1.71 vs. 1.44; t = 3.6, P < 0.001). Parallel analysis revealed a three-factor structure that explained 83% of the variance: depression (7 items), anxiety (5 items), and somatic symptoms (7 items). The ordinal alpha statistics for the sub-scales ranged from 0.83 to 0.91. Depending on the sub-scale, between 27 and 41% of the sample met criteria for caseness. Strong evidence of construct validity was shown in the estimated correlations between sub-scale scores and happiness, food insecurity, and self-reported overall health. The HSCL-25 is a reliable and valid measure of mental health among PLHIV in rural Uganda. In cultural contexts where somatic complaints are commonly elicited when screening for symptoms of depression, it may be undesirable to exclude somatic items from depression symptom checklists administered to PLHIV.
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Changes in Anxiety and Depression Symptoms Predict Sexual Risk Behaviors Among Young Men Living in Dar es Salaam, Tanzania. AIDS Behav 2018; 22:1435-1445. [PMID: 29168066 DOI: 10.1007/s10461-017-1991-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Young men are important targets in HIV prevention in Tanzania and throughout sub-Saharan Africa. Anxiety and depression are common among youth and may be important predictors of HIV risk behaviors; evidence of these relationships in high-risk populations is needed. Using baseline and 1 year follow-up assessments from an HIV prevention trial we assessed the association between changes in symptoms of anxiety and depression and follow-up sexual risk behaviors (condom use and sexual partner concurrency) controlling for baseline sexual risk behaviors among 1113 male members of social groups known as "camps" in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. In separate models, increases in anxiety and depression were associated with sexual partner concurrency and with lower levels of condom use. In a combined model, both anxiety and depression appeared to independently affect concurrency but only depression was independently associated with condom use, with the association between anxiety and condom use being likely attributable to covariance with depression symptoms. The results of this study indicate the importance of screening and providing treatment for depression and anxiety disorders in high HIV-prevalence contexts, and the need to develop effective HIV prevention interventions targeting young men living with anxiety and depression.
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Depressive Symptoms, Disclosure, HIV-Related Stigma, and Coping Following HIV Testing Among Outpatients in Uganda: A Daily Process Analysis. AIDS Behav 2018; 22:1639-1651. [PMID: 29081046 DOI: 10.1007/s10461-017-1953-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As efforts to end the HIV epidemic accelerate there is emphasis on reaching those living with undiagnosed HIV infection. Newly diagnosed individuals face a number of psychosocial challenges, yet we know little about depressive symptoms in the weeks immediately following diagnosis and how disclosure, coping, and other factors may affect short and longer-term depressive symptoms. Purposively sampled Ugandan outpatients completed structured interviews immediately prior to testing for HIV, daily for 28 days after receiving their test results, and at 3 and 6 months post-test. The sample included a total of 244 participants: 20 who tested HIV positive at baseline and who provided 342 daily data points, and 224 who tested HIV negative at baseline and who provided 4388 daily data points. We used linear mixed effects modeling to examine changes in depressive symptom scores over the 28 day daily interview period and predictors of depressive symptom scores and changes over time. Results from the mixed modeling revealed that while those diagnosed with HIV showed initially high depressive symptoms following diagnosis, their symptoms decreased significantly and on average fell below the cutoff for possible depression approximately 15 days after diagnosis. Among those who tested HIV-negative, on average their depressive symptoms were below the cutoff for possible depression and did not change over time. Among those diagnosed with HIV, disclosure, especially to a partner, on a particular day was associated with higher depressive symptoms that day. However, those who disclosed to their partner during the 28 days after diagnosis had significantly lower depression scores by the end of the 28 days as well as lower depression scores 3 and 6 months after diagnosis than did those who did not disclose to their partner during the 28 days after diagnosis. Scoring higher on HIV-related stigma on a particular day was associated with higher depressive symptoms that day and engaging in positive coping on a particular day was associated with lower depressive symptoms that day. Positive coping also accelerated the decrease in depressive symptoms over time. These data underscore the importance of timely disclosure to partners and suggest that regular depression screening after diagnosis and provision of mental health services could improve HIV care engagement and treatment outcomes.
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Denison JA, Packer C, Stalter RM, Banda H, Mercer S, Nyambe N, Katayamoyo P, Mwansa JK, McCarraher DR. Factors Related to Incomplete Adherence to Antiretroviral Therapy among Adolescents Attending Three HIV Clinics in the Copperbelt, Zambia. AIDS Behav 2018; 22:996-1005. [PMID: 29103190 DOI: 10.1007/s10461-017-1944-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Little is known about adherence to antiretroviral therapy (ART) among adolescents in sub-Saharan Africa, where the majority of the world's HIV-positive adolescents reside. We assessed individual, household, and HIV self-management characteristics associated with a 48-hour treatment gap in the preceding 3 months, and a pharmacy medication possession ratio (MPR) that assessed the number of ART pills dispensed divided by the number of ART pills required in the past 6 months, among 285 Zambians, ages 15-19 years. Factors significantly associated with a 48-hour treatment gap were being male, not everyone at home being aware of the adolescent's HIV status, and alcohol use in the past month. Factors associated with an MPR < 90% included attending the clinic alone, alcohol use in the past month, and currently not being in school. Findings support programs to strengthen adolescents' HIV management skills with attention to alcohol use, family engagement, and the challenges adolescents face transitioning into adulthood, especially when they are no longer in school.
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Maharaj V, Tomita A, Thela L, Mhlongo M, Burns JK. Food Insecurity and Risk of Depression Among Refugees and Immigrants in South Africa. J Immigr Minor Health 2018; 19:631-637. [PMID: 26984226 DOI: 10.1007/s10903-016-0370-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.
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Affiliation(s)
- Varsha Maharaj
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
| | - Andrew Tomita
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, P.O. Box 198, Mtubatuba, Durban, 3935, South Africa
| | - Lindokuhle Thela
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Mpho Mhlongo
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
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Steel JL, Dunlavy AC, Harding CE, Theorell T. The Psychological Consequences of Pre-Emigration Trauma and Post-Migration Stress in Refugees and Immigrants from Africa. J Immigr Minor Health 2018; 19:523-532. [PMID: 27562386 DOI: 10.1007/s10903-016-0478-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Over 50 million people have been displaced, some as a result of conflict, which exposure can lead to psychiatric sequelae. The aims of this study were to provide estimates of pre-emigration trauma, post-migration stress, and psychological sequelae of immigrants and refugees from predominantly Sub-Saharan Africa who immigrated to Sweden. We also examined the predictors of the psychiatric sequelae as well as acculturation within the host country. A total of 420 refugees and immigrants were enrolled using stratified quota sampling. A battery of questionnaires including the Harvard Trauma Questionnaire, Post-Migration Living Difficulties Scale, the Cultural Lifestyle Questionnaire; and the Hopkins Checklist were administered. Descriptive statistics, Chi square analyses, Pearson correlations, analysis of variance, and logistic and linear regression were performed to test the aims of the study. Eighty-nine percent of participants reported at least one traumatic experience prior to emigration. Forty-seven percent of refugees reported clinically significant PTSD and 20 % reported clinically significant depressive symptoms. Males reported a significantly greater number of traumatic events [F(1, 198) = 14.5, p < 0.001] and post-migration stress than females [F(1, 414) = 5.3, p = 0.02], particularly on the financial, discrimination, and healthcare subscales. Females reported a higher prevalence of depressive symptoms when compared to males [F(1, 419) = 3.9, p = 0.05]. Those with a shorter duration in Sweden reported higher rates of PTSD [F(63, 419) = 1.7, p < 0.001]. The greater number of traumatic events was found to be significantly associated with the severity of PTSD symptoms [F(34, 419) = 9.6, p < 0.001]. Using regression analysis, 82 and 83 % of the variances associated with anxiety and depression, respectively, was explained by gender, education, religion, PTSD and post-migration stress. Sixty-nine percent of the variance associated with PTSD included education, number of traumatic events, depressive symptoms and post-migration stress. Forty-seven percent of the variance for acculturation was accounted for by a model that included age, education, duration in Sweden, anxiety, depression, and post-migration stress. These predictors were also significant for employment status with the exception of depressive symptoms. Multidimensional interventions that provide treatments to improve psychiatric symptoms in combination with advocacy and support to reduce stress (e.g., financial, access to health care) are recommended. The focus of the intervention may also be modified based on the gender of the participants.
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Affiliation(s)
- Jennifer L Steel
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Andrea C Dunlavy
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Collette E Harding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Töres Theorell
- Department of Neuroscience Karolinska Institute, Karolinska Institutet, 171 77, Stockholm, Sweden
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Hill LM, Moody J, Gottfredson NC, Kajula LJ, Pence BW, Go VF, Maman S. Peer norms moderate the association between mental health and sexual risk behaviors among young men living in Dar es Salaam, Tanzania. Soc Sci Med 2018; 196:77-85. [PMID: 29156358 PMCID: PMC5768456 DOI: 10.1016/j.socscimed.2017.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/17/2017] [Accepted: 10/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Young men living in Dar es Salaam's informal settlements face environmental stressors that may expose them to multiple determinants of HIV risk including poor mental health and risky sexual behavior norms. We aimed to understand how these co-occurring risk factors not only independently affect men's condom use and sexual partner concurrency, but also how they interact to shape these risk behaviors. METHODS Participants in the study were male members of 59 social groups known as "camps" in Dar es Salaam, Tanzania. We assessed moderation by changes in peer norms of the association between changes in symptoms of anxiety and depression and sexual risk behaviors (condom use and sexual partner concurrency) among 1113 sexually active men. Participants nominated their three closest friends in their camp and reported their perceptions of these friends' behaviors, attitudes, and encouragement of condom use and concurrency. Anxiety and depression were measured using the HSCL-25, and condom use and sexual partner concurrency were assessed through self-report. RESULTS Perceptions of decreasing condom use among friends (descriptive norms) and decreasing encouragement of condom use were associated with lower levels of condom use. Perceptions of increasing partner concurrency and acceptability of partner concurrency (injunctive norms) among friends were associated with higher odds of concurrency. Changes in perceived condom use norms (descriptive norms and encouragement) interacted with changes in anxiety symptoms in association with condom use such that the negative relationship was amplified by norms less favorable for condom use, and attenuated by more favorable norms for condom use. CONCLUSIONS These results provide novel evidence of the interacting effects of poor mental health and risky sexual behavior norms among a hard to reach population of marginalized young men in Dar es Salaam. Our findings provide important information for future norms-based and mental health promotion interventions targeting HIV prevention in this key population.
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Affiliation(s)
- L M Hill
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
| | - J Moody
- Department of Sociology, Duke University, Box 90088, Durham, NC 27708, United States; Department of Sociology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - N C Gottfredson
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
| | - L J Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - B W Pence
- Department of Epidemiology, UNC Chapel Hill, CB# 7435, Chapel Hill, NC 27599, United States.
| | - V F Go
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
| | - S Maman
- Department of Health Behavior, UNC Chapel Hill, CB #7440, Chapel Hill, NC 27599, United States.
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Whitsett D, Sherman MF. Do resettlement variables predict psychiatric treatment outcomes in a sample of asylum-seeking survivors of torture? Int J Soc Psychiatry 2017; 63:674-685. [PMID: 28838279 DOI: 10.1177/0020764017727022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Mental health clinicians who work with asylum seekers provide services to patients who face stressful everyday living conditions. However, little is known about how these problems potentially impact psychiatric treatment within these populations. The purpose of this study was thus to examine whether resettlement factors predict outcomes of a mental health intervention for a sample of asylum-seeking survivors of torture. METHODS The study included data from a US outpatient clinic that specialized in treating asylum-seeking survivors of torture. Patients (primarily from Iraq, Afghanistan and African Countries) were evaluated on demographic factors at intake and psychiatric symptoms throughout the course of treatment. RESULTS Patients experienced significant reductions in depression, anxiety and trauma symptoms, although symptoms still remained near or above clinical thresholds. Stable, uncrowded housing conditions significantly predicted lower depression, anxiety and trauma symptoms at follow-up. CONCLUSION These findings support the hypotheses that individuals seeking asylum within the United States who have survived torture can benefit from psychiatric treatment and emphasize the importance of stable living conditions in improving treatment effectiveness. This suggests the need for further research on social predictors of treatment outcomes, as well as the need for clinicians and policymakers to target improved housing as a potentially important tool to reduce psychiatric problems related to torture and forced migration.
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Affiliation(s)
- David Whitsett
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
| | - Martin F Sherman
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
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Housen T, Lenglet A, Ariti C, Shah S, Shah H, Ara S, Viney K, Janes S, Pintaldi G. Prevalence of anxiety, depression and post-traumatic stress disorder in the Kashmir Valley. BMJ Glob Health 2017; 2:e000419. [PMID: 29082026 PMCID: PMC5654454 DOI: 10.1136/bmjgh-2017-000419] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Following the partition of India in 1947, the Kashmir Valley has been subject to continual political insecurity and ongoing conflict, the region remains highly militarised. We conducted a representative cross-sectional population-based survey of adults to estimate the prevalence and predictors of anxiety, depression and post-traumatic stress disorder (PTSD) in the 10 districts of the Kashmir Valley. METHODS Between October and December 2015, we interviewed 5519 out of 5600 invited participants, ≥18 years of age, randomly sampled using a probability proportional to size cluster sampling design. We estimated the prevalence of a probable psychological disorder using the Hopkins Symptom Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ-16). Both screening instruments had been culturally adapted and translated. Data were weighted to account for the sampling design and multivariate logistic regression analysis was conducted to identify risk factors for developing symptoms of psychological distress. FINDINGS The estimated prevalence of mental distress in adults in the Kashmir Valley was 45% (95% CI 42.6 to 47.0). We identified 41% (95% CI 39.2 to 43.4) of adults with probable depression, 26% (95% CI 23.8 to 27.5) with probable anxiety and 19% (95% CI 17.5 to 21.2) with probable PTSD. The three disorders were associated with the following characteristics: being female, over 55 years of age, having had no formal education, living in a rural area and being widowed/divorced or separated. A dose-response association was found between the number of traumatic events experienced or witnessed and all three mental disorders. INTERPRETATION The implementation of mental health awareness programmes, interventions aimed at high risk groups and addressing trauma-related symptoms from all causes are needed in the Kashmir Valley.
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Affiliation(s)
- Tambri Housen
- Medical Department, Medecins Sans Frontieres, New Delhi, India
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Annick Lenglet
- Public Health Department, Artsen zonder Grenzen, Amsterdam, Netherlands
| | - Cono Ariti
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Showkat Shah
- Department of Psychology, University of Kashmir, Srinagar, India
| | - Helal Shah
- N/A, Medecins Sans Frontieres, Srinagar, India
| | - Shabnum Ara
- N/A, Medecins Sans Frontieres, Srinagar, India
| | - Kerri Viney
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Simon Janes
- Medical Department, Medecins Sans Frontieres, New Delhi, India
| | - Giovanni Pintaldi
- Public Health Department, Artsen zonder Grenzen, Amsterdam, Netherlands
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Thela L, Tomita A, Maharaj V, Mhlongo M, Burns JK. Counting the cost of Afrophobia: Post-migration adaptation and mental health challenges of African refugees in South Africa. Transcult Psychiatry 2017; 54:715-732. [PMID: 29226791 PMCID: PMC5827949 DOI: 10.1177/1363461517745472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are few studies on the role of migration within sub-Saharan Africa and its relation to the development of mental illness. We investigated post-resettlement adaptation and mental health challenges of African refugees/migrants in Durban, South Africa. We interviewed 335 African help-seeking refugees/migrants for anxiety, depression (25-item Hopkins Symptom Checklist) and post-traumatic stress symptoms (30-item Harvard Trauma Questionnaire). Socio-demographic and migration history, focusing on post-migration circumstances and experiences of discrimination in the host country, were obtained. Association between migration and post-settlement factors and mental health outcomes were assessed using adjusted logistic regression models. Prevalence of mental distress was high: 49.4% anxiety, 54.6% depression and 24.9% post-traumatic stress symptoms. After adjustment for family separation since migration, recent arrival in South Africa was associated with increased risk for depression (aOR = 4.0, 95% CI:1.3-11.8) and post-traumatic stress (aOR = 5.2, 95% CI:1.7-15.9), while in unadjusted models, older age on arrival was associated with anxiety (aOR = 5.3, 95% CI:1.4-19.8) and depression (aOR = 6.2, 95% CI:1.6-24.3). History of family separation since migration was independently associated with depression and post-traumatic stress in all models. Discriminatory experiences since migration was also an independent risk factor for all three mental health outcomes. Finally, being divorced/widowed was associated with an increased risk for post-traumatic stress, while higher income earners were protected against post-traumatic symptoms, even after adjustment. Refugees/migrants in South Africa show a significant burden of mental distress that is linked to challenges of adjustment in an often hostile context. Services addressing these and other health-related, social-economic needs should be developed as a priority.
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Transitioning to Second-line Antiretroviral Therapy Among Adolescents in Copperbelt Province, Zambia: Predictors of Treatment Switching and Adherence to Second-line Regimens. Pediatr Infect Dis J 2017; 36:768-773. [PMID: 28099228 DOI: 10.1097/inf.0000000000001547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescents living with HIV (ALHIV) experience less favorable antiretroviral therapy (ART) outcomes than other age groups. First-line treatment failure complicates ART management as second-line regimens can be costlier and have greater pill burdens. Understanding predictors of switching ART regimens and adherence among adolescents on second-line ART may help to prevent poor treatment outcomes. METHODS A quantitative survey was administered to 309 ALHIV attending 3 ART clinics in the Copperbelt Province, Zambia. Medical chart data, including pharmacy refill data, were abstracted. Associations between being on second-line ART and sociodemographic, psychosocial and ART adherence characteristics were tested. Cox proportional hazards models were used to estimate the effect of baseline ART variables on time to switching. RESULTS Ten percent of participants were on second-line regimens. Compared with ALHIV on first-line ART, adolescents on second-line regimens were older (P = 0.02), out of school due to completion of secondary studies (P = 0.04) and on ART longer (P = 0.03). Adolescents on second-line regimens were more likely to report missing ≥48 consecutive hours of drugs in the last 3 months (P = 0.01). Multivariable analysis showed that adolescents who initiated ART with efavirenz-based regimens were more likely to switch to second-line than those put on nevirapine-based regimens (hazard ratio = 2.6; 95% confidence interval: 1.1-6.4). CONCLUSIONS Greater support is needed for ALHIV who are on second-line regimens. Interventions for older adolescents that bridge the gap between school years and young adulthood would be helpful. More research is needed on why ALHIV who start on efavirenz-based regimens are more likely to switch within this population.
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Haroz EE, Ritchey M, Bass JK, Kohrt BA, Augustinavicius J, Michalopoulos L, Burkey MD, Bolton P. How is depression experienced around the world? A systematic review of qualitative literature. Soc Sci Med 2017; 183:151-162. [PMID: 28069271 PMCID: PMC5488686 DOI: 10.1016/j.socscimed.2016.12.030] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022]
Abstract
To date global research on depression has used assessment tools based on research and clinical experience drawn from Western populations (i.e., in North American, European and Australian). There may be features of depression in non-Western populations which are not captured in current diagnostic criteria or measurement tools, as well as criteria for depression that are not relevant in other regions. We investigated this possibility through a systematic review of qualitative studies of depression worldwide. Nine online databases were searched for records that used qualitative methods to study depression. Initial searches were conducted between August 2012 and December 2012; an updated search was repeated in June of 2015 to include relevant literature published between December 30, 2012 and May 30, 2015. No date limits were set for inclusion of articles. A total of 16,130 records were identified and 138 met full inclusion criteria. Included studies were published between 1976 and 2015. These 138 studies represented data on 170 different study populations (some reported on multiple samples) and 77 different nationalities/ethnicities. Variation in results by geographical region, gender, and study context were examined to determine the consistency of descriptions across populations. Fisher's exact tests were used to compare frequencies of features across region, gender and context. Seven of the 15 features with the highest relative frequency form part of the DSM-5 diagnosis of Major Depressive Disorder (MDD). However, many of the other features with relatively high frequencies across the studies are associated features in the DSM, but are not prioritized as diagnostic criteria and therefore not included in standard instruments. The DSM-5 diagnostic criteria of problems with concentration and psychomotor agitation or slowing were infrequently mentioned. This research suggests that the DSM model and standard instruments currently based on the DSM may not adequately reflect the experience of depression at the worldwide or regional levels.
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Affiliation(s)
- E E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - M Ritchey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - B A Kohrt
- Duke University, Duke Global Health Institute & Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, United States
| | - J Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - L Michalopoulos
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - M D Burkey
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - P Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
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Tay AK, Jayasuriya R, Jayasuriya D, Silove D. Measurement invariance of the Hopkins Symptoms Checklist: a novel multigroup alignment analytic approach to a large epidemiological sample across eight conflict-affected districts from a nation-wide survey in Sri Lanka. Confl Health 2017; 11:8. [PMID: 28450885 PMCID: PMC5405490 DOI: 10.1186/s13031-017-0109-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The alignment method, a novel psychometric approach, represents a more flexible procedure for establishing measurement invariance in geographically, ethnically, or linguistically diverse samples, especially in large epidemiological surveys. Although the Hopkins Symptoms Checklist (HSCL-25) has been used extensively in the field to assess anxiety and depressive symptoms, questions remain about the comparability of findings when the instrument is applied across regions in large-scale national surveys. METHODS The present study is the first in the field to apply the alignment method to test the structure and measurement invariance of the anxiety and depression dimensions of the HSCL-25 amongst Sri Lankan subpopulations (n = 8456) stratified by geographical regions, levels of past exposure to conflict, and ethnic composition. RESULTS Multigroup CFA analysis yielded non-converging models requiring substantial modifications to the models. As a result, multigroup alignment analysis was applied and the results supported the bifactorial structure and measurement invariance of the HSCL-25 across eight (severe and moderate) conflict-affected districts. The alignment analysis based on a good-fitting configural model yielded a metric non-invariance of 22.22% and scalar non-invariance of 5.88% (both under the established 25% threshold). The bifactorial model outperformed the tripartite and other models. In comparison to the anxiety items, the depressive items showed higher levels of metric non-invariance across districts. CONCLUSIONS Our findings demonstrate the methodological feasibility of applying the alignment method to test the structure and invariance of the HSCL across ethnically diverse populations living in conflict-affected districts in Sri Lanka. Further studies are needed to examine ethnicity and language factors more critically.
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Affiliation(s)
- Alvin Kuowei Tay
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, Liverpool Hospital; School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Rohan Jayasuriya
- Community Medicine and Public Health, Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Dinuk Jayasuriya
- Development Policy Centre, Australian National University, Canberra, Australian Capital Territory (ACT) Australia
| | - Derrick Silove
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, Liverpool Hospital; School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
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Abstract
In spite of the absolute prohibition against torture in international law, this grave human rights abuse is still practiced systematically and with impunity in the majority of countries around the world. Mental health professionals can play a positive role in the fight against torture and impunity, by developing competencies to assess the psychological sequelae of torture. High-quality psychological evidence can help to substantiate allegations of torture, thereby increasing the likelihood of success in civil, administrative, and criminal proceedings. This article will orient mental health professionals to issues specific to forensic assessment of torture survivors. It provides a brief introduction to the sociopolitical context of torture, reviews literature on the psychological sequelae of torture, introduces the reader to key competencies, offers information on strategies for producing documentary evidence and expert opinion, highlights ethical considerations, and suggests areas for development in the field.
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Kikuchi K, Poudel KC, Rwibasira JM, Majyambere A, Mutabazi V, Nyonsenga SP, Muhayimpundu R, Jimba M. Caring for perinatally HIV-infected children: call for mental care for the children and the caregivers. AIDS Care 2017; 29:1280-1286. [PMID: 28359213 DOI: 10.1080/09540121.2017.1307917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antiretroviral therapy has dramatically improved the survival rate of perinatally HIV-infected children. For them to thrive, it is necessary to understand better their mental health issues. Caregivers play an important role in children's daily care and caregiver mental health may relate to children's mental health. However, this association has rarely been studied. Accordingly, the present study examined the associations between depression of caregivers and that of perinatally HIV-infected children in Kigali, Rwanda. We conducted a cross-sectional study of 475 perinatally HIV-infected children aged 7-14 years and their caregivers. We collected children's depression score data via face-to-face interviews with children using the Beck Depression Inventory for Youth. We also collected sociodemographic data using a semi-structured questionnaire with caregivers. In addition, we measured children's weight, height, and collected their clinical records. Data were analyzed via linear and logistic regression analyses. Of all children, 22% had symptoms of depression. Among those who had depressive symptoms (n= 105), 49% had never received psychological support. In both the linear and logistic regression analysis, caregiver's high depression scores were positively associated with children's higher depression scores (AOR: 3.064, 95% CI: 1.723, 4.855, and AOR: 1.759, 95% CI: 1.129, 2.740, respectively). Taking Efavirenz and low height-for-age were also positively associated with higher depression scores among HIV-infected children. Mental health needs to be addressed to improve quality of life of perinatally HIV-infected children. Caregiver's depression was positively associated with children's depressive symptoms. Caring for both children and the caregivers' mental health may prevent the mutual fostering of depression.
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Affiliation(s)
- Kimiyo Kikuchi
- a Institute of Decision Science for a Sustainable Society (IDS3) , Kyushu University , Fukuoka , Japan.,b Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Krishna C Poudel
- c Department of Health Promotion and Policy, School of Public Health and Health Sciences , University of Massachusetts-Amherst , Amherst , USA
| | | | | | | | | | | | - Masamine Jimba
- b Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
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Chorwe-Sungani G, Chipps J. A systematic review of screening instruments for depression for use in antenatal services in low resource settings. BMC Psychiatry 2017; 17:112. [PMID: 28340609 PMCID: PMC5366121 DOI: 10.1186/s12888-017-1273-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/15/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings. METHODS Searching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots. RESULTS Eleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity. CONCLUSION This review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity. PROSPERO REGISTRATION CRD42015020316 .
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Affiliation(s)
- Genesis Chorwe-Sungani
- School of Nursing, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa. .,Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi.
| | - Jennifer Chipps
- 0000 0001 2156 8226grid.8974.2School of Nursing, University of the Western Cape, Private Bag X17, Bellville, 7535 South Africa ,0000 0004 1936 834Xgrid.1013.3Honorary Affiliate, Sydney Nursing School, University of Sydney, Sydney, Australia
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68
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Workman CL, Ureksoy H. Water insecurity in a syndemic context: Understanding the psycho-emotional stress of water insecurity in Lesotho, Africa. Soc Sci Med 2017; 179:52-60. [PMID: 28254659 DOI: 10.1016/j.socscimed.2017.02.026] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
Syndemics occur when populations experience synergistic and multiplicative effects of co-occurring epidemics. Proponents of syndemic theory highlight the importance of understanding the social context in which diseases spread and cogently argue that there are biocultural effects of external stresses such as food insecurity and water insecurity. Thus, a holistic understanding of disease or social vulnerability must incorporate an examination of the emotional and social effects of these phenomena. This paper is a response to the call for a renewed focus on measuring the psycho-emotional and psychosocial effects of food insecurity and water insecurity. Using a mixed-method approach of qualitative interviews and quantitative assessment, including a household demographic, illness, and water insecurity scale, the Household Food Insecurity Access Scale, and the Hopkins Symptoms Checklist-25, this research explored the psycho-emotional effects of water insecurity, food insecurity, and household illness on women and men residing in three low-land districts in Lesotho (n = 75). Conducted between February and November of 2011, this exploratory study first examined the complicated interaction of water insecurity, food insecurity and illness to understand and quantify the relationship between these co-occurring stresses in the context of HIV/AIDS. Second, it sought to separate the role of water insecurity in predicting psycho-emotional stress from other factors, such as food insecurity and household illness. When asked directly about water, qualitative research revealed water availability, access, usage amount, and perceived water cleanliness as important dimensions of water insecurity, creating stress in respondents' daily lives. Qualitative and quantitative data show that water insecurity, food insecurity and changing household demographics, likely resulting from the HIV/AIDS epidemic, are all associated with increased anxiety and depression, and support the conclusion that water insecurity is a critical syndemic dimension in Lesotho. Together, these data provide compelling evidence of the psycho-emotional burden of water insecurity.
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Affiliation(s)
- Cassandra L Workman
- Department of Anthropology, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
| | - Heather Ureksoy
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Wanyama JN, Tsui S, Kwok C, Wanyenze RK, Denison JA, Koole O, van Praag E, Castelnuovo B, Wabwire-Mangen F, Kwesigabo GP, Colebunders R. Persons living with HIV infection on antiretroviral therapy also consulting traditional healers: a study in three African countries. Int J STD AIDS 2017; 28:1018-1027. [PMID: 28162034 DOI: 10.1177/0956462416685890] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditional healers provide healthcare to a substantial proportion of people living with HIV infection (PLHIV) in high HIV burden countries in sub-Saharan Africa. However, the impact on the health of retained patients visiting traditional healers is unknown. In 2011, a study to asses adherence to anti-retroviral therapy (ART) performed in 18 purposefully selected HIV treatment centers in Tanzania, Zambia and Uganda showed that 'consulting a traditional healer/herbalist because of HIV' was an independent risk factor for incomplete ART adherence. To identify characteristics of PLHIV on ART who were also consulting traditional healers, we conducted a secondary analysis of the data from this study. It was found that 260 (5.8%) of the 4451 patients enrolled in the study had consulted a traditional healer during the last three months because of HIV. In multivariable analysis, patients with fewer HIV symptoms, those who had been on ART for >5.3 years and those from Tanzania were more likely to have consulted a traditional healer. However, at the time of the study, there was a famous healer in Manyara district, Loliondo village of Tanzania who claimed his herbal remedy was able to cure all chronic diseases including HIV. HIV treatment programs should be aware that patients with fewer HIV symptoms, those who have been on ART for five or more years, and patients attending ART centers near famous traditional healers are likely to consult traditional healers. Such patients may need more support or counseling about the risks of both stopping ART and poor adherence. Considering the realities of inadequate human resources for health and the burden of disease caused by HIV in sub-Saharan Africa, facilitating a collaboration between allopathic and traditional health practitioners is recommended.
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Affiliation(s)
- Jane N Wanyama
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sharon Tsui
- 2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA
| | - Cynthia Kwok
- 2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA
| | - Rhoda K Wanyenze
- 3 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julie A Denison
- 4 Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - Olivier Koole
- 5 Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | | | - Barbara Castelnuovo
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Wabwire-Mangen
- 3 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gideon P Kwesigabo
- 7 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Robert Colebunders
- 5 Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium.,8 Global Health Institute, University of Antwerp, Belgium
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Kiene SM, Lule H, Sileo KM, Silmi KP, Wanyenze RK. Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior. BMC Infect Dis 2017; 17:88. [PMID: 28103834 PMCID: PMC5248514 DOI: 10.1186/s12879-016-2162-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/22/2016] [Indexed: 12/27/2022] Open
Abstract
Background Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators. Methods In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators. Results Twelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95–2.77) and two or more conditions (AOR 12.77, 95% CI 7.97–20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ2 24.68, p < 0.001). Women experiencing one condition (AOR 3.33, 95% CI 137–8.08) and two co-occurring conditions (AOR 5.87, 95% CI 1.99–17.35) were more likely to test positive for HIV or an STI and women with two co-occurring conditions were also at increased risk for risky sex (AOR 2.18, 95% CI 1.64–2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression. Conclusions This study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an outpatient setting in rural Uganda. The co-occurrence of these factors was associated with greater HIV risk, highlighting the need for a more holistic approach to HIV prevention and care research and programming.
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Affiliation(s)
- Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
| | | | - Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
| | - Kazi Priyanka Silmi
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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71
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Sudfeld CR, Kaaya S, Gunaratna NS, Mugusi F, Fawzi WW, Aboud S, Smithfawzi MC. Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV. AIDS 2017; 31:263-271. [PMID: 27835614 PMCID: PMC5177498 DOI: 10.1097/qad.0000000000001323] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of the study was to assess the relationship of depression at antiretroviral therapy (ART) initiation with mortality and clinical outcomes among Tanzanian women living with HIV. DESIGN We conducted a prospective cohort study of 1487 women who initiated ART in Dar es Salaam, Tanzania. METHODS Symptoms of depression and anxiety were assessed using a Tanzanian-adapted and validated version of the Hopkins Symptom Checklist. Participants attended monthly clinic visits during the first 2 years of ART and CD4 T-cell counts were assessed every 4 months. Proportional hazard models were used to assess the relationship of depression with mortality and clinical outcomes. RESULTS Symptoms consistent with depression were prevalent among 57.8% of women at ART initiation. After multivariate adjustment, including social support and stigma, depression at ART initiation was associated with increased risk of mortality [hazard ratio (HR): 1.92; 95% confidence interval (CI): 1.15-3.20; P = 0.01] and incidence of severe anemia (hemoglobin <8.5 g/dl; HR: 1.59; 95% CI: 1.07-2.37; P = 0.02). Under the assumption of causality, we estimate 36.1% (95% CI: 13.6-55.1%) of deaths among the study cohort were attributable to depression and its consequences. Depression was not significantly associated with trajectory of CD4 T-cell reconstitution or the risk of immunologic failure (P values >0.05). CONCLUSION Elimination of depression may reduce mortality during the first 2 years of ART by one-third in our study cohort. Randomized trials and rigorous implementation studies are needed to evaluate the individual and population-level effects of integrated mental health interventions and HIV treatment approaches in resource-limited settings.
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Affiliation(s)
- Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nilupa S. Gunaratna
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fedinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C. Smithfawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Stranix-Chibanda L, Chibanda D, Chingono A, Montgomery E, Wells J, Maldonado Y, Chipato T, Shetty AK. Screening for Psychological Morbidity in HIV-Infected and HIV-Uninfected Pregnant Women Using Community Counselors in Zimbabwe. ACTA ACUST UNITED AC 2016; 4:83-8. [PMID: 16533796 DOI: 10.1177/1545109706286555] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To examine the prevalence of psychological morbidity in HIV-infected and uninfected pregnant women seeking antenatal care in Zimbabwe. Methods: Pregnant women were screened for psychological morbidity at the initial antenatal care visit using the 14-item Shona Symptom Questionnaire (SSQ) before voluntary HIV counseling and testing (VCT). The primary outcome measure was “cases,” as determined by a SSQ score of= 8. Demographic characteristics and HIV status were compared between cases and noncases to determine the risk factors for psychological morbidity. Results: Of the 437 participants, psychological morbidity was detected in 73 (17%) women before undergoing VCT. Risk factors for psychological morbidity included having a spouse older than 35 years of age. HIV infection by itself was not a risk factor for psychological morbidity for women. Conclusions: There is a high burden of psychological morbidity among pregnant women in Zimbabwe. Mental health services should be integrated into antenatal care to improve psychological health for all women in Zimbabwe.
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Affiliation(s)
- Lynda Stranix-Chibanda
- Department of Pediatrics, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Kagee A, van der Merwe M. Predicting Treatment Adherence among Patients Attending Primary Health Care Clinics: The Utility of the Theory of Planned Behaviour. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124630603600404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment regimens for conditions such as hypertension and Type II diabetes require strict adherence to medical instructions. Yet, adherence among patients living with chronic medical conditions attending public health clinics is typically low. The present study sought to determine the extent to which the Theory of Planned Behaviour (TPB) was able to significantly explain variance in adherence intentions and behaviour in a sample of 117 formerly disadvantaged South Africans living with diabetes and hypertension in the Western Cape. The results showed that the linear combination of TPB variables — Attitudes, Perceived behavioural control, and Subjective norms — was able to account for 47 per cent of the variance in adherence intentions and 23 per cent of the variance in self-reported adherence behaviour. The addition of the variables Psychological distress and Social support to the two regression models, hypothesised to add predictive power to the TPB, yielded non-significant results. The findings of the study are discussed in the context of applying theoretical models of behaviour developed in the industrially developed world and tested on middle-class subjects to patient samples in developing countries such as South Africa. Our findings suggest that social cognitive models of health behaviour such as the TPB may be useful in predicting treatment adherence but should be used in a critical and cautious manner.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
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Hill LM, Maman S, Kilonzo MN, Kajula LJ. Anxiety and depression strongly associated with sexual risk behaviors among networks of young men in Dar es Salaam, Tanzania. AIDS Care 2016; 29:252-258. [PMID: 27469516 DOI: 10.1080/09540121.2016.1210075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study tested the association between mental health scores and sexual risk behaviors among male members of social groups known as "camps" in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. A total of 1113 sexually active men with an average age of 27 years were included in the analyses. Higher anxiety and depression scores were significantly associated with both condom use (Anxiety AOR = 0.58, 95% CI: 0.44, 0.77; Depression AOR = 0.60, 95% CI: 0.47, 0.77) and concurrency (Anxiety AOR = 2.32, 95% CI: 1.73, 3.12; Depression AOR = 2.08, 95% CI: 1.60, 2.70). The results of this study provide information salient to the development of effective HIV prevention interventions targeting populations with high burdens of anxiety and depression. The feasibility and effect of integrating mental health promotion activities into HIV prevention interventions should be explored.
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Affiliation(s)
- Lauren M Hill
- a Department of Health Behavior , University of North Carolina, Chapel Hill , Chapel Hill , NC , USA
| | - Suzanne Maman
- a Department of Health Behavior , University of North Carolina, Chapel Hill , Chapel Hill , NC , USA
| | - Mrema Noel Kilonzo
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , United Republic of Tanzania
| | - Lusajo Joel Kajula
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , United Republic of Tanzania
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Riddler SA, Husnik M, Gorbach PM, Levy L, Parikh U, Livant E, Pather A, Makanani B, Muhlanga F, Kasaro M, Martinson F, Elharrar V, Balkus JE. Long-term follow-up of HIV seroconverters in microbicide trials - rationale, study design, and challenges in MTN-015. HIV CLINICAL TRIALS 2016; 17:204-11. [PMID: 27465646 DOI: 10.1080/15284336.2016.1212561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the effect of biomedical prevention interventions on the natural history of HIV-1 infection in participants who seroconvert is unknown, the Microbicide Trials Network (MTN) established a longitudinal study (MTN-015) to monitor virologic, immunological, and clinical outcomes, as well as behavioral changes among women who become HIV-infected during MTN trials. We describe the rationale, study design, implementation, and enrollment of the initial group of participants in the MTN seroconverter cohort. METHODS Initiated in 2008, MTN-015 is an ongoing observational cohort study enrolling participants who acquire HIV-1 infection during effectiveness studies of candidate microbicides. Eligible participants from recently completed and ongoing MTN trials are enrolled after seroconversion and return for regular follow-up visits with clinical and behavioral data collection. Biologic samples including blood and genital fluids are stored for future testing. RESULTS MTN-015 was implemented initially at six African sites and enrolled 100/139 (72%) of eligible women who seroconverted in HIV Prevention Trials Network protocol 035 (HPTN 035, conducted by the MTN). The median time from seroconversion in HPTN 035 to enrollment in MTN-015 was 18 months. Retention was good with >70% of visits completed. Implementation challenges included regulatory reviews, translation, and testing of questionnaires, and site readiness. CONCLUSIONS Enrollment of HIV-seroconverters into a longitudinal observational follow-up study is feasible and acceptable to participants. Data and samples collected in this protocol will be used to assess safety of investigational HIV microbicides and answer other important public health questions for HIV infected women.
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Affiliation(s)
- Sharon A Riddler
- a Division of Infectious Diseases , University of Pittsburgh , Pittsburgh , PA , USA
| | - Marla Husnik
- b MTN Statistical and Data Management Center , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Pamina M Gorbach
- c Department of Epidemiology , University of California , Los Angeles , CA , USA
| | | | - Urvi Parikh
- a Division of Infectious Diseases , University of Pittsburgh , Pittsburgh , PA , USA
| | - Edward Livant
- e Microbicide Trials Network , Magee-Womens Research Institute , Pittsburgh , PA , USA
| | - Arendevi Pather
- f HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa
| | - Bonus Makanani
- g College of Medicine-John Hopkins University Research Project , Queen Elizabeth Central Hospital , Blantyre , Malawi
| | - Felix Muhlanga
- h UZ-UCSF Collaborative Research Programme , University of Zimbabwe , Harare , Zimbabwe
| | - Margaret Kasaro
- i Centre for Infectious Disease Research in Zambia , Lusaka , Zambia
| | - Francis Martinson
- j UNC Project - Tidziwe Centre , Kamuzu Central Hospital , Lilongwe , Malawi
| | - Vanessa Elharrar
- k Division of AIDS , National Institutes of Health , Bethesda , MD , USA
| | - Jennifer E Balkus
- b MTN Statistical and Data Management Center , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
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Kaaya S, Garcia ME, Li N, Lienert J, Twayigize W, Spiegelman D, Smith Fawzi MC. Association of maternal depression and infant nutritional status among women living with HIV in Tanzania. MATERNAL & CHILD NUTRITION 2016; 12:603-13. [PMID: 25382710 PMCID: PMC6240341 DOI: 10.1111/mcn.12154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antenatal and post-natal depression has demonstrated a significant burden in sub-Saharan Africa, with rates ranging from 10% to 35%. However, perinatal women living with HIV in Tanzania have reported an even greater prevalence of depression (43-45%). The primary goal of this study was to examine the relationship between maternal depression and infant malnutrition among women living with HIV. The design was a retrospective cohort study within the context of a randomised controlled trial among women living with HIV and their infants. Within this trial, 699 mother-child pairs were analysed for the present study. Although antenatal depression was not associated with infant malnutrition and post-natal depression was negatively associated [relative risk (RR = 0.80, P = 0.04], cumulative depression demonstrated a positive association with infant wasting (RR = 1.08, P < 0.01) and underweight (RR = 1.03, P < 0.01) after controlling for confounding factors. Variation in the association between depression and infant nutritional status was observed for episodic vs. chronic depression. These findings suggest that providing evidence-based services for persistent depression among women living with HIV may have an effect on infant malnutrition. In addition, other positive outcomes may be related to infant cognitive development as well as HIV disease prognosis and survival among women.
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Affiliation(s)
- Sylvia Kaaya
- School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Maria E. Garcia
- Department of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Nan Li
- Department of Global Health and PopulationHarvard School of Public HealthBostonMassachusettsUSA
| | - Jeffrey Lienert
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - William Twayigize
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Donna Spiegelman
- Department of EpidemiologyHarvard School of Public HealthBostonMassachusettsUSA
| | - Mary C. Smith Fawzi
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
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Cilliers J, Dube O, Siddiqi B. Reconciling after civil conflict increases social capital but decreases individual well-being. Science 2016; 352:787-94. [PMID: 27174981 DOI: 10.1126/science.aad9682] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/29/2016] [Indexed: 11/02/2022]
Abstract
Civil wars divide nations along social, economic, and political cleavages, often pitting one neighbor against another. To restore social cohesion, many countries undertake truth and reconciliation efforts. We examined the consequences of one such effort in Sierra Leone, designed and implemented by a Sierra Leonean nongovernmental organization called Fambul Tok. As a part of this effort, community-level forums are set up in which victims detail war atrocities, and perpetrators confess to war crimes. We used random assignment to study its impact across 200 villages, drawing on data from 2383 individuals. We found that reconciliation had both positive and negative consequences. It led to greater forgiveness of perpetrators and strengthened social capital: Social networks were larger, and people contributed more to public goods in treated villages. However, these benefits came at a substantial cost: The reconciliation treatment also worsened psychological health, increasing depression, anxiety, and posttraumatic stress disorder in these same villages. For a subset of villages, we measured outcomes both 9 months and 31 months after the intervention. These results show that the effects, both positive and negative, persisted into the longer time horizon. Our findings suggest that policy-makers need to restructure reconciliation processes in ways that reduce their negative psychological costs while retaining their positive societal benefits.
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Affiliation(s)
- Jacobus Cilliers
- McCourt School of Public Policy, Georgetown University, 3700 O Street, Washington, DC 20057, USA
| | - Oeindrila Dube
- Department of Politics, New York University, 19 West 4th Street, New York, NY 10012, USA.
| | - Bilal Siddiqi
- Development Research Group, World Bank, 1818 H Street NW, Washington, DC 20433, USA
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Mlunde LB, Sunguya BF, Mbwambo JKK, Ubuguyu OS, Shibanuma A, Yasuoka J, Jimba M. Correlates of health care seeking behaviour among people who inject drugs in Dar es Salaam, Tanzania. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:66-73. [DOI: 10.1016/j.drugpo.2015.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/02/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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Larsson M, Ross MW, Tumwine G, Agardh A. Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience. Glob Health Action 2016; 9:30790. [PMID: 27032809 PMCID: PMC4816809 DOI: 10.3402/gha.v9.30790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. OBJECTIVE To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. DESIGN In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. RESULTS Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7-5.7; OR 2.0, 95% CI: 1.3-3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1-4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7-3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9-5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04-3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1-8.5; AOR 2.8, 95% CI: 1.3-5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6-7.1; AOR 2.7, 95% CI: 1.4-5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. CONCLUSIONS These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental health and trauma response are critical to meet the health needs of this population.
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Affiliation(s)
- Markus Larsson
- Division for Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden;
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gilbert Tumwine
- Department of Obstetrics and Gynaecology, St Francis Hospital Nsambya, Kampala, Uganda
| | - Anette Agardh
- Division for Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Agardh A, Ross M, Östergren PO, Larsson M, Tumwine G, Månsson SA, Simpson JA, Patton G. Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies. PLoS One 2016; 11:e0150627. [PMID: 26982494 PMCID: PMC4794142 DOI: 10.1371/journal.pone.0150627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/17/2016] [Indexed: 11/29/2022] Open
Abstract
Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group’s health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10–25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6–16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0–2.3), sexual coercion (2010, AOR 2.9; CI: 1.9–4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4–3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.
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Affiliation(s)
- Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
- * E-mail:
| | - Michael Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, United States of America
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Markus Larsson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gilbert Tumwine
- Department of Obstetrics and Gynaecology, St Francis Hospital, Nsambya, Uganda
| | - Sven-Axel Månsson
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - George Patton
- Centre for Adolescent Health, Royal Children’s Hospital, Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Victoria, Australia
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Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:74-81. [PMID: 27017376 DOI: 10.1016/j.drugpo.2016.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL. METHODS This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores. RESULTS A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts. CONCLUSION Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.
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Familiar I, Nakasujja N, Bass J, Sikorskii A, Murray S, Ruisenor-Escudero H, Bangirana P, Opoka R, Boivin MJ. Caregivers' depressive symptoms and parent-report of child executive function among young children in Uganda. LEARNING AND INDIVIDUAL DIFFERENCES 2016; 46:17-24. [PMID: 27175052 PMCID: PMC4860739 DOI: 10.1016/j.lindif.2015.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Maternal mental health (particularly depression) may influence how they report on their child's behavior. Few research studies have focused on Sub-Saharan countries where pediatric HIV concentrates and impacts child neuropsychological development and caregiver mental health. We investigated the associations between caregivers' depressive symptoms and neuropsychological outcomes in HIV-infected (n=118) and HIV-exposed (n=164) Ugandan children aged 2-5 years. We compared performance-based tests of development (Mullen Scales of Early Learning, Color Object Association Test), to a caregiver report of executive function (Behavior Rating Inventory of Executive Function, BRIEF). Caregivers were assessed with Hopkins Symptom Checklist-25 depression subscale. The associations between all BRIEF indices and caregiver's depression symptoms were differential according to child's HIV status. Caregivers with greater depressive symptoms reported their HIV-infected children as having more behavioral problems related to executive functioning. Assessment of behavior of HIV-infected children should incorporate a variety of sources of information and screening of caregiver mental health.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall A227, Lansing MI 48824
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Box 7072, Kampala, Uganda
| | - Judith Bass
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Hampton House Room 861, Baltimore MD 21205
| | - Alla Sikorskii
- Department of Statistics and Probability, Michigan State University, 619 Red Cedar Rd., Wells Hall C423, Lansing MI 48824
| | - Sarah Murray
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Hampton House Room 861, Baltimore MD 21205
| | - Horacio Ruisenor-Escudero
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall A227, Lansing MI 48824
| | - Paul Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, Box 7072, Kampala, Uganda
| | - Robert Opoka
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University PO Box 7072, Kampala, Uganda
| | - Michael J. Boivin
- Department of Psychiatry, Michigan State University, 965 Fee Road, East Fee Hall A227, Lansing MI 48824
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Hall CE, Hall AB, Kok G, Mallya J, Courtright P. A needs assessment of people living with diabetes and diabetic retinopathy. BMC Res Notes 2016; 9:56. [PMID: 26829927 PMCID: PMC4736166 DOI: 10.1186/s13104-016-1870-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 01/18/2016] [Indexed: 12/29/2022] Open
Abstract
Background The Kilimanjaro Diabetic Programme was initiated in response to the needs of people living with diabetes (PWLD) to identify barriers to uptake of screening for diabetic retinopathy, to improve management of diabetes, and establish an affordable, sustainable eye screening and treatment programme for diabetic retinopathy. Intervention Mapping was used as the framework for the needs assessment. Methods A mixed methods approach was used. Five psychometric measures, Diabetes Knowledge Questionnaire, Diabetes Health Beliefs, Self-Efficacy scale, Problem Areas in Diabetes scale, and Hopkins Scale Checklist-25 and a structured interview relating to self-efficacy, addressing disclosure of living with diabetes and life-style changes were used to triangulate the quantitative findings. These were administered to 26 PWLD presenting to rural district hospitals. Results The interviewees demonstrated low levels of perceived stigma regarding disclosure of living with diabetes and high levels of self-efficacy in raising community awareness of diabetes, seeking on going treatment from Western medicine over traditional healers and in seeking care on sick days. Self-efficacy was high for adjusting diet, although comprehensive dietary knowledge was poor. Negative emotions expressed at diagnosis, changes in life style and altered quality of life were reflected in high levels of anxiety and depression. Conclusions Low levels of stigma surrounding living with diabetes were linked to a desire to raise community awareness of diabetes, help others live with diabetes and to secure social support to access hospital services. Confusion over what constituted a healthy diet showed the importance of comprehensive, accessible diabetes education, essential to ensuring good glycaemic control, and preventing diabetic complications, including diabetic retinopathy. Low levels of self-efficacy along with high levels of anxiety and depression may have a negative impact on the uptake of screening for Diabetic Retinopathy. The findings of this needs assessment led to the planning and delivery of a comprehensive health intervention programme for PLWD in Kilimanjaro Region. The programme has provided them with support, resources, education, and screening for diabetic retinopathy at the regional hospital and at district level with mobile digital retinal cameras, an electronic diabetic database and computerised follow up to ensure continuity of care.
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Affiliation(s)
- Claudette E Hall
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, University Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Anthony B Hall
- Newcastle Eye Hospital Research Foundation, 182 Christo Road, Waratah, NSW, 2289, Australia.
| | - Gerjo Kok
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, University Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Joyse Mallya
- Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania.
| | - Paul Courtright
- KCCO International, Division of Ophthalmology, H53 OMB, Groote Schuur Hospital, University of Cape Town, Observatory, 7925, South Africa.
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Koole O, Denison JA, Menten J, Tsui S, Wabwire-Mangen F, Kwesigabo G, Mulenga M, Auld A, Agolory S, Mukadi YD, van Praag E, Torpey K, Williams S, Kaplan J, Zee A, Bangsberg DR, Colebunders R. Reasons for Missing Antiretroviral Therapy: Results from a Multi-Country Study in Tanzania, Uganda, and Zambia. PLoS One 2016; 11:e0147309. [PMID: 26788919 PMCID: PMC4720476 DOI: 10.1371/journal.pone.0147309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/31/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence. METHODS Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (≥ 18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients' medical, pharmacy, and laboratory records. Incomplete adherence was defined as having missed ART for at least 48 consecutive hours during the past 3 months. RESULTS Twenty-nine percent of participants reported at least one reason for having ever missed ART (1278/4425). The most frequent reason was simply forgetting (681/1278 or 53%), followed by ART-related hunger or not having enough food (30%), and symptoms (12%). The median number of symptoms reported by participants was 4 (IQR: 2-7). Every additional symptom increased the odds of incomplete adherence by 12% (OR: 1.1, 95% CI: 1.1-1.2). Female participants and participants initiated on a regimen containing stavudine were more likely to report greater numbers of symptoms. CONCLUSIONS Symptoms were a common reason for missing ART, together with simply forgetting and food insecurity. A combination of ART regimens with fewer side effects, use of mobile phone text message reminders, and integration of food supplementation and livelihood programmes into HIV programmes, have the potential to decrease missed ART and hence to improve adherence and the outcomes of ART programmes.
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Affiliation(s)
- Olivier Koole
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- * E-mail:
| | - Julie A Denison
- FHI 360, Social and Behavioral Health Sciences, Durham, North Carolina, United States of America
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
| | - Joris Menten
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | - Sharon Tsui
- FHI 360, Social and Behavioral Health Sciences, Durham, North Carolina, United States of America
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
| | - Fred Wabwire-Mangen
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gideon Kwesigabo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Andrew Auld
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Simon Agolory
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ya Diul Mukadi
- FHI 360, Social and Behavioral Health Sciences, Durham, North Carolina, United States of America
| | - Eric van Praag
- FHI 360, Social and Behavioral Health Sciences, Durham, North Carolina, United States of America
| | - Kwasi Torpey
- FHI 360, Social and Behavioral Health Sciences, Durham, North Carolina, United States of America
| | - Seymour Williams
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Kaplan
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aaron Zee
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David R Bangsberg
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robert Colebunders
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
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Decaro JA, Manyama M, Wilson W. Household-level predictors of maternal mental health and systemic inflammation among infants in Mwanza, Tanzania. Am J Hum Biol 2015; 28:461-70. [DOI: 10.1002/ajhb.22807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/08/2015] [Accepted: 11/01/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jason A. Decaro
- Department of Anthropology; The University of Alabama; Tuscaloosa Alabama
| | - Mange Manyama
- Department of Anatomy; Catholic University of Health and Allied Sciences; Mwanza Tanzania
| | - Warren Wilson
- Department of Anthropology and Archaeology; University of Calgary; Alberta Canada
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Makhubela M, Mashegoane S. Validation of the Beck Depression Inventory–II in South Africa: factorial validity and longitudinal measurement invariance in university students. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2015. [DOI: 10.1177/0081246315611016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study evaluated the factorial validity of the Beck Depression Inventory–II with a diverse sample of 919 university students. A randomised split of the data was done, and then exploratory and confirmatory factor analyses were conducted on Group 1 ( n = 460). Thereafter, confirmatory factor analysis was performed on Group 2 ( n = 459) to cross-validate the determined factor structure. A lower-order factor structure that comprised three factors, namely, Negative Attitude, Performance Difficulty, and Somatic Complaints was found. A hierarchical second-order analysis indicated that the lower-order factors tap into a higher-order general factor of Depression. Results based on multigroup confirmatory factor analysis further indicated evidence of factorial invariance for this three lower-order factor structure across time. Evidence for convergent and discriminant validity were provided by predicted associations with subscales from the Hopkins Symptom Checklist–25. It is concluded that the Beck Depression Inventory–II is a reliable and valid measure that can be used to assess the severity of depressive symptoms over time among South African university students.
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Affiliation(s)
- M.S Makhubela
- Department of Psychology, University of Pretoria, South Africa
| | - S Mashegoane
- Department of Psychology, University of Limpopo, South Africa
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Mahenge B, Stöckl H, Likindikoki S, Kaaya S, Mbwambo J. The prevalence of mental health morbidity and its associated factors among women attending a prenatal clinic in Tanzania. Int J Gynaecol Obstet 2015; 130:261-5. [DOI: 10.1016/j.ijgo.2015.04.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 03/21/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
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Park SD, Kim SY. Clinical feasibility of cervical exercise to improve neck pain, body function, and psychosocial factors in patients with post-traumatic stress disorder: a randomized controlled trial. J Phys Ther Sci 2015; 27:1369-72. [PMID: 26157221 PMCID: PMC4483399 DOI: 10.1589/jpts.27.1369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/11/2015] [Indexed: 01/19/2023] Open
Abstract
[Purpose] To investigate the effect of cervical exercise on neck pain, disability, and psychosocial factors in patients with post-traumatic stress disorder. [Subjects] Thirty patients with post-traumatic stress disorder, who also complained of neck pain. [Methods] The cervical exercise group (n = 15) participated in cervical exercises for 30 min, 3 times/week for 6 weeks, and the control group (n = 16) underwent conventional physical therapy alone, without exercise. The exercises were performed in the following order: cervical relaxation, local muscle stabilization, and global muscle stabilization using a sling system. [Results] Compared to the control group, the cervical exercise group demonstrated significant decreases as follows: Visual analogue scale score, 4.2 vs. 1.0; Neck disability index, 3.9 vs. 1.9; and depression on the Symptom checklist-90-revised, 9.4 vs. 4.3 and on the Hopkins symptom checklist-25, 6.3 vs. 2.8. However, anxiety on the Symptom checklist-90-revised (3.1 vs. 1.3) was not significantly different. Effect sizes were as follows: Visual analogue scale score, 1.8; Neck disability index, 0.9; depression, 1.0; and anxiety on Symptom checklist-90-revised and Hopkins symptom checklist-25, 0.6 and 0.8, respectively. [Conclusion] Cervical exercise is effective in improving neck pain, disability, and efficacy of psychological treatment for depression in patients with post-traumatic stress disorder.
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Affiliation(s)
- Seong Doo Park
- Department of Physical Therapy, The Graduate School,
Daejeon University, Republic of Korea
| | - Suhn Yeop Kim
- Department of Physical Therapy, College of Health and
Medical Science, Daejeon University, Republic of
Korea
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89
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Depression during pregnancy and the postpartum among HIV-infected women on antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr 2015; 67 Suppl 4:S179-87. [PMID: 25436816 PMCID: PMC4251908 DOI: 10.1097/qai.0000000000000370] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Among HIV-infected women, perinatal depression compromises clinical, maternal, and child health outcomes. Antiretroviral therapy (ART) is associated with lower depression symptom severity but the uniformity of effect through pregnancy and postpartum periods is unknown. Methods: We analyzed prospective data from 447 HIV-infected women (18–49 years) initiating ART in rural Uganda (2005–2012). Participants completed blood work and comprehensive questionnaires quarterly. Pregnancy status was assessed by self-report. Analysis time periods were defined as currently pregnant, postpartum (0–12 months post-pregnancy outcome), or non–pregnancy-related. Depression symptom severity was measured using a modified Hopkins Symptom Checklist 15, with scores ranging from 1 to 4. Probable depression was defined as >1.75. Linear regression with generalized estimating equations was used to compare mean depression scores over the 3 periods. Results: At enrollment, median age was 32 years (interquartile range: 27–37), median CD4 count was 160 cells per cubic millimeter (interquartile range: 95–245), and mean depression score was 1.75 (s = 0.58) (39% with probable depression). Over 4.1 median years of follow-up, 104 women experienced 151 pregnancies. Mean depression scores did not differ across the time periods (P = 0.75). Multivariable models yielded similar findings. Increasing time on ART, viral suppression, better physical health, and “never married” were independently associated with lower mean depression scores. Findings were consistent when assessing probable depression. Conclusions: Although the lack of association between depression and perinatal periods is reassuring, high depression prevalence at treatment initiation and continued incidence across pregnancy and non–pregnancy-related periods of follow-up highlight the critical need for mental health services for HIV-infected women to optimize both maternal and perinatal health.
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90
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Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia. AIDS 2015; 29:361-71. [PMID: 25686684 DOI: 10.1097/qad.0000000000000543] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To characterize antiretroviral therapy (ART) adherence across different programmes and examine the relationship between individual and programme characteristics and incomplete adherence among ART clients in sub-Saharan Africa. DESIGN A cross-sectional study. METHODS Systematically selected ART clients (≥18 years; on ART ≥6 months) attending 18 facilities in three countries (250 clients/facility) were interviewed. Client self-reports (3-day, 30-day, Case Index ≥48 consecutive hours of missed ART), healthcare provider estimates and the pharmacy medication possession ratio (MPR) were used to estimate ART adherence. Participants from two facilities per country underwent HIV RNA testing. Optimal adherence measures were selected on the basis of degree of association with concurrent HIV RNA dichotomized at less than or greater/equal to 1000 copies/ml. Multivariate regression analysis, adjusted for site-level clustering, assessed associations between incomplete adherence and individual and programme factors. RESULTS A total of 4489 participants were included, of whom 1498 underwent HIV RNA testing. Nonadherence ranged from 3.2% missing at least 48 consecutive hours to 40.1% having an MPR of less than 90%. The percentage with HIV RNA at least 1000 copies/ml ranged from 7.2 to 17.2% across study sites (mean = 9.9%). Having at least 48 consecutive hours of missed ART was the adherence measure most strongly related to virologic failure. Factors significantly related to incomplete adherence included visiting a traditional healer, screening positive for alcohol abuse, experiencing more HIV symptoms, having an ART regimen without nevirapine and greater levels of internalized stigma. CONCLUSION Results support more in-depth investigations of the role of traditional healers, and the development of interventions to address alcohol abuse and internalized stigma among treatment-experienced adult ART patients.
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91
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Psaros C, Haberer JE, Boum Y, Tsai AC, Martin JN, Hunt PW, Bangsberg DR, Safren SA. The factor structure and presentation of depression among HIV-positive adults in Uganda. AIDS Behav 2015; 19:27-33. [PMID: 24854877 DOI: 10.1007/s10461-014-0796-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is one of the most prevalent psychiatric comorbidities of HIV and one of the greatest barriers to HIV self-care and adherence. Despite this, little consensus exists on how to best measure depression among people living with HIV/AIDS (PLWHA) in African settings. Measurement of depression among PLWHA may be confounded by somatic symptoms. Some research recommends excluding these items to enhance measurement validity; sensitivity may be lost with this approach. We sought to characterize depression among a cohort (N = 453) of PLWHA initiating antiretroviral therapy in Uganda via factor analysis of a widely used measure of depression, the Hopkins Symptom Checklist (HSCLD). Common factor analysis was performed, associations between HSCLD and the Mental Health subscale of the Medical Outcomes Study HIV (MOS-HIV) estimated, and a Cronbach's alpha calculated to examine validity. Factor analysis yielded two factors: (1) somatic-cognitive symptoms and (2) behavioral disengagement. Persons with more versus less advanced disease (CD4 cell count of ≤200 cells/mm(3)) showed no statistically significant differences in depression scores (1.7 vs. 1.7, P ≥ 0.5). Both factors were significantly associated with the MOS-HIV (P < .01). Factor one was highly reliable (α = .81); factor two had only modest reliability (α = .65). Somatic-cognitive symptoms of depression and disengagement from life's activities appear to be distinct components of depression in this sample. Consideration of somatic items may be valuable in identifying depression in this setting.
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92
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Kumar M, Ongeri L, Mathai M, Mbwayo A. Translation of EPDS Questionnaire into Kiswahili: Understanding the Cross-Cultural and Translation Issues in Mental Health Research. ACTA ACUST UNITED AC 2015; 2. [PMID: 25893218 DOI: 10.4172/2376-127x.1000134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The need for a suitable tool for assessing postpartum depression in Kenya led to the process of translation of the 10 items Edinburgh Postnatal Scale into Kiswahili. The idea was to seek semantic, conceptual as well as normative equivalence in this translation. The paper discusses issues and the process of translation and provides in depth discussions around translation from the point of view of cross-cultural mental health research and practice. The English version of the EPDS screening tool was finally successfully translated into Kiswahili and the translated version is attached with this paper.
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Affiliation(s)
- Manasi Kumar
- Senior Lecturer, Department of Psychiatry, University of Nairobi, Kenya
| | - Linnet Ongeri
- Research Officer, Centre for Clinical Research, KEMRI, Nairobi, Kenya
| | - Muthoni Mathai
- Senior Lecturer, Department of Psychiatry, University of Nairobi, Kenya
| | - Anne Mbwayo
- Honorary Lecturer, Department of Psychiatry, University of Nairobi, Kenya
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93
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Ellis BH, Lankau EW, Ao T, Benson MA, Miller AB, Shetty S, Lopes Cardozo B, Geltman PL, Cochran J. Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2015; 85:43-55. [PMID: 25642653 DOI: 10.1037/ort0000028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community.
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Affiliation(s)
| | - Emily W Lankau
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine
| | - Trong Ao
- Centers for Disease Control and Prevention, Global Disease Detection Branch
| | | | | | - Sharmila Shetty
- Centers for Disease Control and Prevention, Immigrant, Refugee, and Migrant Health Branch
| | - Barbara Lopes Cardozo
- Centers for Disease Control and Prevention, Emergency Response and Recovery Branch, Center for Global Health
| | - Paul L Geltman
- Massachusetts Department of Public Health, Division of Global Populations and Infections Disease Prevention
| | - Jennifer Cochran
- Massachusetts Department of Public Health, Division of Global Populations and Infectious Disease Prevention, Bureau of Infectious Disease
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94
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Mental, Neurological, and Substance Use Disorders in People Living With HIV/AIDS in Low- and Middle-Income Countries. J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S54-67. [DOI: 10.1097/qai.0000000000000258] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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95
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Hyle EP, Naidoo K, Su AE, El-Sadr WM, Freedberg KA. HIV, tuberculosis, and noncommunicable diseases: what is known about the costs, effects, and cost-effectiveness of integrated care? J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S87-95. [PMID: 25117965 PMCID: PMC4147396 DOI: 10.1097/qai.0000000000000254] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Unprecedented investments in health systems in low- and middle-income countries (LMICs) have resulted in more than 8 million individuals on antiretroviral therapy. Such individuals experience dramatically increased survival but are increasingly at risk of developing common noncommunicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different health care interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as 1 example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as 2 examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV in LMICs will help to prioritize specific health care services by contributing to an understanding of the affordability and implementation of an integrated approach.
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Affiliation(s)
- Emily P. Hyle
- Harvard Medical School, Boston, MA
- The Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South Africa
| | - Amanda E. Su
- The Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA
| | - Wafaa M. El-Sadr
- ICAP at Columbia University Department of Epidemiology, Mailman School of Public Health, New York, NY
| | - Kenneth A. Freedberg
- Harvard Medical School, Boston, MA
- The Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA
- Center for AIDS Research (CFAR), Harvard University, Boston, MA
- Department of Epidemiology, Boston University, Boston MA
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
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96
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Higher quality of life and lower depression for people on ART in Uganda as compared to a community control group. PLoS One 2014; 9:e105154. [PMID: 25171340 PMCID: PMC4149377 DOI: 10.1371/journal.pone.0105154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 07/21/2014] [Indexed: 12/21/2022] Open
Abstract
Provision of antiretroviral treatment (ART) to people living with HIV (PLWH) has increased globally. Research measuring whether ART restores subjective well-being to "normal" levels is lacking, particularly in resource limited settings. The study objectives are to compare quality of life and depression symptoms for PLWH on ART to a general community population and to explore factors to explain these differences, including socio-economic status and the impact of urban or rural residence. PLWH on ART (n = 263) were recruited from ART delivery sites and participants not on ART (n = 160) were recruited from communities in Wakiso District, Uganda. Participants were interviewed using the translated World Health Organisation Quality of Life brief measure, the Hopkins Symptom Checklist depression section, and questions about socio-economic status, residence as urban or rural and, for PLWH on ART, self-reported adherence and use of HIV counselling. Compared to the community sample and controlling for location of residence, PLWH on ART had significantly higher quality of life (QOL) for physical, psychological and environment domains, but not the social domain. These differences were not due to socio-economic status alone. Depression scores were significantly lower for PLWH on ART. Both comparisons controlled for the effect of location of residence. People on ART self-reported high adherence and the majority had used HIV counselling services. Our findings show better QOL amongst PLWH on ART compared to a general community sample, which cannot be explained solely by differences in socio-economic status nor location of residence. The general community sample results point towards the challenges of life in this setting. Access to health services may underpin this difference and further research should explore this finding, in addition to identification of psychological mechanisms that relate to better QOL. ART provision infrastructure has clear benefits. Further work should consider sustainability and replication for other health conditions.
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97
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Muya AN, Geldsetzer P, Hertzmark E, Ezeamama AE, Kawawa H, Hawkins C, Sando D, Chalamilla G, Fawzi W, Spiegelman D. Predictors of Nonadherence to Antiretroviral Therapy among HIV-Infected Adults in Dar es Salaam, Tanzania. J Int Assoc Provid AIDS Care 2014; 14:163-71. [PMID: 24966305 DOI: 10.1177/2325957414539193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adherence rates of ≥95% to antiretroviral therapy (ART) are necessary to maintain viral suppression in HIV-infected individuals. We identified predictors of nonadherence to scheduled antiretroviral drug pickup appointments in a large HIV care and treatment program in Tanzania. METHODS We performed a prospective cohort study of 44, 204 HIV-infected adults on ART between November 2004 and September 2012. Multivariate generalized estimating equation for repeated binary data was used to estimate the relative risk and 95% confidence intervals of nonadherence. RESULTS Nonadherence was significantly greater among patients with high CD4 counts, high body mass indices, males, younger patients, patients with longer durations on ART, and those with perceived low social support. CONCLUSIONS Targeted interventions should be developed to improve ART adherence among healthier, younger, and more experienced patients who are on ART for longer durations within HIV care and treatment programs. Social support for patients on ART should be emphasized.
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Affiliation(s)
- Aisa N Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | | | - Amara E Ezeamama
- Department of Epidemiology & Biostatistics, The University of Georgia, Athens, GA, USA
| | - Hawa Kawawa
- Dar es Salaam City Council, Department of Health and Social services, Dar es Salaam, Tanzania
| | | | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Wafaie Fawzi
- Harvard School of Public Health, Boston, MA, USA
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Breuer E, Stoloff K, Myer L, Seedat S, Stein DJ, Joska JA. The validity of the Substance Abuse and Mental Illness Symptom Screener (SAMISS) in people living with HIV/AIDS in primary HIV care in Cape Town, South Africa. AIDS Behav 2014; 18:1133-41. [PMID: 24452497 DOI: 10.1007/s10461-014-0698-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Given the high prevalence of HIV in South Africa and co-morbid mental disorders in people living with HIV/AIDs (PLWHA) we sought to validate a brief screening tool in primary HIV care. METHODS 366 PLWHA were recruited prior to combination anti-retroviral treatment (CART) initiation from two primary health HIV clinics. A mental health nurse administered a socio-demographic questionnaire and the Mini Neuropsychiatric Interview (MINI) and a lay counsellor administered the Substance and Mental Illness Symptom Screener (SAMISS). RESULTS Using the MINI, 17 % of participants were identified with either depression, anxiety disorders or adjustment disorder and 18 % with substance or alcohol abuse/dependence. The sensitivity and specificity of the SAMISS was 94 % (95 % CI: 88-98 %) and 58 % (95 % CI: 52-65 %) respectively, with the alcohol component (sensitivity: 94 %; specificity: 85 %) performing better than the mental illness component of the SAMISS (sensitivity: 97 %; specificity: 60 %). The specificity of the tool improved when the cut-off for the mental illness component was increased. CONCLUSION The SAMISS may provide a useful first tier screening tool for common mental disorders in primary care for PLWHA.
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Affiliation(s)
- Erica Breuer
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Rd, Rondebosch, Cape Town, 7700, South Africa,
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Lambdin BH, Masao F, Chang O, Kaduri P, Mbwambo J, Magimba A, Sabuni N, Bruce RD. Methadone treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: a retrospective cohort study. Clin Infect Dis 2014; 59:735-42. [PMID: 24855149 DOI: 10.1093/cid/ciu382] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) in Dar es Salaam, Tanzania, have an estimated human immunodeficiency virus (HIV) prevalence of 42%-50% compared with 6.9% among the general population. Extensive evidence supports methadone maintenance to lower morbidity, mortality, and transmission of HIV and other infectious diseases among PWID. In 2011, the Tanzanian government launched the first publicly funded methadone clinic on the mainland of sub-Saharan Africa at Muhimbili National Hospital. METHODS We conducted a retrospective cohort study of methadone-naive patients enrolling into methadone maintenance treatment. Kaplan-Meier survival curves were constructed to assess retention probability. Proportional hazards regression models were used to evaluate the association of characteristics with attrition from the methadone program. RESULTS Overall, 629 PWID enrolled into methadone treatment during the study. At 12 months, the proportion of clients retained in care was 57% (95% confidence interval [CI], 53%-62%). Compared with those receiving a low dose (<40 mg), clients receiving a medium (40-85 mg) (adjusted hazard ratio [aHR], 0.50 [95% CI, .37-.68]) and high (>85 mg) (aHR, 0.41 [95% CI, .29-.59]) dose of methadone had a lower likelihood of attrition, adjusting for other characteristics. Older clients (aHR, 0.53 per 10 years [95% CI, .42-.69]) and female clients (aHR, 0.50 [95% CI, .28-.90]) had a significantly lower likelihood of attrition, whereas clients who reported a history of sexual abuse (aHR, 2.84 [95% CI, 1.24-6.51]) had a significantly higher likelihood of attrition. CONCLUSIONS Patient retention in methadone maintenance is comparable to estimates from programs in North America, Europe, and Asia. Future implementation strategies should focus on higher doses and flexible dosing strategies to optimize program retention and strengthened efforts for clients at higher risk of attrition.
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Affiliation(s)
- Barrot H Lambdin
- Department of Global Health, University of Washington, Seattle Pangaea Global AIDS Foundation, Oakland, California
| | - Frank Masao
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Olivia Chang
- Pangaea Global AIDS Foundation, Oakland, California
| | - Pamela Kaduri
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayoub Magimba
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Norman Sabuni
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - R Douglas Bruce
- Pangaea Global AIDS Foundation, Oakland, California School of Medicine, Yale University, New Haven, Connecticut
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100
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Sweetland AC, Belkin GS, Verdeli H. Measuring depression and anxiety in sub-saharan Africa. Depress Anxiety 2014; 31:223-32. [PMID: 23780834 PMCID: PMC4109689 DOI: 10.1002/da.22142] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/03/2013] [Accepted: 05/10/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite being one of the leading causes of disability worldwide, fewer than 10% of depressed individuals in low-resource settings have access to treatment. Mounting evidence suggests that nonspecialist workers are capable of providing counseling and case management at the community level. They often use brief psychiatric screening instruments as clinical tools to identify cases and monitor symptoms over time. In order for such tools to be used in diverse settings, they must demonstrate adequate reliability and validity in addition to cross-cultural relevance. To be used to guide routine care they also need to be flexibly adapted and sensitive to change. The goal of this paper is to assess the cross-cultural validity of brief psychiatric screening instruments in sub-Saharan Africa, identify best practices, and discuss implications for clinical management and scale-up of mental health treatment in resource-poor settings. METHOD Systematic review of studies assessing the validity of screening instruments for depression, anxiety, and mental distress in sub-Saharan Africa using Medline and PsycINFO. RESULTS Sixty-five studies from 16 countries assessing the validity of brief screening instruments for depression, anxiety, and/or mental distress. CONCLUSIONS Despite evidence of underlying universality in the experience of depression and anxiety in sub-Saharan Africa, differences in the salience, manifestation, and expression of symptoms suggest the need for the local adaptation of instruments. Rapid ethnographic assessment has emerged as a promising, low-cost, and efficient strategy for doing so.
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Affiliation(s)
- Annika C. Sweetland
- Columbia University College of Physicians and Surgeons, Department of Psychiatry,Correspondence to: Annika C. Sweetland, Research Foundation for Mental Hygiene, New York State Psychiatric Institute, 1051 Riverside Drive, Box 24, New York, NY 10032.
| | - Gary S. Belkin
- New York University School of Medicine, Department of Psychiatry
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