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Luitel NP, Rimal D, Eleftheriou G, Rose-Clarke K, Nayaju S, Gautam K, Pant SB, Devkota N, Rana S, Chaudhary JM, Gurung BS, Åhs JW, Carvajal-Velez L, Kohrt BA. Translation, cultural adaptation and validation of Patient Health Questionnaire and generalized anxiety disorder among adolescents in Nepal. Child Adolesc Psychiatry Ment Health 2024; 18:74. [PMID: 38898474 PMCID: PMC11188246 DOI: 10.1186/s13034-024-00763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Depression and anxiety are significant contributors to the global burden of disease among young people. Accurate data on the prevalence of these conditions are crucial for the equitable distribution of resources for planning and implementing effective programs. This study aimed to culturally adapt and validate data collection tools for measuring depression and anxiety at the population level. METHODS The study was conducted in Kathmandu, Nepal, a diverse city with multiple ethnicities, languages, and cultures. Ten focus group discussions with 56 participants and 25 cognitive interviews were conducted to inform adaptations of the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Generalized Anxiety Disorder (GAD-7). To validate the tools, a cross-sectional survey of 413 adolescents (aged 12-19) was conducted in three municipalities of Kathmandu district. Trained clinical psychologists administered the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-DSM 5 version) to survey participants. RESULTS A number of cultural adaptations were required, such as changing statements into questions, using a visual scale (glass scale) to maintain uniformity in responses, and including a time frame at the beginning of each item. For younger adolescents aged 12 to 14 years, a PHQ-A cut-off of > = 13 had a sensitivity of 0.93, specificity of 0.80, positive predictive value (PPV) of 0.33, and negative predictive value (NPV) of 0.99. For older adolescents aged 15-19, a cut-off of > = 11 had a sensitivity of 0.89, specificity of 0.70, PPV of 0.32, and NPV of 0.97. For GAD-7, a cut-off of > = 8 had a sensitivity of 0.70 and specificity of 0.67 for younger adolescents and 0.71 for older adolescents, with a PPV of 0.39 and NPV of 0.89. The individual symptom means of both PHQ-A and GAD-7 items showed moderate ability to discriminate between adolescents with and without depression and anxiety. CONCLUSION The PHQ-A and GAD-7 demonstrate fair psychometric properties for screening depression but performed poorly for anxiety, with high rates of false positives. Even when using clinically validated cut-offs, population prevalence rates would be inflated by 2-4 fold with these tools, requiring adjustment when interpreting epidemiological findings.
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Affiliation(s)
- Nagendra P Luitel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA.
| | - Damodar Rimal
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Georgia Eleftheriou
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Suvash Nayaju
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Kamal Gautam
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
| | - Sagun Ballav Pant
- Department of Psychiatry & Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Narmada Devkota
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Shruti Rana
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Jug Maya Chaudhary
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | | | - Jill Witney Åhs
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Liliana Carvajal-Velez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, USA
| | - Brandon A Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
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Alsamara K, Kakaje A, Soqia J, Ghareeb A, Watson L, Hadakie R, Jawich K, Al-Homsi A, Forbes D. Exploring Women's Religious Coping Strategies and Psychological Impact After the 2023 Earthquake in Syria. JOURNAL OF RELIGION AND HEALTH 2024; 63:2314-2326. [PMID: 38361001 DOI: 10.1007/s10943-024-02005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
This paper examined gender (N = 1406;77.7% women) patterns of religious coping and psychological impact following the devastating 2023 Syrian earthquakes. Measures in this nation-wide convenience sample study included positive religious coping (PRC) and negative religious coping (NRC) using the Brief Religious Coping Scale (RCOPE), and probable PTSD, depression, and anxiety, using the PCL-5, PHQ-9, and GAD-7, respectively. Women reported higher endorsement of PRC items while men higher endorsement of NRC items. Within the women only sample, lower education and lower income, education and younger age predicted PRC and NRC, respectively. NRC was strongly positively associated with PTSD, depression and anxiety; while, PRC was positively associated only with PTSD. These vulnerable women require targeted support to adopt more adaptive religious coping strategies.
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Affiliation(s)
- Kinda Alsamara
- Centre for Arabic and Islamic Studies, College of Arts and Social Sciences, Australian National University, Canberra, ACT, Australia
| | - Ameer Kakaje
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Jameel Soqia
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Amjad Ghareeb
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Loretta Watson
- Department of Psychiatry, Phoenix Australia-Centre for Posttraumatic Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rana Hadakie
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Kenda Jawich
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Alaa Al-Homsi
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - David Forbes
- Department of Psychiatry, Phoenix Australia-Centre for Posttraumatic Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Soqia J, Ghareeb A, Hadakie R, Alsamara K, Forbes D, Jawich K, Al-Homsi A, Kakaje A. The mental health impact of the 2023 earthquakes on the Syrian population: cross-sectional study. BJPsych Open 2023; 10:e1. [PMID: 38037419 PMCID: PMC10755557 DOI: 10.1192/bjo.2023.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Natural disasters have a significant impact on the mental health of affected populations. The February 2023 earthquakes in Syria and Turkey caused widespread devastation. AIMS To explore the mental health impact of the earthquakes in Syria on the population across areas differentially damaged by the disaster. METHOD This cross-sectional study conducted in Syria included 1406 adults recruited via social media platforms 1 month after the February 2023 earthquakes. Demographic information, earthquake exposure questions, the PTSD Checklist for DSM-5 (PCL-5: for probable post-traumatic stress disorder, PTSD), the Patient Health Questionnaire-9 (PHQ-9: for probable depression) and the seven-item Generalized Anxiety Disorder scale (GAD-7: for probable anxiety) were included to compare outcomes across areas severely, moderately and slightly damaged by the earthquakes. RESULTS Probable PTSD and GAD rates were higher in the severely (57.9 and 57.3% respectively) and moderately damaged regions (55.4 and 56.3% respectively) than in the slightly damaged regions (44.6 and 48.3% respectively) (PTSD: P < 0.001, GAD: P = 0.005). More participants in severely damaged regions (60.6%) reported symptoms of depression compared with moderately (53.1%) and slightly damaged (50.8%) regions (P = 0.003). Poorer mental health outcomes were associated with being female, single, younger, having a damaged or destroyed house, seeing something tragic in person and hearing tragic stories. Seeing something tragic on social media was not statistically significant. CONCLUSIONS This study highlights the higher prevalence of probable mental disorders in areas with more severe earthquake damage, with over 50% of the population reporting probable PTSD, depression or anxiety. The study also suggests a significant cumulative effect of these earthquakes on an already trauma- and disaster-affected population.
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Affiliation(s)
| | | | - Rana Hadakie
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Syria
| | - Kinda Alsamara
- Centre for Arab and Islamic Studies, Australian National University, Canberra, Australia
| | - David Forbes
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | - Kenda Jawich
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Damascus University, Syria
| | | | - Ameer Kakaje
- Faculty of Medicine, Damascus University, Syria; and University Hospital Geelong, Barwon Health, Geelong, Australia
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Connecting Crises: Young People in Nepal Reflecting on Life Course Transitions and Trajectories during Times of Uncertainty. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10110439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During certain crises, displacement of populations seeking safe refuge elsewhere can occur without the certainty of a return, if at all. Children and young people in such contexts often face the additional challenge of restrictions or disregard towards engaging their agency in migration decision-making processes. Through 60 in-depth interviews with 30 trans-Himalayan participants (ages of 16–23) and multi-sited ethnography throughout Nepal, this paper investigates multiple experiences of crises experienced by young people and the effects on their life course trajectories. From focusing on the Civil War in 1996–2006, the 2015 earthquake, and most recently the COVID-19 pandemic, this paper proposes that initial displacements from the Civil War, when connected with other crises later on in a participant’s life course, better prepared them to deal with crises and enabled them to create a landscape of resilience. Furthermore, a landscape of resilience that connects past and present life course experiences during crises prepared some participants for helping their larger communities alleviate certain crises-related tension. Overall, this paper extends analysis on an under-researched group of young migrants by connecting crises that shaped their (im)mobility and life trajectories, rather than approaching crises as singular, isolated experiences.
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