1
|
Ramaiya MK, McLean CL, Pokharel M, Thapa K, Schmidt MA, Berg M, Simoni JM, Rao D, Kohrt BA. Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114497. [PMID: 36361372 PMCID: PMC9655041 DOI: 10.3390/ijerph192114497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND Child and adolescent mental health problems are major contributors to the global burden of disease in low- and middle-income country (LMIC) settings. To advance the evidence base for adolescent mental health interventions in LMICs, we evaluated the feasibility and acceptability of a school-based emotion regulation prevention intervention (READY-Nepal) for adolescents who had a recent exposure to a humanitarian disaster. METHODS A mixed-method, non-randomized controlled trial was conducted with Nepali secondary school students in one heavily affected post-earthquake district. Students (N = 102; aged 13 to 17 years) were enrolled in the intervention (n = 42) and waitlist control (n = 60) conditions. Feasibility and acceptability were examined via attendance, and by qualitative interviews with a subset of students (n = 15), teachers (n = 2), and caregivers (n = 3). Preliminary efficacy was examined on primary outcome (emotion regulation) and secondary outcomes (anxiety symptoms, posttraumatic stress symptoms, functional impairment, resilience, coping skills), which were measured at baseline and post-intervention (four weeks). RESULTS Delivering the intervention was feasible and acceptable, as demonstrated by low dropout (8%) and high program attendance (6.7 of 8 sessions). Qualitative data suggested high uptake of anger regulation skills, but lower uptake of mindfulness skills. Despite this, there were no significant differences by condition on primary or secondary outcomes at four-week follow-up. Students provided suggestions for improvement of the program. CONCLUSION Further research on longitudinal outcome measurement, use of alternatives to retrospective self-report data, and rigorous development of culturally grounded models of emotion regulation is necessary to explore the utility of school-based emotion regulation interventions in Nepal and other LMICs.
Collapse
Affiliation(s)
- Megan K. Ramaiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA
- Correspondence:
| | - Caitlin L. McLean
- VA San Diego Healthcare System, University of California, San Diego, CA 92161, USA
| | - Manjila Pokharel
- Transcultural Psychosocial Organization Nepal, Kathmandu 44600, Nepal
| | - Kiran Thapa
- College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - M. Andi Schmidt
- School of Graduate Psychology, Pacific University Oregon, Forest Grove, OR 97116, USA
| | - Martha Berg
- Department of Psychology, University of Michigan-Ann Arbor, Ann Arbor, MI 48103, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA 98104, USA
| | - Brandon A. Kohrt
- Division of Global Mental Health, George Washington University, Washington, DC 20052, USA
| |
Collapse
|
2
|
A meta-ethnography of participatory health research and co-production in Nepal. Soc Sci Med 2022; 301:114955. [PMID: 35452892 DOI: 10.1016/j.socscimed.2022.114955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
Abstract
As global health research seeks to decolonialise, democratise, and become more culturally engaging, researchers are increasingly employing participatory and co-productive methods. Working from post-structural perspectives, this meta-ethnographic review explores how such health research in Nepal engages with the epistemological, methodological, and ethical questions it encounters. Five databases including Nepali NepJOL were searched for studies from inception to March 2021. The review included seven studies covering women's group co-production, interviews guided by photo-elicitation, observational methods to explore maternal and child health, mental health, and environmental determinants of health. This meta-ethnography identified that, against the background of a pluralist heritage of health practices, global collaborations involving Nepali researchers and practitioners used participatory research methodology to work with the local populations to improve health and co-production seek primarily to promote Western biomedical and psychosocial interventions. Both advantages and disadvantages were acknowledged. Empirical verification and global acceptance of Western biomedical and psychosocial knowledge were seen as beneficial. Moreover, Western biomedicine was perceived by some as more effective than some local practices in improving health; nevertheless, Nepal faces many challenges that neither can address alone. For participatory and co-productive approaches to become epistemologically enculturated within Nepali health research, researchers need to co-develop more local models and methods which are culturally sensitive and appropriate. Meaningful and effective participatory research can promote active involvement of people who deliver as well as people who use the community-based health care support. These are crucial to optimise sustainable change that global health research partnerships set out to achieve. This meta-ethnography recommends that researchers engage at a deeper level with the epistemological differences between themselves and the communities with whom they seek partnership. Cross-cultural research teams should discuss and address the power differentials which might affect them.
Collapse
|
3
|
Gooding PA, Harris K, Haddock G. Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073813. [PMID: 35409502 PMCID: PMC8997645 DOI: 10.3390/ijerph19073813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 01/03/2023]
Abstract
It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.
Collapse
Affiliation(s)
- Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK; (P.A.G.); (G.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
| | - Kamelia Harris
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK; (P.A.G.); (G.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
- Correspondence:
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, UK; (P.A.G.); (G.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK
| |
Collapse
|
4
|
Steyn PJ, Koen L, Jarvis L. Characteristics of inpatients in dialectical behaviour therapy modified for a resource-limited setting. S Afr J Psychiatr 2022; 28:1701. [PMID: 35169509 PMCID: PMC8832019 DOI: 10.4102/sajpsychiatry.v28i0.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/15/2021] [Indexed: 11/02/2022] Open
Abstract
Background Aim Setting Methods Results Conclusions
Collapse
Affiliation(s)
- Petrus J Steyn
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lucy Jarvis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
5
|
Pierson AM, Arunagiri V, Bond DM. “You Didn’t Cause Racism, and You Have to Solve it Anyways”:Antiracist Adaptations to Dialectical Behavior Therapy for White Therapists. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
6
|
Keng SL, Mohd Salleh Sahimi HB, Chan LF, Woon L, Eu CL, Sim SH, Wong MK. Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes. BMC Psychiatry 2021; 21:486. [PMID: 34607589 PMCID: PMC8489091 DOI: 10.1186/s12888-021-03500-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
AIM/BACKGROUND Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia. METHODS Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention. RESULTS There were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants' feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial. CONCLUSION These preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.
Collapse
Affiliation(s)
- Shian-Ling Keng
- Division of Social Science, Yale-NUS College, Singapore, Singapore.
| | - Hajar Binti Mohd Salleh Sahimi
- grid.412113.40000 0004 1937 1557Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- grid.412113.40000 0004 1937 1557Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras Kuala Lumpur, Malaysia
| | - Luke Woon
- grid.412113.40000 0004 1937 1557Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras Kuala Lumpur, Malaysia
| | - Choon Leng Eu
- grid.412113.40000 0004 1937 1557Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras Kuala Lumpur, Malaysia
| | - Su Hua Sim
- grid.449013.b0000 0004 0434 6930Department of Psychology, HELP University, Bukit Damansara Kuala Lumpur, Malaysia
| | - Man Kuan Wong
- grid.449013.b0000 0004 0434 6930Department of Psychology, HELP University, Bukit Damansara Kuala Lumpur, Malaysia
| |
Collapse
|
7
|
Aggarwal S, Patton G, Berk M, Patel V. Psychosocial interventions for self-harm in low-income and middle-income countries: systematic review and theory of change. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1729-1750. [PMID: 33394070 PMCID: PMC7611648 DOI: 10.1007/s00127-020-02005-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To synthesise the evidence on effectiveness, acceptability and the delivery mechanisms of psychosocial interventions for self-harm in low and middle income countries and to develop a pathway of change specific for self-harm interventions. METHOD Studies reporting one or more patient or implementation outcomes of a psychosocial intervention targeting self-harm and conducted in low- and middle-income countries were included. Taxonomy of treatment components and a theory of change map was created using information from the studies. RESULTS We identified thirteen studies including nine randomised controlled trials (RCT), three non-RCTs, and a single experimental case design study. A single study using postcard contact and another using cognitive behaviour therapy (CBT) reported a reduction in self-harm attempts. Suicidal ideations were significantly reduced with CBT, volitional help sheets and postcard contact in different studies. Suicide risk assessment, problem solving and self-validation were the most frequently used elements in interventions. Goal-setting was the technique used most commonly. Cultural adaptations of psychotherapies were used in two studies. High attrition rates in psychotherapy trials, limited benefit of the delivery of treatment by non-specialist providers, and variable benefit observed using phone contact as a means to deliver intervention were other important findings. CONCLUSION There were no strong positive findings to draw definitive conclusions. Limited availability and evidence for culturally adapted interventions in self-harm, lack of evaluation of task sharing using evidence based interventions as well as a dearth in evaluation and reporting of various intervention delivery models in low- and middle-income countries were major literature gaps.
Collapse
Affiliation(s)
- Shilpa Aggarwal
- Public Health Foundation of India (Centre for Chronic Conditions), New Delhi, India. .,Faculty of Health, School of Medicine, Deakin University, Geelong, Australia.
| | - George Patton
- Murdoch Children’s Research Institute (Centre for Adolescent Health), Victoria, Australia
| | - Michael Berk
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia,Department of Psychiatry, Orygen (Centre for Youth Mental Health), Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Vikram Patel
- Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, MA, USA
| |
Collapse
|
8
|
Pham TV, Koirala R, Wainberg ML, Kohrt BA. Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness? Community Ment Health J 2021; 57:777-791. [PMID: 32894398 PMCID: PMC7936992 DOI: 10.1007/s10597-020-00705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.
Collapse
Affiliation(s)
- Tony V Pham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27705, USA.
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal.
| | - Rishav Koirala
- University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- Brain and Neuroscience Center Nepal, Krishna Dhara Marg, Kathmandu, 44600, Nepal
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Brandon A Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- George Washington University School of Medicine and Health Sciences, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
| |
Collapse
|
9
|
Aggarwal S, Patton G, Berk M, Patel V. Design of a brief psychological intervention for youth who self-harm: a formative study in India. EVIDENCE-BASED MENTAL HEALTH 2020; 24:e2. [PMID: 33208508 DOI: 10.1136/ebmental-2020-300188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs). OBJECTIVE The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms. METHODS A systematic, sequential approach was used to integrate available scientific evidence, expert service providers' knowledge and experience, and service users' lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops. FINDINGS We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients. CONCLUSION AND CLINICAL IMPLICATIONS ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers.
Collapse
Affiliation(s)
- Shilpa Aggarwal
- Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia .,Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen (Centre for Youth Mental Health), Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Vikram Patel
- Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Kohrt BA, Ottman K, Panter-Brick C, Konner M, Patel V. Why we heal: The evolution of psychological healing and implications for global mental health. Clin Psychol Rev 2020; 82:101920. [PMID: 33126037 DOI: 10.1016/j.cpr.2020.101920] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
Why do humans heal one another? Evolutionary psychology has advanced our understanding of why humans suffer psychological distress and mental illness. However, to date, the evolutionary origins of what drives humans to alleviate the suffering of others has received limited attention. Therefore, we draw upon evolutionary theory to assess why humans psychologically support one another, focusing on the interpersonal regulation of emotions that shapes how humans heal and console one another when in psychosocial distress. To understand why we engage in psychological healing, we review the evolution of cooperation among social species and the roles of emotional contagion, empathy, and self-regulation. We discuss key aspects of human biocultural evolution that have contributed to healing behaviors: symbolic logic including language, complex social networks, and the long period of childhood that necessitates identifying and responding to others in distress. However, both biological and cultural evolution also have led to social context when empathy and consoling are impeded. Ultimately, by understanding the evolutionary processes shaping why humans psychologically do or do not heal one another, we can improve our current approaches in global mental health and uncover new opportunities to improve the treatment of mental illness across cultures and context around the world.
Collapse
Affiliation(s)
- Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA.
| | - Katherine Ottman
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Catherine Panter-Brick
- Jackson Institute of Global Affairs, Yale University, New Haven, and Department of Anthropology, Yale University, New Haven, USA
| | - Melvin Konner
- Department of Anthropology, Emory University, Atlanta, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, and Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA
| |
Collapse
|
11
|
Wagenaar BH, Hammett WH, Jackson C, Atkins DL, Belus JM, Kemp CG. Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review. Glob Ment Health (Camb) 2020; 7:e7. [PMID: 32346482 PMCID: PMC7176918 DOI: 10.1017/gmh.2020.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/07/2020] [Accepted: 01/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage. METHODS PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. RESULTS A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectiveness-implementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). CONCLUSIONS Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability.
Collapse
Affiliation(s)
- Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Wilson H. Hammett
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Courtney Jackson
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dana L. Atkins
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jennifer M. Belus
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | |
Collapse
|
12
|
Taylor P. System Entrapment: Dehumanization While Help-Seeking for Suicidality in Women Who Have Experienced Intimate Partner Violence. QUALITATIVE HEALTH RESEARCH 2020; 30:530-546. [PMID: 31303117 DOI: 10.1177/1049732319857671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Attention to power imbalances when seeking help for suicidality after having been controlled within intimate partner violence (IPV) is crucial in improving health care delivery. Well documented in the literature is the correlation between suicidality and IPV and that help-seeking for each is difficult; however, a gap exists when both intersect. The process of women's help-seeking is explored in this feminist grounded theory and photovoice multiple qualitative method study. Analysis of interviews with 32 women from New Brunswick, Canada, and photovoice meetings with seven women revealed a basic psycho-social problem. System Entrapment or being dehumanized while seeking help for suicidality occurred as a result of perceived invalidation from health care providers' lack of empathy. Further harm while providing services to women feeling suicidal can be prevented with a shift from an individualist model toward a trauma and violence informed approach. Understanding the contextual factors influencing women's suicidality may reduce victim blaming.
Collapse
Affiliation(s)
- Petrea Taylor
- Faculty of Nursing, University of New Brunswick, Riverview, New Brunswick, Canada
| |
Collapse
|
13
|
|