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Withers M, Trop J, Bayalag M, Schriger SH, Ganbold S, Doripurev D, Davaasambuu E, Bat-Erdene U, Gendenjamts B. "They should ask about our feelings": Mongolian women's experiences of postpartum depression. Transcult Psychiatry 2023; 60:1005-1016. [PMID: 37731351 DOI: 10.1177/13634615231187256] [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: 09/22/2023]
Abstract
Between 16 and 20% of perinatal women in low- and middle-income countries experience depression. Addressing postpartum depression (PPD) requires an appreciation of how it manifests and is understood in different cultural settings. This study explores postpartum Mongolian women's perceptions and experiences of PPD. We conducted interviews with 35 postpartum women who screened positive for possible depression to examine: (1) personal experiences of pregnancy/childbirth; (2) perceived causes and symptoms of PPD; and (3) strategies for help/support for women experiencing PPD. Unless extreme, depression was not viewed as a disease but rather as a natural condition following childbirth. Differences between a biomedical model of PPD and local idioms of distress could explain why awareness about PPD was low. The most reported PPD symptom was emotional volatility expressed as anger and endorsement of fear- or anxiety-related screening questions, suggesting that these might be especially relevant in the Mongolian context. Psychosocial factors, as opposed to biological, were common perceived causes of PPD, especially interpersonal relationship problems, financial strain, and social isolation. Possible barriers to PPD recognition/treatment included lack of awareness about the range of symptoms, reluctance to initiate discussions with providers about mental health, and lack of PPD screening practices by healthcare providers. We conclude that educational campaigns should be implemented in prenatal/postnatal clinics and pediatric settings to help women and families identify PPD symptoms, and possibly destigmatize PPD. Healthcare providers can also help to identify women with PPD through communication with women and families.
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Affiliation(s)
- Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Justin Trop
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Munkhuu Bayalag
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Solongo Ganbold
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Undral Bat-Erdene
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
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Pennington ML, Ylitalo KR, Thomas KL, Coe E, Humphries M, Gulliver SB. Suicides among American Indian/Alaska Native firefighters: Data from the National Violent Death Reporting System, 2003 - 2017. Psychiatry Res 2023; 330:115593. [PMID: 37951031 DOI: 10.1016/j.psychres.2023.115593] [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: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/13/2023]
Abstract
Suicide is a significant public health problem in the United States and disproportionally affects male American Indian/Alaska Natives (AI/AN). Suicide is particularly problematic among AI/AN firefighters who are more likely to report suicide ideation, planning, attempts, and risk compared to non-Hispanic white (NHW) firefighters. The aim of the current study was to compare non-Hispanic AI/AN firefighter and NHW firefighter suicide decedents by demographics and risk/precipitating factors using National Violent Death Reporting System data for 45 male non-Hispanic AI/AN firefighter and 588 male NHW firefighter decedents who died by suicide. Compared to NHW firefighter decedents, AI/AN firefighter decedents were significantly younger and had significantly higher odds of experiencing alcohol use problems and a recent death/suicide of a family member/friend. AI/AN firefighter decedents had significantly lower odds of documented mental health problems, documented diagnosis of depression/dysthymia, receipt of mental health treatment, or leaving a suicide note compared to NHW firefighter decedents. Results from this study may inform tailored suicide prevention and screening efforts among first responders with the goal of lowering suicide mortality among AI/AN firefighters and fire service as a whole.
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Affiliation(s)
- Michelle L Pennington
- Department of Public Health, Baylor University, Waco, TX, USA; Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.
| | - Kelly R Ylitalo
- Department of Public Health, Baylor University, Waco, TX, USA
| | | | - Elizabeth Coe
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - Mariah Humphries
- George W. Truett Theological Seminary, Baylor University, Waco, TX, USA
| | - Suzy B Gulliver
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, Temple, TX, USA
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Sundarapperuma TD, Gamage MWK, Rathnayake N, Weeratunga EB, Jagodage HMH. Psychological disturbances encountered by the healthcare professionals, military professionals and general public in Sri Lanka during COVID-19 pandemic: a cross-sectional study. BMC Psychiatry 2023; 23:452. [PMID: 37344813 DOI: 10.1186/s12888-023-04918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is a serious global health concern, posing a greater risk of psychological vulnerabilities for frontline healthcare workers (HCWs), military professionals and the general public around the globe. These psychological issues appear to be long lasting and heighten the risk of mental health disorders. Therefore, this study aimed to identify psychological problems encountered by HCWs, military professionals, and the general public in Sri Lanka during the COVID-19 pandemic. METHODS A descriptive cross-sectional study was undertaken with 367 participants, including frontline HCWs (n = 128), military professionals (n = 102), and the general public (n = 137). Depression and anxiety were assessed using the Peradeniya Depression Scale (PDS) and the Generalized Anxiety Disorder scale (GAD-7), respectively. RESULTS Mean (± SD) age of the participants was 35.0 (± 10.6) years. A reasonable proportion of participants experienced depressive symptoms (39.25%, n = 144) and severe anxiety (12.8%, n = 47). Military professionals showed depressive symptoms (73.50%, n = 75) and severe anxiety (32.4%, n = 33) predominantly. Multivariate binary logistic regression revealed that only the level of education and professional engagement affected depressive symptoms and severe anxiety (p < 0.01). Having a high level of education was a protective factor for depressive symptoms (Adjusted OR = 0.34) compared to lower-level education, while being a HCW (Adjusted OR = 4.40) and military professional (Adjusted OR = 5.43) were identified as risk factors for depressive symptoms compared to the general public. Similarly, having a high level of education was a protective factor for severe anxiety (Adjusted OR = 0.29) compared to lower-level education, while being a HCW (Adjusted OR = 3.90) and military professional (Adjusted OR = 4.52) were identified as risk factors for severe anxiety compared to the general public. CONCLUSION The current study revealed a greater level of anxiety and depressive symptoms among frontline HCWs and military professionals in Sri Lanka during the pandemic of COVID-19 compared to the general public. Therefore, providing psychological first aid for them to better deal with mental problems and an emergency preparedness plan to deal with sudden outbreaks of infectious situations are important.
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Affiliation(s)
| | | | - Nirmala Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Ruhuna, Sri Lanka
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Fernando M, Chandrasiri A, Dayabandara M, Reavley NJ. Cultural adaptation of mental health first aid guidelines for depression for Sri Lanka: a Delphi expert consensus study. BMC Psychiatry 2021; 21:585. [PMID: 34801017 PMCID: PMC8606054 DOI: 10.1186/s12888-021-03598-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family and friends can play a key role in supporting a person with depression to seek professional help. However, they may lack the knowledge to do so. English-language guidelines for high-income countries have been developed to assist with this. The aim of this study was to adapt the English mental health first aid guidelines for helping a person with depression to the Sri Lankan context. METHODS A Delphi expert consensus study involving mental health professionals and people with lived experience (either their own or as carers) was conducted. Participants were recruited from inpatient, outpatient and community care settings. The English-language questionnaire was translated into Sinhala and participants were asked to rate the importance of each item for inclusion in the guidelines for Sri Lanka. RESULTS Data were collected over two survey rounds. A total of 115 panellists (23% male) consisting of 92 mental health professionals and 23 consumers and carers completed the Round 1 questionnaire. A total of 165 items were included in the final guidelines, with 156 adopted from the guidelines for English-speaking countries and 9 generated from the comments of panellists. CONCLUSIONS The adapted guidelines were similar to the English-language guidelines. However, new items reflecting culturally relevant approaches to autonomy-granting, communication and culture-specific manifestations of depression were reflected in the adapted version. Further research should explore the use of the adapted guidelines, including their incorporation into Mental Health First Aid Training.
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Affiliation(s)
- Madhawee Fernando
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010 Australia
| | - Amila Chandrasiri
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010 Australia ,grid.466905.8Ministry of Health, Colombo, Sri Lanka
| | - Madhubhashinee Dayabandara
- grid.8065.b0000000121828067Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nicola J. Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010 Australia
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Legha RK, Gerbasi ME, Smith Fawzi MC, Eustache E, Therosme T, Fils-Aime JR, Raviola GJ, Affricot E, Pierre EL, Alcindor Y, Severe J, Boyd KA, Grelotti DJ, Darghouth S, Rasmussen A, Becker AE. A validation study of the Zanmi Lasante Depression Symptom Inventory (ZLDSI) in a school-based study population of transitional age youth in Haiti. Confl Health 2020; 14:13. [PMID: 32140176 PMCID: PMC7048134 DOI: 10.1186/s13031-020-0250-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Zanmi Lasante Depression Symptom Inventory (ZLDSI) is a screening tool for major depression used in 12 primary care clinics in Haiti's Central Plateau. Although previously validated in a clinic-based sample, the present study is the first to evaluate the validity and clinical utility of the ZLDSI for depression screening in a school-based population in central Haiti. Methods We assessed depressive symptoms in a school-based sample of transitional age youth (18-22 years; n = 120) with the ZLDSI. Other mental health-related assessments included a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) for current Major Depressive Episode, the Center for Epidemiologic Studies Depression Scale, and selected items adapted from the Global School-Based Health Survey mental health module. Diagnostic assignments of major depressive episode (MDE) were based on modified SCID interviews. Results The ZLDSI demonstrated good overall accuracy in identifying current MDE (Area under the Curve = .92, 95% CI = .86, .98, p < .001). We ascertained ≥12 as the optimal cut-off point to screen for depression with a sensitivity of 100% and a specificity of 73.9%. In addition, the ZLDSI was associated with other measures of depressive symptoms, suggesting that it demonstrates construct validity. Conclusions Study findings support that the ZLDSI has clinical utility for screening for depression among school-going transitional age youth.
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Affiliation(s)
- Rupinder K Legha
- 1Center for Health Services and Society, University of California, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90045 USA
| | - Margaret E Gerbasi
- 2Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Mary C Smith Fawzi
- 2Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Eddy Eustache
- Mental Health and Psychosocial Support Services Program, Zanmi Lasante, Santo 18A, Crois-des-Bouquets, Haiti
| | - Tatiana Therosme
- Mental Health and Psychosocial Support Services Program, Zanmi Lasante, Santo 18A, Crois-des-Bouquets, Haiti
| | - J Reginald Fils-Aime
- Mental Health and Psychosocial Support Services Program, Zanmi Lasante, Santo 18A, Crois-des-Bouquets, Haiti
| | - Giuseppe J Raviola
- 2Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA.,4Partners In Health, 800 Boylston Street, Suite 300, Boston, MA 02199 USA
| | - Emmeline Affricot
- Mental Health and Psychosocial Support Services Program, Zanmi Lasante, Santo 18A, Crois-des-Bouquets, Haiti
| | - Ermaze Louis Pierre
- Mental Health and Psychosocial Support Services Program, Zanmi Lasante, Santo 18A, Crois-des-Bouquets, Haiti
| | - Yoldie Alcindor
- Mental Health and Psychosocial Support Services Program, Zanmi Lasante, Santo 18A, Crois-des-Bouquets, Haiti
| | - Jennifer Severe
- 5Department of Psychiatry, University of Michigan, University School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Katherine A Boyd
- 6Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO 80045 USA
| | - David J Grelotti
- 7Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Sarah Darghouth
- 8Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114 USA
| | - Andrew Rasmussen
- 9Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall 334, Bronx, NY 10458 USA
| | - Anne E Becker
- 2Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA.,8Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114 USA
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Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1519-1533. [PMID: 31317245 PMCID: PMC7050264 DOI: 10.1007/s00127-019-01746-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique. METHODS Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique. RESULTS 19% (CI 17-21%) of respondents reported DS in the past year and 17% (CI 15-18%) lifetime SI. Overall, only 10% (CI 8-11%) of respondents ever sought any care for mental illness, though 26% (CI 23-29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability-especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care. CONCLUSIONS DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique.
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Cork C, Kaiser BN, White RG. The integration of idioms of distress into mental health assessments and interventions: a systematic review. Glob Ment Health (Camb) 2019; 6:e7. [PMID: 31143467 PMCID: PMC6521171 DOI: 10.1017/gmh.2019.5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/12/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Psychiatric diagnostic manuals recognise the importance of local expressions of distress in culturally diverse settings [i.e. idioms/cultural concepts of distress (CCDs)], yet there is a lack of consensus on how these should be incorporated into mental health related research. AIMS To perform a narrative synthesis and critical review of research exploring how idioms/CCDs have been integrated into assessment measures and interventions. METHOD A systematic review was conducted in accordance with PRISMA guidelines. An adapted version of the COSMIN checklist was used to assess the quality of the linguistic translation of the idioms/CCDs. RESULTS Twenty-nine papers were included in the final review. Primary qualitative research was the most common method of gathering information about idioms/CCDs. The majority of studies described integrating idioms/CCDs into assessment measures as opposed to interventions. Some studies used information relating to idioms/CCDs to develop novel assessment measures, while others adapted pre-existing assessment measures. The measures generated moderate to high levels of validity. Information relating to the linguistic translation conducted in the completion of the studies tended to be inadequately reported. CONCLUSIONS Integrating information about idioms/CCDs into assessment measures can enhance the validity of these assessments. Allocating greater research attention to idioms/CCDs can also promote more equitable exchanges of knowledge about mental health and wellbeing between the Global North and the Global South.
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Affiliation(s)
- C. Cork
- School of Education, University of Glasgow, 11 Eldon Street, Glasgow G3 6NH, UK
| | - B. N. Kaiser
- Department of Anthropology, University of California San Diego, La Jolla, CA, USA
| | - R. G. White
- Institute of Human and Life Sciences, University of Liverpool, G.10, Whelan Building, Brownlow Hill, Liverpool L69 3GQ, UK
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De Silva ANLM, Dawson AH, Gawarammana IB, Tennakoon S, Rajapakse T. Study protocol: a pilot randomized controlled trial to evaluate the acceptability and feasibility of a counseling intervention, delivered by nurses, for those who have attempted self-poisoning in Sri Lanka. Pilot Feasibility Stud 2018; 4:150. [PMID: 30258649 PMCID: PMC6151905 DOI: 10.1186/s40814-018-0341-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
Background Deliberate self-harm in the form of non-fatal self-poisoning is a major public health problem in Sri Lanka. Previous work suggests that many nurses in Sri Lanka—particularly those who work in primary care in the medical treatment of persons who attempt self-poisoning—already approach their role in a holistic fashion and consider “advising” or “counseling” patients after self-poisoning to be a part of their nursing role. But there is no formal training given to such nurses at present nor has the efficacy or feasibility of such an intervention been assessed in Sri Lanka. The aims of this pilot study are to explore the potential efficacy, acceptability, and feasibility of carrying out a counseling intervention that could be delivered by nurses for persons who present to hospital for medical management of non-fatal self-poisoning. Methods/design The study will be carried out at the Toxicology Unit of Teaching Hospital Peradeniya, Sri Lanka. A pilot randomized controlled trial will be carried out among participants admitted to Teaching Hospital Peradeniya for medical management of non-fatal self-poisoning. The primary objective of this study is to explore the acceptability and feasibility of a counseling intervention being delivered by nurses. The secondary objectives are to explore the efficacy of the intervention for the improvement of skills to cope with situations of acute emotional distress, and to reduce rates of anxiety, depression, and future repetition and suicidal ideation. A nurse’s experiences and attitudes regarding the acceptability and feasibility of implementing this intervention and participant experiences of the intervention and its effects will be explored via qualitative interviews and focus group discussions. Discussion It is anticipated that the findings of this pilot study will help determine and assess the acceptability and feasibility of this counseling intervention, as well as indicate the more useful aspects of this intervention in order to develop it for further exploration in a larger trial. Trial registration SLCTR/2017/008 Registered on 21st March 2017
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Affiliation(s)
- A N L M De Silva
- 1South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew H Dawson
- 2Central Clinical School, University of Sydney, Sydney, Australia
| | - Indika B Gawarammana
- 3Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sampath Tennakoon
- 4Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- 5Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Psychological Problems and Socioemotional Wellbeing among Children of Mothers with Depression and Their Association with Sociodemographic Factors in a Sri Lankan Setting. PSYCHIATRY JOURNAL 2018; 2018:3809384. [PMID: 29850470 PMCID: PMC5926479 DOI: 10.1155/2018/3809384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/25/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal depression is known to be associated with anxiety, depression, oppositional and conduct disorders, neurocognitive deficits, ADHD, substance abuse, and personality disorder in the offspring. We aimed to describe the proportion of psychological problems among children of mothers with depression in Sri Lanka and to describe the associated sociodemographic factors. METHODS A cross-sectional descriptive study was conducted on 100 children and adolescents between 4 and 16 years, whose mothers have a diagnosis of depression and are currently in remission. Specifically designed instruments were used to extract sociodemographic details and data on mother's illness. Strengths and Difficulties Questionnaire (SDQ) was used to detect psychological problems in children. RESULTS 14% of the children scored abnormally high in hyperactivity, 13% in conduct problems, 12% in emotional problems, 9% in peer problems, and 10% in total difficulties. Children (4-12 years) scored significantly higher than the adolescents in hyperactivity and externalizing problems (p < 0.05). Significant differences were also found in peer problems (p < 0.05), internalizing problems (p < 0.05), and total difficulties (p < 0.05) in relation to the age of the mother. CONCLUSION Screening the children of mothers with depression for psychological problems and developing a holistic management plan, which includes measures to ensure their wellbeing, is important.
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Housen T, Lenglet A, Ariti C, Ara S, Shah S, Dar M, Hussain A, Paul A, Wagay Z, Viney K, Janes S, Pintaldi G. Validation of mental health screening instruments in the Kashmir Valley, India. Transcult Psychiatry 2018; 55:361-383. [PMID: 29553303 DOI: 10.1177/1363461518764487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study aimed to culturally adapt, translate, and validate the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire-Posttraumatic Stress Symptoms Checklist (HTQ-16) prior to use in a cross-sectional mental health population survey in the Kashmir Valley. Cultural adaptation and translation of the HSCL-25 and the HTQ-16 employed multiple forms of transcultural validity check. The HSCL-25 and HTQ-16 were compared against a "gold standard" structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI). Interviews were conducted with 290 respondents recruited using consecutive sampling from general medical outpatient departments in five districts of the Kashmir Valley. Receiver operating characteristics (ROC) analysis was used to estimate the cut point with optimal discriminatory power based on sensitivity and specificity. Internal reliability of the HSCL-25 was high, Cronbach's alpha (α) = .92, intraclass correlation coefficient (ICC) = 0.75, with an estimated optimal cut point of 1.50, lower than the conventional cut point of 1.75. Separation of the instruments into subscales demonstrated a difference in the estimated cut point for the anxiety subscale and the depression subscale, 1.75 and 1.57, respectively. Too few respondents were diagnosed with posttraumatic stress disorder (PTSD) during structured psychiatric interview, and therefore the HTQ-16 could not be validated despite the fact that high internal reliability was demonstrated (α = .90). This study verified the importance of culturally adapting and validating screening instruments in particular contexts. The use of the conventional cut point of 1.75 would likely have misclassified depression in our survey, leading to an underestimate of this condition.
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Affiliation(s)
- Tambri Housen
- 307007 Médecins Sans Frontières Holland , India Australian National University
| | - Annick Lenglet
- Médecins Sans Frontières Operational Centre Amsterdam, the Netherlands
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine
| | | | | | - Maqbool Dar
- Institute of Mental Health and Neurosciences, India
| | | | | | | | | | | | - Giovanni Pintaldi
- Médecins Sans Frontières Operational Centre Amsterdam, the Netherlands
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Amarasuriya SD, Jorm AF, Reavley NJ. Predicting intentions to seek help for depression among undergraduates in Sri Lanka. BMC Psychiatry 2018; 18:122. [PMID: 29728075 PMCID: PMC5935961 DOI: 10.1186/s12888-018-1700-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 04/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies have found that although there are high rates of depression among university students, their help-seeking practices are poor. It is important to identify students who are less likely to seek the necessary help, to encourage better help-seeking among them. This study, which was conducted among undergraduates in Sri Lanka, examined the associations between personal characteristics of the undergraduates and their intentions to seek help for depression. METHODS This was a cross-sectional study in which 4461 undergraduates (Male: n = 1358, 30.4%, Female: n = 3099, 69.5%; Mean age = 22.18; SD = 1.47) indicated their intentions to seek help if personally affected by depression, which was described in a hypothetical vignette about a peer experiencing depression symptomatology. The predictors of the undergraduates' help-seeking intentions, including their sociodemographic characteristics, prior exposure to and recognition of the problem, and their stigma towards those with depression were examined using binary logistic regression analyses models. RESULTS The undergraduates' ability to recognise the problem was one of the strongest predictors of their intentions to seek professional help. Those with higher levels of stigma were less likely to seek both professional and informal help. While females were less likely to consider professional help, they were more likely to consider the help of informal help-providers and to consider religious strategies. Medical undergraduates and those who had sought help for personal experiences of the problem were also more likely to consider informal help. However, all these associations resulted in small effect sizes, except for those between recognition of the problem and the undergraduates' intentions to seek professional help, where medium to very large effect sizes were observed in the case of some the associations examined. CONCLUSIONS Improvement of problem-recognition may be a key strategy for improving help-seeking among these undergraduates. Reduction of stigma may also be associated with better depression-related help-seeking of undergraduates. Females and medical undergraduates need to be educated about the importance of seeking appropriate types of help, and their informal social networks must be educated about how best to help them.
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Affiliation(s)
- Santushi D. Amarasuriya
- 0000000121828067grid.8065.bDepartment of Medical Humanities, Faculty of Medicine, University of Colombo, PO Box 271, 25, Kynsey Road, Colombo 8, Sri Lanka ,0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC 3010 Australia
| | - Anthony F. Jorm
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC 3010 Australia
| | - Nicola J. Reavley
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC 3010 Australia
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Lokuge K, Wallace P, Subasinghe K, Thurber K, De Silva T, Clarke N, Waas D, Liyanage N, Attygalle U, Carron-Arthur B, Rodrigo K, Banks E, D'Este C, Rajapakse T. Protocol for a cluster-randomised controlled trial evaluating the impact of a preschool-based capacity building intervention on intimate partner violence and substance misuse in Sri Lanka. BMC Public Health 2018; 18:572. [PMID: 29716553 PMCID: PMC5930834 DOI: 10.1186/s12889-018-5423-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Past research has identified links between intimate partner violence (IPV) and alcohol misuse and poverty in Sri Lanka. Services that address substance misuse are amongst the few interventions shown to reduce IPV in settings similar to Sri Lanka. This paper describes the protocol for a study examining the impact of a preschool-based capacity building intervention on the prevalence of IPV and substance misuse in parents with children attending preschools, including uptake of available government services. Methods The study is a cluster randomised controlled trial. Government-managed preschools (n = 34) in Galle and Colombo municipalities will be randomly assigned to an intervention (n = 17) or control group (n = 17). Parents with children attending these preschools will be recruited to participate. The study intervention will build the capacity of selected community volunteers (parents) and preschool teachers in the provision of information and support to families affected by IPV and substance misuse. This intervention is directed at improving uptake, access and coordination of existing services. Data will be collected from all parents, and teachers in the intervention group, pre-intervention and 10 months post-intervention. The primary outcome for this study is experience of IPV amongst mothers of preschool-attending children. Secondary outcomes are substance misuse amongst fathers, measured via the locally adapted Alcohol Use Disorders Identification Test and Drug Abuse Screening Test; and awareness and uptake of services for these issues measured through locally-relevant tools. Demographic information and satisfaction with the intervention will also be assessed. Discussion By intervening through preschools we aim to support high-risk families early enough to arrest the cycle of violence that results in children themselves becoming victims and perpetrators of such violence. The innovative project design will reach the most vulnerable sections of the community and will provide a sustainable and feasible strategy for scale-up of the intervention. Trial registration This study is registered with the Sri Lankan Clinical Trials Registry (2017/038) and has been submitted to ClinicalTrials.gov (U.S National Institutes of Health) under the title “Randomized control trial: preschool-based training and support programs to reduce intimate partner violence (IPV) by addressing alcohol and drug misuse in young families in Sri Lanka”; Registration number: NCT03341455; Registration date: 14 November 2017.
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Affiliation(s)
- Kamalini Lokuge
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia
| | - Polly Wallace
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia.
| | | | - Katherine Thurber
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia
| | | | - Naomi Clarke
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia
| | - Dulshika Waas
- Department of Psychiatry, University of Sri Jayawardenapura, Colombo, Sri Lanka
| | | | | | - Bradley Carron-Arthur
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia
| | - Kalyana Rodrigo
- Psychiatry Department, The Canberra Hospital, Woden, Australia
| | - Emily Banks
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia
| | - Cate D'Este
- The Australian National University National Centre for Epidemiology and Public Health, Canberra, Australia.,The University of Newcastle, School of Medicine and Public Health, Newcastle, Australia
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Chandradasa M, Champika L. Transcultural factors related to depressive psychopathology in Sri Lankan migrants living in Australia. Int J Soc Psychiatry 2018; 64:303-304. [PMID: 29322863 DOI: 10.1177/0020764017752970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Miyuru Chandradasa
- 1 Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,2 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Rohanachandra YM, Prathapan S, Wijetunge GS. Characteristics of mothers' depressive illness as predictors for emotional and behavioural problems in children in a Sri Lankan setting. Asian J Psychiatr 2018; 33:74-77. [PMID: 29547751 DOI: 10.1016/j.ajp.2018.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/22/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Maternal depression has been shown to be associated with neurodevelopmental, emotional and behavioural disorders in offspring. We aimed to describe the proportion of psychological problems among children of mothers with depression in Sri Lanka and to describe the association with the characteristics of the mothers' illness. METHODS A cross-sectional descriptive study was conducted on 100 children and adolescents between 4-16 years whose mother has a diagnosis of depression and currently in remission. Specifically designed instruments were used to extract socio-demographic details and data on mother's illness. Strengths and Difficulties Questionnaire (SDQ) was used to detect psychological problems in children. RESULTS 14 % of the children scored abnormally high in hyperactivity, 13 % in conduct problems, 12 % in emotional problems, 9 % in peer problems. Hyperactivity, internalizing problems, and total difficulties were significantly higher in where mothers' had a history of a moderate depressive episode and recurrent depressive disorder. Children whose mothers had no attempts of self-harm scored significantly higher in both emotional problems and internalizing problems. Children whose mothers have comorbid illness scored significantly higher in hyperactivity, conduct problems, emotional problems, externalizing problems, internalizing problems and total difficulties. CONCLUSIONS Screening for psychological problems in children and developing a holistic management plan which include steps to ensure the well-being of the children is important in managing mothers with depression.
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Affiliation(s)
- Yasodha Maheshi Rohanachandra
- Department of Psychiatry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka.
| | - Shamini Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka.
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15
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Attygalle UR, Perera H, Jayamanne BDW. Mental health literacy in adolescents: ability to recognise problems, helpful interventions and outcomes. Child Adolesc Psychiatry Ment Health 2017; 11:38. [PMID: 28814972 PMCID: PMC5557470 DOI: 10.1186/s13034-017-0176-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/28/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although mental health literacy has been widely studied in adults, there are still relatively few studies on adolescent populations. In Sri Lanka, adolescents account for about one fifth of the population. Current evidence shows that most mental health problems diagnosed in adulthood begin in adolescence. There is also growing evidence that the trajectories of these disorders can be altered through early recognition and intervention. Although, help-seeking for mental health problems is known to be poor in adolescents, mental health literacy improves help-seeking. It is also known that adolescents may act as agents of change regarding mental health in their wider communities. Thus, mental health literacy in adolescents is an important aspect of community mental health initiatives. The objective of this study was to describe aspects of mental health literacy in terms of ability to recognise problems, helpful interventions, helpful referral options and outcomes in a target adolescent population in Sri Lanka. The association between socio economic variables and recognition of mental health problems was also examined. METHODS This descriptive cross sectional study used a pretested questionnaire on 1002 adolescents aged between 13 and 16, where mental health literacy was assessed using 4 case vignettes. The vignettes represented depression with suicidal ideation, social phobia, psychosis and diabetes, where the last was for comparison. RESULTS The response rates for recognition as a mental health problem was 82.2% (n = 824) for the vignette depicting depression, 68.7% (n = 689) for the psychosis vignette and 62.3% (n = 623) for the social phobia vignette. "Talking to the person", was responded to as helpful by 49.9% (n = 500), for the depression vignette followed by 49.8% (n = 499) for social phobia, 39.5% (n = 396) for psychosis and 19.5% (n = 195) for the diabetes vignette. The response rate for exercise being a helpful intervention was 25% (n = 251) for the diabetes vignette, followed by 21% (n = 210) for social phobia, 18.7% (n = 187) for psychosis vignette and 18.4% (n = 184) for the depression vignette. While 70.2% (n = 704) responded that there would be benefit in seeing a doctor for the diabetes vignette, the response rates for psychosis was 48.5% (n = 486), and for both depression and social phobia it was 48.2% (n = 483). The responses for the persons in the vignettes becoming better with treatment was 81.4% (n = 816) for the diabetes, 79.5% (n = 797) for depression, 75.6% (n = 758) for psychosis and 63.4% (n = 636) for the social phobia vignette. A statistically significant association was found between the income level of the family and appropriate recognition as mental health problems, for all the 3 mental health related vignettes. CONCLUSIONS The ability to recognise mental health problems, helpful interventions and outcomes in this population was comparable to those of adolescent populations in other countries, with some exceptions. The main differences were in relation to the identification and interventions in response to the psychosis and social phobia vignettes.
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Affiliation(s)
| | - Hemamali Perera
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Stankevitz K, Staton C, Schoenfisch A, de Silva V, Tharindra H, Stroo M, Ostbye T. Prevalence of occupational injury and its contributing factors among rubber tappers in Galle, Sri Lanka. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:333-340. [PMID: 27784205 DOI: 10.1080/10773525.2016.1247026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Rubber tapping involves carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injury among this vulnerable working population. OBJECTIVE To assesses the prevalence, severity, and contributing factors associated with occupational injury among Sri Lankan rubber tappers and to identify possible interventions to improve occupational safety. METHODS A questionnaire was administered to 300 Sri Lankan rubber tappers. The associations between tapper characteristics and injury within the last year were examined using log-binomial regression models. Short response answers were analyzed using qualitative content analysis. RESULTS 300 tappers reported 594 injuries in the previous 12 months, and missed 1,080 days of work. The prevalence of one or more injuries was 49%. Factors associated with injury were being female, working an additional job, tapping with a two-handed approach, and depressive symptomology. Qualitative findings suggest three interventions to address injuries: (1) landscaping, (2) personal protective equipment, and (3) provision of eyeglasses. CONCLUSIONS Work-related injuries are common among Sri Lankan rubber tappers. These results highlight the importance of working with and including informal workers in the creation of Sri Lankan occupational health and safety regulations. We believe that the three interventions identified by respondents could help to reduce the risk of occupational injury among rubber tappers.
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Affiliation(s)
- Kayla Stankevitz
- a Department of Community and Family Medicine , Duke University , Durham , NC , USA
| | - Catherine Staton
- b Duke Global Health Institute, Duke University , Durham , NC , USA.,c Division of Emergency Medicine , Duke University , Durham , NC , USA
| | - Ashley Schoenfisch
- a Department of Community and Family Medicine , Duke University , Durham , NC , USA.,d Duke School of Nursing , Duke University , Durham , NC , USA
| | - Vijitha de Silva
- e Faculty of Medicine, Department of Community Medicine , University of Ruhuna , Galle , Sri Lanka
| | - Hemajith Tharindra
- e Faculty of Medicine, Department of Community Medicine , University of Ruhuna , Galle , Sri Lanka
| | - Marissa Stroo
- a Department of Community and Family Medicine , Duke University , Durham , NC , USA
| | - Truls Ostbye
- a Department of Community and Family Medicine , Duke University , Durham , NC , USA.,b Duke Global Health Institute, Duke University , Durham , NC , USA
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Wickramasinghe ND, Wijesinghe PR, Dharmaratne SD, Agampodi SB. The prevalence and associated factors of depression in policing: a cross sectional study in Sri Lanka. SPRINGERPLUS 2016; 5:1776. [PMID: 27795918 PMCID: PMC5061667 DOI: 10.1186/s40064-016-3474-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Policing is regarded as a high-risk profession for the development of mental health disturbances owing to various critical incidents and potential traumatic events they encounter. Exploration of mental health problems in policing in Sri Lanka, which recently concluded a civil war expanded over three decades, is a timely, yet, a neglected issue. Hence, the present study was conducted with the aim of determining the prevalence and associated factors of depression among police officers in the Kandy police division, Sri Lanka. METHODS A cross sectional study was conducted using a simple random sample of 750 police officers employed in the Kandy police division, Sri Lanka. A self administered questionnaire, including "Peradeniya Depression Scale" to assess depression, was used to collect data. The prevalence of depression was calculated as point prevalence with 95 % confidence intervals. Multivariable logistic regression was carried out using backward elimination method to quantify the association between depression and selected predictors identified at bivariate analysis at p < 0.10. RESULTS A total of 750 Police officers were invited for the study. The response rate was 94.5 % (n = 709). The mean age of the police officers in the sample was 39.6 years (SD 9.2 years). Majority of police officers (n = 591, 83.4 %) were males. The estimated prevalence of depression in the study sample was 22.8 % (95 % CI 19.9-26.1 %). However, the adjusted prevalence of depression was 10.6 % (95 % CI 6.6-15.1 %). In the multivariable analysis, of the postulated occupational factors, satisfactory welfare facilities at work place was negatively associated with depression (adjusted OR 0.5; 95 % CI 0.3-0.7; p = 0.001). Satisfaction of the opportunity to serve the public (adjusted OR 0.2; 95 % CI 0.1-0.6; p = 0.003) and satisfaction related to social status gained in policing (adjusted OR 0.5; 95 % CI 0.3-0.8; p = 0.04) were identified as significant occupational factors that lowered the likelihood of being categorized as having depression. CONCLUSIONS The prevalence of depression among police officers was found to be higher in comparison to other study findings in Sri Lanka. Given the modifiable nature of the significant predictors, it is recommended to design a package of interventions and implement adaptive measures to rectify the problems related to depression among police officers.
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Affiliation(s)
- Nuwan D Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Pushpa R Wijesinghe
- Epidemiology Unit, Ministry of Health, No. 231, De Saram Place, Colombo 10, Sri Lanka
| | - Samath D Dharmaratne
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Suneth B Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Stankevitz K, Schoenfisch A, de Silva V, Tharindra H, Stroo M, Ostbye T. Prevalence and risk factors of musculoskeletal disorders among Sri Lankan rubber tappers. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:91-8. [PMID: 27092589 DOI: 10.1080/10773525.2016.1168073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rubber tapping exposes workers to risk factors for musculoskeletal disorders (MSDs). OBJECTIVES This cross-sectional study assessed the prevalence and factors associated with MSDs among Sri Lankan rubber tappers. METHODS Questionnaires were administered to 300 rubber tappers to measure MSDs and potential associated factors. Ergonomic exposure levels were measured for 90 tappers using the Quick Exposure Check instrument. MSD prevalence and prevalence ratios were calculated using log-binomial regression. RESULTS In the past 12 months, 66% of rubber tappers in our sample experienced an MSD. Ergonomic exposure levels were high or very high in the back (94.4%), shoulders (96.7%), and neck (83.3%). Being female, older, Tamil, working two jobs, alternating tapping hands, and depression were significantly associated with increased risk of MSDs. CONCLUSIONS MSDs are common among rubber tappers in Sri Lanka. These results suggest a need for work process modifications to prevent MSDs.
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Affiliation(s)
- Kayla Stankevitz
- a Duke Global Health Institute, Duke University , Durham , NC ¸ USA
| | - Ashley Schoenfisch
- b Department of Community and Family Medicine , Duke University Medical Center , Durham , NC , USA
| | - Vijitha de Silva
- c Faculty of Medicine, Department of Community Medicine , University of Ruhuna , Galle , Sri Lanka
| | - Hemajith Tharindra
- c Faculty of Medicine, Department of Community Medicine , University of Ruhuna , Galle , Sri Lanka
| | - Marissa Stroo
- b Department of Community and Family Medicine , Duke University Medical Center , Durham , NC , USA
| | - Truls Ostbye
- a Duke Global Health Institute, Duke University , Durham , NC ¸ USA.,b Department of Community and Family Medicine , Duke University Medical Center , Durham , NC , USA.,d Program in Health Service and Systems Research , Duke-NUS Graduate Medical School , Singapore
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Rajapakse T, Christensen H, Cotton S, Griffiths KM. Non-fatal self-poisoning across age groups, in Sri Lanka. Asian J Psychiatr 2016; 19:79-84. [PMID: 26957344 DOI: 10.1016/j.ajp.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 12/29/2015] [Accepted: 01/01/2016] [Indexed: 11/17/2022]
Abstract
Attempted or non-fatal self-poisoning in common in Sri Lanka, but little is known about variation of psychiatric morbidity and suicidal intent across differing ages. The aim of this study was to investigate factors associated with non-fatal self-poisoning in Sri Lanka across three different age groups (namely 14-24 years, 25-34 years and ≥ 35 years). It was anticipated that the findings of the study would inform and guide development of preventive interventions for non-fatal self-poisoning in this country. 935 participants were interviewed within one week of admission to hospital for medical management of non-fatal self-poisoning, over a consecutive 14-month period. Socio-demographic factors, types of poison ingested, triggers and psychiatric morbidity was examined as a function of age. Results showed that a majority (83%) of participants were aged below 35 years. Younger participants aged <25 years were significantly more likely to ingest medicinal overdoses, compared to older persons (aged 25-34 years, and ≥ 35 years), who were more likely to ingest pesticides. Recent interpersonal conflict was a proximal trigger seen in all age groups, but suicidal intent, depression and alcohol use disorders increased with age. The overall study findings indicate that most who carry out acts of non-fatal self-poisoning in Sri Lanka are young (aged <35 years). Interpersonal conflict as a trigger is common to all age groups, but psychiatric morbidity and suicidal intent is higher in the older age groups, as is pesticide ingestion. Age specific interventions may be efficacious in the prevention of non-fatal self-poisoning in Sri Lanka.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Sri Lanka.
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick 2013, NSW, Australia.
| | - Sue Cotton
- Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville 3052, VIC, Australia.
| | - Kathleen Margaret Griffiths
- National Institute for Mental Health Research, Australian National University, Building 63, Canberra 0200, ACT, Australia.
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Amarasuriya SD, Jorm AF, Reavley NJ. Depression literacy of undergraduates in a non-western developing context: the case of Sri Lanka. BMC Res Notes 2015; 8:593. [PMID: 26493708 PMCID: PMC4619076 DOI: 10.1186/s13104-015-1589-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research examining the depression literacy of undergraduates in non-western developing countries is limited. This study explores this among undergraduates in Sri Lanka. METHODS A total of 4671 undergraduates responded to a survey presenting a vignette of a depressed undergraduate. They were asked to identify the problem, describe their intended help-seeking actions if affected by it and rate the helpfulness of a range of help-providers and interventions for dealing with it. Mental health experts also rated these options, providing a benchmark for assessing the undergraduates' responses. RESULTS Only 17.4% of undergraduates recognised depression, but this was significantly lower among those responding in Sinhala compared to English (3.5 vs 36.8%). More undergraduates indicated intentions of seeking informal help, such as from friends and parents, than from professionals, such as psychiatrists and counsellors. However, a majority rated all these help-providers as 'helpful', aligning with expert opinion. Other options recommended by experts and rated as 'helpful' by a large proportion of undergraduates included counselling/psychological therapy and self-help strategies such as doing enjoyable activities and meditation/yoga/relaxation exercises. However, a low proportion of undergraduates rated "western medicine to improve mood" as 'helpful', deviating from expert opinion. Although not endorsed by experts, undergraduates indicated intentions of using religious strategies, highly endorsing these as 'helpful'. Labelling the problem as depression and using mental health-related labels were both associated with higher odds of endorsing professional help, with the label 'depression' associated with endorsing a wider range of professional options. CONCLUSIONS The recognition rate of depression might be associated with the language used to label it. These undergraduates' knowledge about the use of medication for depression needs improvement. Health promotion interventions for depressed undergraduates must be designed in light of the prevalent socio-cultural backdrop, such as the undergraduates' high endorsement of informal and culturally relevant help-seeking. Improving their ability to recognise the problem as being mental health-related might trigger their use of professional options of help.
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Affiliation(s)
- Santushi D Amarasuriya
- Behavioural Sciences Stream, Faculty of Medicine, University of Colombo, 25, Kynsey Road, PO Box 271, Colombo 8, Sri Lanka. .,Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC, 3010, Australia.
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC, 3010, Australia.
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC, 3010, Australia.
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Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry 2014; 14:221. [PMID: 25103532 PMCID: PMC4149235 DOI: 10.1186/s12888-014-0221-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity. METHODS Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years. RESULTS Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders. CONCLUSIONS Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Kathleen Margaret Griffiths
- National Institute for Mental Health Research, The Australian National University, Building 63, Canberra, ACT 0200 Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwich, NSW 2013 Australia
| | - Sue Cotton
- Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville, VIC 3052 Australia
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