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Lan L, Liu W, Liu C, Wang H, Wang M, Abbey C, Singh MK, Rozelle S, She X, Tong L. Effects of Mindfulness and Life-Skills Training on Emotion Regulation and Anxiety Symptoms in Chinese Migrant Children: A Randomized Controlled Trial. J Adolesc Health 2024; 75:404-415. [PMID: 38970607 DOI: 10.1016/j.jadohealth.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE China's rapid urbanization has been associated with increased mental health challenges, especially in rural-to-urban migrant children. This study evaluates the effects of mindfulness and life-skills (LS) training on emotional regulation and anxiety symptoms from a randomized controlled trial aimed at improving the mental health of Chinese migrant children. METHODS Two intervention arms-mindfulness training (MT) and MT plus LS mentorship (MT + LS)-were compared to a waitlist control group of 368 migrant children aged 9-17 years. Volunteers were trained to deliver interventions to 285 migrant children in small groups of 15 for eight weeks weekly. Social integration varied: migrant children mixed with local children at public schools were considered highly integrated, those in migrant-only classrooms at public schools had intermediate levels of integration, and children in private migrant schools had low integration. Emotion regulation and anxiety symptoms were assessed preintervention, postintervention, and three months postintervention. RESULTS Postintervention and compared to the control group, children with high social integration in the MT arm showed increased cognitive reappraisal ability (p < .05) but higher physical anxiety (p < .01). Children with high social integration in the MT + LS arm had lower anxiety symptoms of harm avoidance (p < .01) and physical anxiety (p < .05). Children with low social integration in the MT + LS arm showed lower cognitive reappraisal (p < .01) and poorer overall emotion regulation abilities (p < .01). Three months later, children with intermediate integration in the MT + LS arm had lower separation anxiety (p < .05) and harm avoidance anxiety (p < .05). No other groups showed significant improvements in emotion regulation or reducing in anxiety symptoms three months postintervention. DISCUSSION Mindfulness and LS training may benefit Chinese migrant children who have higher levels of social integration but increase anxiety in those with lower social integration. Future research should consider the sociocultural context in which a treatment is implemented.
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Affiliation(s)
- Luwan Lan
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wanqing Liu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Chen Liu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Huan Wang
- Stanford Center of China's Economy and Institutions, Stanford, California
| | - Min Wang
- Stanford Center of China's Economy and Institutions, Stanford, California
| | - Cody Abbey
- Stanford Center of China's Economy and Institutions, Stanford, California
| | | | - Scott Rozelle
- Stanford Center of China's Economy and Institutions, Stanford, California
| | - Xinshu She
- Stanford University School of Medicine, Stanford, California.
| | - Lian Tong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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Oswald TK, Nguyen MT, Mirza L, Lund C, Jones HG, Crowley G, Aslanyan D, Dean K, Schofield P, Hotopf M, Das-Munshi J. Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Psychol Med 2024; 54:1475-1499. [PMID: 38523245 DOI: 10.1017/s0033291724000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.
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Affiliation(s)
- Tassia Kate Oswald
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Minh Thu Nguyen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Luwaiza Mirza
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- University Hospitals Sussex, UK
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Hannah Grace Jones
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Grace Crowley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Daron Aslanyan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, New South Wales, Australia
| | - Peter Schofield
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, UK
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Gkintoni E, Kourkoutas E, Yotsidi V, Stavrou PD, Prinianaki D. Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:579. [PMID: 38790574 PMCID: PMC11119036 DOI: 10.3390/children11050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74100 Rethymno, Greece;
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University, 17671 Athens, Greece;
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Harte P, Barry MM. A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries. Glob Ment Health (Camb) 2024; 11:e55. [PMID: 38751723 PMCID: PMC11094552 DOI: 10.1017/gmh.2024.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024] Open
Abstract
Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.
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Affiliation(s)
- Patricia Harte
- WHO Collaborating Centre for Health Promotion Research, University of Galway, Galway, Ireland
| | - Margaret M. Barry
- WHO Collaborating Centre for Health Promotion Research, University of Galway, Galway, Ireland
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Gonçalves JS, Oliveira JLD, Almeida JCPD, Morero JAP, Pegoraro NPJ, Zanetti MOB, Souza JD. Effect of an Online Intervention on Nursing Students' Alcohol Consumption and Social Support. J Addict Nurs 2024; 35:51-58. [PMID: 38829994 DOI: 10.1097/jan.0000000000000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This research aimed to evaluate the impact of custom-developed software on nursing students' alcohol consumption and perception of social support. METHOD A quasi-experimental study was conducted with 88 students in the early years of nursing courses at a Brazilian public university. The members of the intervention group (n = 40) participated in a lecture delivered by a nurse and used online software developed based on cognitive behavioral techniques and social skills training. The members of the control group (n = 48) participated only in the lecture. Data on alcohol consumption profiles and social support characteristics were collected. Descriptive statistics, an analysis of variance test, and the Dunnett's test were utilized for data analysis. RESULTS Alcohol consumption decreased in both groups without significant differences between them. However, in terms of frequency of use, binge drinking, and the number of drinks consumed, a significant decrease occurred among participants in the intervention group. Regarding social support, both groups showed an increase in satisfaction with support and a decrease in the number of supporters. This reduction was less pronounced in the intervention group than in the control group. CONCLUSION This investigation presents relevant results that suggest the potential of using online technologies as supplemental materials for promoting students' mental health.
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Kirchhoff E, Keller R, Blanc B. Empowering young people-the impact of camp experiences on personal resources, well-being, and community building. Front Psychol 2024; 15:1348050. [PMID: 38420173 PMCID: PMC10899333 DOI: 10.3389/fpsyg.2024.1348050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Personal resources and resources of the sociocultural environment help children and adolescents to successfully cope with challenges in everyday life, which is associated with better individual well-being. SCOUT, the 'Study on Competence development in OUT-of-school settings', investigated whether participation in a summer camp enhanced adolescents' personal resources, well-being, and readiness to contribute to the community. Methods The research took place during the Swiss National Jamboree of the Swiss Guide and Scout Movement, a two-week event in the summer of 2022, with a paper-pencil pretest (beginning of the camp - T1) and posttest (end of the camp - T2) survey (N = 607, aged 14-17). Confirmatory factor analyses were used to examine whether personal resources, well-being, and readiness to contribute to the community changed over time, and structural equation models were applied to test the direct and indirect effects of caring support from group leaders on the development of these variables. Results In less than two weeks, camp participants demonstrated increased empathy, emotional self-control, optimism, and assertiveness. Furthermore, the adolescents reported more positive emotions, higher self-esteem, and stronger readiness to contribute to the community. Group leaders played a crucial role by influencing the positive development of well-being and readiness to contribute to the community both directly and indirectly through the promotion of personal resources. Discussion The findings indicate that young people benefit not only from participating in collaborative activities in a stimulating environment, but also from caring support provided by their group leaders.
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Affiliation(s)
| | - Roger Keller
- Zurich University of Teacher Education, Zürich, Switzerland
| | - Barbara Blanc
- Zurich University of Teacher Education, Zürich, Switzerland
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Miller L, Butera NM, Ellsberg M, Baird S. Polyvictimization and Adolescent Health and Well-Being in Ethiopia: The Mediating Role of Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6755. [PMID: 37754614 PMCID: PMC10530940 DOI: 10.3390/ijerph20186755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
Interpersonal violence is a pervasive experience affecting one billion children and adolescents annually, resulting in adverse health and well-being outcomes. Evidence suggests that polyvictimization, the experience of multiple forms of violence, is associated with more harmful consequences for adolescents than experiencing individual types of violence, although data from low-and middle-income countries are limited. This study analyzed data on over 4100 adolescents from the Gender and Adolescence, Global Evidence Study in Ethiopia to examine the association between polyvictimization and adolescent mental and physical health and the mediating role of resilience using linear regression and path analysis. We hypothesized that adolescents experiencing polyvictimization would experience worse mental and physical health than those experiencing no types or individual types of victimization, and that resilience would mediate these relationships. Half of sampled girls and over half of boys experienced polyvictimization. Among both sexes, polyvictimization was associated with worse mental but not worse physical health. Resilience mediated the association between polyvictimization and mental health among girls only. Strengthening resilience among girls may be an effective avenue for mitigating polyvictimization's negative mental health effects, but additional research and programming for preventing and identifying polyvictimized adolescents and linking them to care is needed.
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Affiliation(s)
- Lior Miller
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (M.E.); (S.B.)
| | - Nicole M. Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA;
| | - Mary Ellsberg
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (M.E.); (S.B.)
- Global Women’s Institute, The George Washington University, Washington, DC 20052, USA
| | - Sarah Baird
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (M.E.); (S.B.)
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Zheng S, Ji X, Cheng L, Xu J, Cronin LD. Perceptions of the motivational climate, basic psychological needs, and life skills development in Chinese physical education students. Front Psychol 2023; 14:1232849. [PMID: 37649686 PMCID: PMC10462985 DOI: 10.3389/fpsyg.2023.1232849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Life skills can have a positive impact on young people's mental health, academic performance, and overall well-being. Physical education (PE) is viewed as a promising setting for developing students' life skills, but less is known about this in non-English speaking countries such as China. Based on the integration of Self-Determination Theory (SDT) and Achievement Goal Theory (AGT), we aimed to examine the relationships between students' perceptions of the teacher-initiated motivational climate (mastery- or performance-oriented) and their life skills development in PE, as well as the mediating role of their basic psychological needs (BPNs) (satisfaction or frustration). Methods We employed a cross-sectional survey. Chinese students (N = 533, Age range = 13-18 years) completed measures assessing these variables. We fulfilled correlational and mediational analyses. Results These findings showed that mastery climate was positively associated with needs satisfaction (r = 0.66) and eight life skills (r range = 0.44-0.61), whereas negatively associated with needs frustration (r = -0.49). Performance climate was positively related to needs frustration (r = 0.52), but negatively related to needs satisfaction (r = -0.38) and eight life skills (r range = -0.28 - -0.15). Needs satisfaction was positively (r range = 0.44-0.65), while needs frustration was negatively (r range = -0.50 - -0.34) linked with eight life skills. Furthermore, needs satisfaction positively mediated the effect of mastery climate on life skills development, but it is not found that needs frustration mediated the effect of performance climate on life skills besides goal setting, social skills, and time management. Conclusion In conclusion, our study extended the previous literature on life skills in PE, and highlighted the roles of motivational climate and BPNs on students' life skills development. In practice, PE teachers should be encouraged to create a mastery climate as well as avoid a performance climate, to foster students' BPNs satisfaction, which in turn, promote their life skills development.
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Affiliation(s)
- Shaofeng Zheng
- Department of Physical Education, The Open University of Fujian, Fuzhou, China
| | - Xiangbo Ji
- School of Physical Education and Sport Science, Nanjing Normal University, Nanjing, China
| | - Liping Cheng
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
| | - Jianhua Xu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, China
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Sherif Y, Azman AZF, Awang H, Mokhtar SA, Mohammadzadeh M, Alimuddin AS. Effectiveness of Life Skills Intervention on Depression, Anxiety and Stress among Children and Adolescents: A Systematic Review. Malays J Med Sci 2023; 30:42-59. [PMID: 37425380 PMCID: PMC10325125 DOI: 10.21315/mjms2023.30.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/03/2022] [Indexed: 07/11/2023] Open
Abstract
Children and adolescents are at a significantly high risk of mental health problems during their lifetime, among which are depression and anxiety, which are the most common. Life skills education is one of the intervention programmes designed to improve mental well-being and strengthen their ability to cope with the daily stresses of life. This review aimed to identify and evaluate the effect of life skills intervention on the reduction of depression, anxiety and stress among children and adolescents. Following the Population, Intervention, Comparison and Outcome (PICO) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2009 checklist, eight databases (Academic Search Complete, CINAHL, Cochrane, MEDLINE, Psychology and Behavioural Sciences Collection, PubMed, Scopus and Web of Science) were systematically reviewed from 2012 to 2020. The search was limited to English papers only. It included published experimental and quasi-experimental studies addressing the effect of life skills interventions on the reduction of at least one of the following mental health disorders: depression, anxiety and stress among children and adolescents (from the age of 5 years old to 18 years old). We used the Joanna Briggs Institute checklist for experimental and quasi-experimental studies to evaluate the quality of the included studies. This study was registered in PROSPERO [CRD42021256603]. The search identified only 10 studies (three experimental and seven quasi-experimental) from 2,160 articles. The number of the participants was 6,714 aged between 10 years old and 19 years old. Three studies in this review focused on depression and anxiety, whereas one study investigated depression and the other anxiety. Three studies targeted only stress and two examined the three outcomes, namely, depression, anxiety and stress. Almost in all studies, the life skills intervention positively impacted mental disorders, considering the differences among males and females. The overall methodological quality of the findings was deemed to be moderate to high. Our results clearly indicated the advantages of life skills programmes among adolescents in different settings and contexts. Nonetheless, the results highlight some important policy implications by emphasising the crucial roles of developers and policymakers in the implementation of appropriate modules and activities. Further research examining life skills intervention with a cultural, gender perspective, age-appropriate and long-term effect is recommended.
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Affiliation(s)
- Yosra Sherif
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ahmad Zaid Fattah Azman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Hamidin Awang
- Psychiatry Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia
| | - Siti Aisha Mokhtar
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Marjan Mohammadzadeh
- Institute of Health and Nursing Sciences, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aisha Siddiqah Alimuddin
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Haag K, Du Toit S, Mikus N, Skeen S, Steventon Roberts K, Marlow M, Notholi V, Sambudla A, Chideya Y, Sherr L, Tomlinson M. Does pre-COVID impulsive behaviour predict adherence to hygiene and social distancing measures in youths following the COVID-19 pandemic onset? Evidence from a South African longitudinal study. BMC Public Health 2023; 23:533. [PMID: 36941589 PMCID: PMC10027426 DOI: 10.1186/s12889-023-15310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Engagement in protective behaviours relating to the COVID-19 pandemic has been proposed to be key to infection control. This is particularly the case for youths as key drivers of infections. A range of factors influencing adherence have been identified, including impulsivity and risk taking. We assessed the association between pre-COVID impulsivity levels and engagement in preventative measures during the COVID-19 pandemic in a longitudinal South African sample, in order to inform future pandemic planning. METHODS Data were collected from N = 214 youths (mean age at baseline: M = 17.81 (SD = .71), 55.6% female) living in a South African peri-urban settlement characterised by high poverty and deprivation. Baseline assessments were taken in 2018/19 and the COVID follow-up was conducted in June-October 2020 via remote data collection. Impulsivity was assessed using the Balloon Analogue Task (BART), while hygiene and social distancing behaviours were captured through self-report. Stepwise hierarchical regression analyses were performed to estimate effects of impulsivity on measure adherence. RESULTS Self-rated engagement in hygiene behaviours was high (67.1-86.1% "most of the time", except for "coughing/sneezing into one's elbow" at 33.3%), while engagement in social distancing behaviours varied (22.4-57.8% "most of the time"). Higher impulsivity predicted lower levels of hygiene (β = .14, p = .041) but not social distancing behaviours (β = -.02, p = .82). This association was retained when controlling for a range of demographic and COVID-related factors (β = .14, p = .047) and was slightly reduced when including the effects of a life-skills interventions on hygiene behaviour (β = -.13, p = .073). CONCLUSIONS Our data indicate that impulsivity may predict adolescent engagement in hygiene behaviours post COVID-19 pandemic onset in a high risk, sub-Saharan African setting, albeit with a small effect size. For future pandemics, it is important to understand predictors of engagement, particularly in the context of adversity, where adherence may be challenging. Limitations include a small sample size and potential measure shortcomings.
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Affiliation(s)
- Katharina Haag
- Institute for Global Health, University College London, London, UK
- Present affiliation: Department of Child Health and Development, Norwegian Institute for Public Health, Oslo, Norway
| | - Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nace Mikus
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Interacting Minds Centre, Aarhus University, Aarhus, Denmark
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | | | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Akhona Sambudla
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Yeukai Chideya
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
- School of Nursing and Midwifery, Queens University, Belfast, UK.
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Kip A, Iseke LN, Papola D, Gastaldon C, Barbui C, Morina N. Efficacy of psychological interventions for PTSD in distinct populations - An evidence map of meta-analyses using the umbrella review methodology. Clin Psychol Rev 2023; 100:102239. [PMID: 36529109 DOI: 10.1016/j.cpr.2022.102239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/26/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
We aimed at mapping the meta-analytic evidence base on the efficacy of psychological treatments for posttraumatic stress disorder (PTSD) in specific populations. We conducted a systematic search until January 2022 in MEDLINE, PsycINFO, PTSDpubs, Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses of randomized controlled trials. We contrasted all eligible meta-analyses irrespective of overlapping datasets to present a comprehensive overview of the state of research. Reporting quality was assessed using the AMSTAR 2 tool and certainty of evidence was assessed using established umbrella review criteria. Nine meta-analyses with distinct adult populations (51 unique trials) and four with children and adolescents (24 unique trials) were included. Reporting quality of meta-analyses was heterogeneous with risk of bias assessment being rated lowest. The certainty of evidence on the efficacy of psychological interventions for adult populations was thoroughly weak because of small samples and large heterogeneity. In war- and conflict-affected youth, the certainty of evidence was suggestive. Our review highlights the need to improve quality of meta-analyses on treatment efficacy for PTSD. More importantly, however, the findings demonstrate the need for new large-scale trials on the efficacy of treatments for PTSD in distinct populations in order to increase certainty of evidence and to identify potential differences in treatment responses.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | - Linnéa N Iseke
- Institute of Psychology, University of Münster, Münster, Germany
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany.
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12
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Jeong J, Sullivan EF, McCann JK, McCoy DC, Yousafzai AK. Implementation characteristics of father-inclusive interventions in low- and middle-income countries: A systematic review. Ann N Y Acad Sci 2023; 1520:34-52. [PMID: 36482863 PMCID: PMC9974925 DOI: 10.1111/nyas.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low-resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low- and middle-income countries. Forty-four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community-based peer-groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Juliet K McCann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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13
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Venturo-Conerly KE, Eisenman D, Wasil AR, Singla DR, Weisz JR. Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries. J Am Acad Child Adolesc Psychiatry 2022:S0890-8567(22)01980-3. [PMID: 36563875 DOI: 10.1016/j.jaac.2022.12.005] [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: 01/30/2022] [Revised: 07/20/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators. METHOD We searched 9 international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including post-traumatic stress disorder [PTSD] and obsessive-compulsive disorder), depression, conduct problems, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at post treatment and follow-up for intervention vs control conditions. RESULTS Of 5,145 articles identified, 34 articles (with 43 treatment-control comparisons and 4,176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI = 0.72-1.29, p < .001) at post treatment and 0.68 (95% CI = 0.29-1.07, p = .003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay providers (g = 1.59 vs 0.53), but all interventions for conduct problems were delivered by professionals, and the difference for interventions targeting internalizing problems (g = 1.33 vs .53) was not significant. Interventions developed non-locally were more effective if they were not adapted to local contexts than if they were adapted locally (g = 2.31 vs 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified. CONCLUSION Overall, pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs, as well as a need for more RCTs and improved study quality.
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Affiliation(s)
| | | | | | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; Sinai Health, Toronto, Ontario, Canada
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14
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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.
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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
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15
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Hassan E, BK P, Magar J, Luitel N, Kohrt BA, Jordans M, Rose-Clarke K. Community perspectives on the implementation of a group psychological intervention for adolescents with depression: A qualitative study in rural Nepal. Front Psychiatry 2022; 13:949251. [PMID: 36339866 PMCID: PMC9634215 DOI: 10.3389/fpsyt.2022.949251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Group-based psychological interventions could help to close the treatment gap for depression in low-resource settings, but implementation barriers exist. In Nepal we sought community members' perspectives on how to implement group interpersonal therapy for adolescents. We conducted qualitative interviews with 25 adolescents with depression (aged 13-18) and seven health and non-governmental organization workers, and four focus groups with non-depressed adolescents, four with parents/guardians, and two with teachers (126 participants total). Data were analyzed using the Framework Method. Participants recommended same-sex groups. School was the preferred location because it is accessible for adolescents and acceptable to parents. Adolescents wanted facilitators from their own community with good communication skills. They did not want parents or teachers to participate in groups but emphasized the need to inform parents and obtain their permission. Community members supported group psychological intervention. School-based psychological interventions facilitated by local people could be an acceptable option in rural Nepal.
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Affiliation(s)
- Eliz Hassan
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Prakash BK
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Mark Jordans
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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16
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Shinde S, Pereira B, Khandeparkar P. Acceptability and feasibility of the Heartfulness Way: A social-emotional learning program for school-going adolescents in India. Indian J Psychiatry 2022; 64:489-498. [PMID: 36458088 PMCID: PMC9707669 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_293_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The interest in life skills education programs in schools is growing. Yet, there is limited evidence on implementation indicators for such programs in low-income countries. AIM We present a qualitative evaluation of the acceptability and feasibility of the Heartfulness Way program-a secondary school-based social-emotional program, based on mindfulness techniques delivered by teachers in India. METHODS This qualitative study collected data from 12 schools in four Indian cities, namely, Chennai, Hyderabad, Prayagraj, and Pune. Data collection included focus group discussions with adolescents (n = 24) and teachers (n = 12), semistructured interviews with school principals (n = 12), program delivering teachers (n = 7), and program staff (n = 4). A thematic analysis was performed using NVivo 12. RESULTS Overall, the mindfulness-based classroom curriculum was strongly supported by participants. Acceptability was determined by positive responses, prosocial behavior, self-acceptance, and supportive bonds, according to students. Several themes of perceived benefits of the program including, improved relationships among peers and between students and teachers were identified. In general, the teachers' interviews indicated that there was a high level of satisfaction with the training and curriculum provided by the program. Teachers were able to provide high coverage (75%-80%) of the program activities, but several potential barriers were also identified, including insufficient training for teachers and the need for direct supervision. CONCLUSION The Heartfulness Way program, a social-emotional learning intervention, has shown strong support for acceptance and delivery by school communities. Future studies are needed to examine the effectiveness and cost-effectiveness of this program for improving the health and well-being of school-aged adolescents.
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Affiliation(s)
- Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.,Center for Inquiry into Mental Health, Pune, Maharashtra, India
| | | | - Prachi Khandeparkar
- Center for Inquiry into Mental Health, Pune, Maharashtra, India.,Sangath, Goa, India
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17
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Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, Allan J, Udomratn P. Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9:169-182. [PMID: 35065723 PMCID: PMC8776278 DOI: 10.1016/s2215-0366(21)00199-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.
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Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK.
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Shekhar Saxena
- Department of Global Health and Population at the Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London, UK
| | - John Allan
- Office of the President, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Pichet Udomratn
- Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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18
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Mao P, Peng L, Yuwen W, Liu D, Yan F, Chen Y, Long Y, Hash J. The Mediating and Moderating Roles of Life Skills and Cortisol in the Relationship Between Sleep Quality and Depressive Symptoms Among Chinese Adolescents With Childhood Household Dysfunction. Front Psychiatry 2022; 13:870349. [PMID: 35903627 PMCID: PMC9314773 DOI: 10.3389/fpsyt.2022.870349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Various studies show that sleep quality, life skills, and cortisol are associated with depressive symptoms, separately. However, the relationships between sleep quality, life skills, cortisol, and depressive symptoms remain unclear. Thus, this study aims to examine the mediating or moderating roles of life skills and cortisol in the relationship between sleep quality and depressive symptoms. METHODS A retrospective cross-sectional study was performed among 212 adolescents with childhood household dysfunction (CHD) from August to October 2020 in China. We used the Pittsburgh Sleep Quality Index, the Secondary School Student Life Skills Rating Scale, and the Center for Epidemiologic Studies Depression Scale to measure sleep quality, life skills, and depressive symptoms, respectively. Additionally, 65 participants provided blood samples to assess their blood cortisol levels. Analyses included correlations, regressions, and structural equation models. Bootstrapping was performed to examine the mediation effect. Multiple regression analysis was performed to examine the moderation effect. RESULTS The results showed that sleep quality and life skills were significantly associated with depressive symptoms (p < 0.01). Life skills mediated the relationship between sleep quality and depressive symptoms. Cortisol moderated the relationship between sleep quality and depressive symptoms. CONCLUSION Our findings support potential mediating and moderating roles of life skills and cortisol in the relationship between sleep quality and depressive symptoms, which suggests improving sleep quality, life skills are of great significance in the prevention and intervention of depression in adolescents with CHD, and disseminating knowledge about the high risk of developing increased depressive symptoms among adolescents with CHD with higher cortisol levels is indicated.
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Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research, College of Hunan Province, Central South University, Changsha, China
| | - Lianhua Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, Tacoma, WA, United States
| | - Dongdong Liu
- Department of Cardiothoracic Vascular Surgery, Affiliated Hospital of Jinggangshan University, Ji'an, China
| | - Fang Yan
- Department of Nursing, Third Xiangya Hospital of Central South University, Changsha, China
| | - Yang Chen
- Department of Nursing, Third Xiangya Hospital of Central South University, Changsha, China
| | - Yixiang Long
- Department of Nursing, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jonika Hash
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
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19
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Sparling TM, Cheng B, Deeney M, Santoso MV, Pfeiffer E, Emerson JA, Amadi FM, Mitu K, Corvalan C, Verdeli H, Araya R, Kadiyala S. Global Mental Health and Nutrition: Moving Toward a Convergent Research Agenda. Front Public Health 2021; 9:722290. [PMID: 34722437 PMCID: PMC8548935 DOI: 10.3389/fpubh.2021.722290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Both malnutrition and poor mental health are leading sources of global mortality, disease, and disability. The fields of global food security and nutrition (FSN) and mental health have historically been seen as separate fields of research. Each have undergone substantial transformation, especially from clinical, primary care orientations to wider, sociopolitical approaches to achieve Sustainable Development Goals. In recent years, the trajectories of research on mental health and FSN are further evolving into an intersection of evidence. FSN impacts mental health through various pathways such as food insecurity and nutrients important for neurotransmission. Mental health drives FSN outcomes, for example through loss of motivation and caregiving capacities. They are also linked through a complex and interrelated set of determinants. However, the heterogeneity of the evidence base limits inferences about these important dynamics. Furthermore, interdisciplinary projects and programmes are gaining ground in methodology and impact, but further guidance in integration is much needed. An evidence-driven conceptual framework should inform hypothesis testing and programme implementation. The intersection of mental health and FSN can be an opportunity to invest holistically in advancing thinking in both fields.
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Affiliation(s)
- Thalia M Sparling
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan Cheng
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Megan Deeney
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marianne V Santoso
- Department of Anthropology, Northwestern University, Evanston, IL, United States
| | - Erin Pfeiffer
- Independent Consultant, Winston-Salem, NC, United States
| | | | | | - Khadija Mitu
- Department of Anthropology, University of Chittagong, Chittagong, Bangladesh
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Ricardo Araya
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suneetha Kadiyala
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Fine SL, Malik A, Guimond MF, Nemiro A, Temu G, Likindikoki S, Annan J, Tol WA. Improving mental health in low-resource settings: A feasibility randomized controlled trial of a transdiagnostic psychological intervention among Burundian refugee adolescents and their caregivers. Behav Res Ther 2021; 145:103944. [PMID: 34392115 DOI: 10.1016/j.brat.2021.103944] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 05/21/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
There is a paucity of evidence regarding interventions that can improve the mental health of adversity-affected young adolescents living in low-resource settings. We evaluated the feasibility, acceptability, relevance, and safety of the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention among Burundian refugee adolescents and their caregivers in Tanzania. This study consisted of a feasibility cluster randomized controlled trial (cRCT) and a process evaluation. The feasibility cRCT included 82 young adolescents and their 64 caregivers, with two clusters randomized to EASE and two to an enhanced control condition. EASE was delivered by adult refugees without prior training in mental health. The process evaluation consisted of 36 semi-structured qualitative interviews with key stakeholders, including adolescents, caregivers, and facilitators. EASE participants and facilitators gave positive feedback about its format, accessibility, and content. Trained non-specialist refugee facilitators were able to deliver EASE with high fidelity. The research protocol functioned well in terms of balanced randomization, limited loss to follow-up, and psychometrically promising measures, but discordance was observed between the short screener and psychological distress symptom checklist. This formative study suggests the potential of EASE in targeting psychological distress among displaced young adolescents and lays the groundwork for a future definitive trial.
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Affiliation(s)
- Shoshanna L Fine
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Aiysha Malik
- World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | | | - Ashley Nemiro
- International Rescue Committee, 122 East 42nd St., New York, NY, 10168, USA
| | - Getruda Temu
- International Rescue Committee, 122 East 42nd St., New York, NY, 10168, USA
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Jeannie Annan
- International Rescue Committee, 122 East 42nd St., New York, NY, 10168, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark; HealthRight International, 14 East 14th St., New York, NY, 10012, USA
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21
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Castro-Ramirez F, Al-Suwaidi M, Garcia P, Rankin O, Ricard JR, Nock MK. Racism and Poverty are Barriers to the Treatment of Youth Mental Health Concerns. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:534-546. [PMID: 34339320 DOI: 10.1080/15374416.2021.1941058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Traditional studies of treatment moderators have focused largely on psychological factors such as clinical severity. Racial and economic inequity exert large effects on youth mental health, on treatment efficacy, and on the likelihood of receiving treatment altogether. Yet, these factors are studied less often by clinical psychological scientists. METHOD We conducted a narrative review of literature on racial and economic inequities and their impact on youth mental health. RESULTS First, systemic problems such as racism and poverty increase the risk of developing complex health issues and decrease the likelihood of benefiting from treatment. Second, attitudinal barriers, such as mistrust associated with treatments provided by researchers and government agencies, decrease the likelihood that minoritized groups will engage with or benefit from evidence-based treatments. Third, minoritized and underserved communities are especially unlikely to receive evidence-based treatment. CONCLUSION Clinical psychological science has unique insights that can help address systemic inequities that can decrease treatment efficacy for youth mental health treatment. Psychological scientists can help eliminate disparities in accessing evidence-based treatment and help end violent policies in underserved minoritized communities by at the very least (1) building and supporting scalable community-based treatments as well as (2) publicly advocating for an end to violent policies that impose negative social costs.
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Affiliation(s)
| | | | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University.,Department of Psychiatry, Massachusetts General Hospital.,Mental Health Research Program, Franciscan Children's
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22
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A bioecocultural approach to supporting adolescent mothers and their young children in conflict-affected contexts. Dev Psychopathol 2021; 33:714-726. [PMID: 33517930 DOI: 10.1017/s095457942000156x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An estimated 12 million girls aged 15-19 years, and 777,000 girls younger than 15 give birth globally each year. Contexts of war and displacement increase the likelihood of early marriage and childbearing. Given the developmentally sensitive periods of early childhood and adolescence, adolescent motherhood in conflict-affected contexts may put a family at risk intergenerationally. We propose that the specifics of normative neuroendocrine development during adolescence, including increased sensitivity to stress, pose additional risks to adolescent girls and their young children in the face of war and displacement, with potential lifelong consequences for health and development. This paper proposes a developmental, dual-generational framework for research and policies to better understand and address the needs of adolescent mothers and their small children. We draw from the literature on developmental stress physiology, adolescent parenthood in contexts of war and displacement internationally, and developmental cultural neurobiology. We also identify culturally meaningful sources of resilience and provide a review of the existing literature on interventions supporting adolescent mothers and their offspring. We aim to honor Edward Zigler's groundbreaking life and career by integrating basic developmental science with applied intervention and policy.
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23
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Araya R, Menezes PR, Claro HG, Brandt LR, Daley KL, Quayle J, Diez-Canseco F, Peters TJ, Vera Cruz D, Toyama M, Aschar S, Hidalgo-Padilla L, Martins H, Cavero V, Rocha T, Scotton G, de Almeida Lopes IF, Begale M, Mohr DC, Miranda JJ. Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials. JAMA 2021; 325:1852-1862. [PMID: 33974019 PMCID: PMC8114139 DOI: 10.1001/jama.2021.4348] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Importance Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).
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Affiliation(s)
- Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Paulo Rossi Menezes
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- School of Nursing, Universidade Estadual de Campinas, Campinas, Brazil
| | - Lena R. Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kate L. Daley
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Julieta Quayle
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tim J. Peters
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniela Vera Cruz
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Suzana Aschar
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Liliana Hidalgo-Padilla
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hellen Martins
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thais Rocha
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - George Scotton
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan F. de Almeida Lopes
- Federal University of ABC, Engineering, Modeling and Applied Social Sciences Center (CECS), Santo André, Brazil
| | - Mark Begale
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study. Dev Psychopathol 2021; 33:748-765. [PMID: 33955347 PMCID: PMC8139285 DOI: 10.1017/s0954579420002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Exposure to childhood adversity is a powerful risk factor for psychopathology. Despite extensive efforts, we have not yet identified effective or scalable interventions that prevent the emergence of mental health problems in children who have experienced adversity. In this modified Delphi study, we identified intervention strategies for effectively targeting both the neurodevelopmental mechanisms linking childhood adversity and psychopathology - including heightened emotional reactivity, difficulties with emotion regulation, blunted reward processing, and social information processing biases, as well as a range of psychopathology symptoms. We iteratively synthesized information from experts in the field and relevant meta-analyses through three surveys, first with experts in intervention development, prevention, and childhood adversity (n = 32), and then within our study team (n = 8). The results produced increasing stability and good consensus on intervention strategy recommendations for specific neurodevelopmental mechanisms and symptom presentations and on strength of evidence ratings of intervention strategies targeting youth and parents. More broadly, our findings highlight how intervention decision making can be informed by meta-analyses, enhanced by aggregate group feedback, saturated before consensus, and persistently subjective or even contradictory. Ultimately, the results converged on several promising intervention strategies for prevention programming with adversity-exposed youth, which will be tested in an upcoming clinical trial.
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Mohammadipour F, Fathi M, Amirkhani M, Nouriyengejeh S, Pourabbasi A. Comparison of Behavioral Concerns Priorities among Iranian Adolescent Boys, Parents and Teachers: Reporting the Results of a Modified Delphi. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2021; 9:2-17. [PMID: 33521145 PMCID: PMC7829589 DOI: 10.30476/ijcbnm.2020.85222.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Adolescence is a time of risks and opportunities. This study aimed to investigate and prioritize the behavioral concerns of male adolescents. Methods A modified Delphi study (2018-2019) was conducted in two stages. In the first stage, adolescents' behavioral concerns were extracted based on seven qualitative interviews and a focus group. Then, a questionnaire was designed using the obtained data; also, two-round consensus-building approach (rating and ranking) through surveys were conducted among 90students, teachers and parents covered by the Health Departments of Tehran University of Medical Sciences, who had been selected using a stratified cluster random sampling method. Qualitative content analysis was used in the first stage and descriptive statistics in the second stage to analyze the data. Results In the first stage, eight categories emerged, including relational challenges with parents and other adults; poor interaction with peers; lack of adaptation to conditions; emotional dysregulation; self-esteem and sense of purposefulness issues; materialistic tendencies; cyberspace issues; and non-adherence to religious beliefs. Then 63 behavioral concerns were identified. In each round (rating/ranking), 29/27, 28/29, and 30/30, responses were received for students, parents and teachers, respectively. According to the specified scores given to different issues, ten top problems according to the viewpoint of different groups were extracted. Conclusion "lack of planning and prioritization skill", "insufficient skill for controlling crisis", and "lack of resilience" are the most important priority for male adolescents, teachers and parents, respectively. These findings can be used for planning programs based on the adolescents' behavioral concerns.
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Affiliation(s)
- Fatemeh Mohammadipour
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Manzar Amirkhani
- Department of Counseling, Faculty of Educational Sciences, Tonekabon Branch, Islamic Azad University, Mazandaran, Iran
| | - Sarah Nouriyengejeh
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Pourabbasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Miller KE, Jordans MJD, Tol WA, Galappatti A. A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings. Epidemiol Psychiatr Sci 2021; 30:e5. [PMID: 33413736 PMCID: PMC8057504 DOI: 10.1017/s2045796020001110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. METHODS We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. RESULTS Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. CONCLUSIONS Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
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Affiliation(s)
| | - M. J. D. Jordans
- War Child Holland, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - W. A. Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Atif N, Rahman A, Huma ZE, Hamdani SU. Preparing for parenthood: developing a life-skills and socioemotional health program for young married couples in rural Pakistan. Glob Health Action 2021; 14:1982485. [PMID: 34605368 PMCID: PMC8491718 DOI: 10.1080/16549716.2021.1982485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Socioemotional life-skills to negotiate important life-transitions such as marriage and parenthood are critical for the wellbeing of young couples and their offspring, but programs addressing this issue are lacking in Low and Middle-Income Countries (LMICs). Objective This study describes the development of a ‘life-skills’ program for young married women, their husbands and families, living in rural settings in Pakistan. Methods Our methods included: a) a targeted review of relevant literature on life-skills and mental health in young people, b) a qualitative study and, c) intervention development workshops with experts and stakeholders. The review showed that common life-skills employed as part of psychosocial interventions in LMICs were communication skills, problem-solving, assessing relations, stress management, emotional regulation, identifying/eliciting affect, and self-awareness. Results The qualitative study indicated that areas of particular need included interpersonal communication skills with significant others, coping with the pressures of parenthood, and mental well-being. Existing helpful practices included social support by family members and elders. Lack of empowerment in young married women and poor engagement of husbands were identified as a barrier to accessing a potential intervention. Our proposed intervention called ‘Preparing for Parenthood’ consisted of 10 core sessions and 10 follow-up sessions designed to be delivered by lay health workers. It synergistically combined evidence-based socioemotional life-skills (awareness, communication skills, assertiveness, decision-making skills, goal-setting, critical thinking, problem-solving, and coping with stress), with cognitive behavioural strategies (gently challenging existing thoughts and attitudes, behaviour activation and problem solving). The intervention focuses on engagement of the entire family, including husbands. Conclusions The intervention can supplement existing sexual and reproductive health programs by providing skills to prospective parents to effectively negotiate stressful life-transitions and life-events. We envisage the intervention would improve mental as well as sexual and reproductive health of young couples and plan to test this in future randomised trials.
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Affiliation(s)
- Najia Atif
- Child and Adolescent Mental Health, Human Development Research Foundation, Rawalpindi, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Zill-E- Huma
- Child and Adolescent Mental Health, Human Development Research Foundation, Rawalpindi, Pakistan.,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Syed Usman Hamdani
- Child and Adolescent Mental Health, Human Development Research Foundation, Rawalpindi, Pakistan.,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Boustani MM, Daleiden E, Bernstein A, Michelson D, Gellatly R, Malik K, Patel V, Chorpita B. Using relevance mapping methodology to design an adolescent mental health intervention in India. Glob Health Action 2020; 13:1775062. [PMID: 32588780 PMCID: PMC7480414 DOI: 10.1080/16549716.2020.1775062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adolescents in low and middle-income countries experience pronounced mental health needs in contexts where infrastructure and resources are scarce. While evidence-based treatment are readily available, they may not fit the unique needs of certain contexts. OBJECTIVE This manuscript illustrates the systematic process of applying 'relevance mapping' methodology to leverage the youth mental health evidence base to identify candidate practices for inclusion in the development of a contextually appropriate psychological treatment protocol for common adolescent mental health problems in India. METHODS The practice identification was informed by two datasets obtained from adolescent samples in India. The first was an epidemiological dataset from a large community sample in Goa (N = 2,048); the second incorporated 'youth top problems' reported by service-seeking students presenting to school counsellors in Goa and Delhi (N = 78). Problems identified in each dataset were categorized using structured codes. Problem codes and youth demographics were then indexed against a database of hundreds of evidence-based psychological treatments and their associated clinical trials. This methodology revealed the most common practice elements (discrete therapeutic strategies) and their most efficient combinations with evidence of effectiveness matching the demographics and diagnostic category (anxiety, disruptive behaviors and depression) prevalent in the planned treatment population. RESULTS For anxiety, the most common practice elements for this age group were exposure, cognitive coping, and psychoeducation. For disruptive behaviors, the most common practices were problem-solving, goal-setting, and rapport-building. For depression, cognitive coping, behavioral activation, and psychoeducation were the most common practice elements. CONCLUSION These practice elements provided the treatment development team with a preliminary list of candidate content for the development of an intensive psychological treatment within a stepped care service model to address common adolescent mental health problems in schools in India.
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Affiliation(s)
- Maya M Boustani
- Department of Psychology, Loma Linda University , Loma Linda, CA, USA
| | | | | | | | - Resham Gellatly
- Department of Psychology, University of California , Los Angeles, CA, USA
| | | | - Vikram Patel
- Sangath , Goa, India.,Department of Global Health and Population, Harvard Medical School , Cambridge, MA, USA
| | - Bruce Chorpita
- Department of Psychology, University of California , Los Angeles, CA, USA
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Yano K, Kase T, Oishi K. Sensory Processing Sensitivity Moderates the Relationships Between Life Skills and Depressive Tendencies in University Students
1. JAPANESE PSYCHOLOGICAL RESEARCH 2020. [DOI: 10.1111/jpr.12289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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School-based interventions to promote adolescent health: A systematic review in low- and middle-income countries of WHO Western Pacific Region. PLoS One 2020; 15:e0230046. [PMID: 32134985 PMCID: PMC7058297 DOI: 10.1371/journal.pone.0230046] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background In the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO. Methods For this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up. Results Despite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments. Conclusions Only eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.
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