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Imran N, Bodla ZH, Asif A, Shoukat R, Azeem MW. Pakistan's First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period. Pak J Med Sci 2021; 37:305-311. [PMID: 33679904 PMCID: PMC7931300 DOI: 10.12669/pjms.37.2.2611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & Objective: Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit. Methods: Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed. Results: Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3 ± 2.3. Mean duration of admission was 15.60 ± 6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge. Conclusion: Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries.
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Affiliation(s)
- Nazish Imran
- Prof. Dr. Nazish Imran, MBBS, FRCPsych (London), MRCPsych (London), MHPE, Department of Child & Family Psychiatry, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Zubair Hassan Bodla
- Dr. Zubair Hassan Bodla, MBBS, Medical Officer, Department of Child and Family Psychiatry, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Aftab Asif
- Prof. Aftab Asif, MRCPsych (London), Professor & Head, Academic Department of Psychiatry & Behavioural Sciences, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Rabia Shoukat
- Rabia Shoukat, MS Psychology. Intern Psychologist, Department of Child & Family Psychiatry, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - M Waqar Azeem
- Prof. Dr. M. Waqar Azeem, MD, DFAACAP, DFAPA, Chair, Department of Psychiatry / Child & Adolescent Psychiatry, Sidra Medical and Research Center, Professor of Psychiatry, Weil Cornell Medicine, Doha Qatar
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Yavuz M, Aluç N, Tasa H, Hamamcıoğlu İ, Bolat N. The relationships between attachment quality, metacognition, and somatization in adolescents: The mediator role of metacognition. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:33-39. [DOI: 10.1111/jcap.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Mesut Yavuz
- Department of PsychologyFrench Lape Hospital, Child and Adolescent Psychiatry, İstanbul Aydin Universityİstanbul Turkey
| | - Nurşah Aluç
- Department of Psychologyİstanbul Aydin Universityİstanbul Turkey
| | - Hande Tasa
- Department of Psychologyİstanbul Aydin Universityİstanbul Turkey
| | - İrem Hamamcıoğlu
- Department of Child and Adolescent PsychiatryYalova State HospitalYalova Turkey
| | - Nurullah Bolat
- Department of Child and Adolescent PsychiatryÇanakkale Onsekiz Mart University School of MedicineÇanakkale Turkey
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Qadir F, Maqsood A, Us-Sahar N, Bukhtawer N, Khalid A, Pauli R, Gilvarry C, Medhin G, Essau CA. Factor Structure of the Urdu Version of the Spence Children's Anxiety Scale in Pakistan. Behav Med 2018. [PMID: 28632003 DOI: 10.1080/08964289.2016.1276427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Spence Children's Anxiety Scale (SCAS) is one of the most commonly used self-report questionnaires to measure symptoms of anxiety disorders in adolescents. Despite its common use, studies that examine the psychometric properties of SCAS in Pakistan is lacking. Therefore, the purpose of this study was to examine the psychometric properties of the Urdu translated version of the SCAS among adolescents in Pakistan. A total of 1277 students (708 boys and 569 girls), aged 13 to17 years, who had been recruited from 13 schools in Rawalpindi, Pakistan participated in the study. The mean overall anxiety score was significantly higher in girls than males on all the SCAS subscales except for obsessive compulsive disorder. The internal consistency of the Urdu SCAS was good. Confirmatory factor analyses supported six separate factor structures. Results of the study are discussed with reference to the sociocultural milieu of Pakistan and culture sensitive conceptualization of anxiety and its subtypes.
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Stavropoulos I, Pervanidou P, Gnardellis C, Loli N, Theodorou V, Mantzou A, Soukou F, Sinani O, Chrousos GP. Increased hair cortisol and antecedent somatic complaints in children with a first epileptic seizure. Epilepsy Behav 2017; 68:146-152. [PMID: 28189919 DOI: 10.1016/j.yebeh.2016.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Stress is the most frequent seizure-precipitating factor reported by patients with epilepsy, while stressful life events may increase seizure susceptibility in humans. In this study, we investigated the relations between both biological and behavioral measures of stress in children with a first epileptic seizure (hereafter called seizure). We hypothesized that hair cortisol, a biomarker of chronic stress reflecting approximately 3months of preceding exposure, might be increased in children with a first seizure. We also employed standardized questionnaires to examine presence of stress-related behavioral markers. METHODS This was a cross-sectional clinical study investigating stress-related parameters in children with a first seizure (First Epileptic Seizure Group (FESG), n=22) in comparison to healthy children without seizures (Control Group, n=29). Within 24h after a first seizure, hair samples were collected from children for the determination of cortisol. In parallel, perceived stress and anxiety and depressive symptoms were examined with appropriate self- and parent-completed questionnaires, and history of stressful life events during the past year was recorded. Emotional and behavioral problems were also assessed by parent-reported validated and widely-used questionnaires. RESULTS Higher hair cortisol measurements were observed in the FESG than control children (7.5 versus 5.0pg/mg respectively, p=0.001). The former were more likely to complain of somatic problems than the latter (59.8 vs. 55.4 according to DSM-oriented Scale, p=0.021); however, there were no differences in perceived stress and anxiety or depressive symptoms between the two groups. Using ROC analysis of hair cortisol measurements for predicting disease status, the maximum sensitivity and specificity were observed for a cut-off point of 5.25pg/mg. SIGNIFICANCE Increased hair cortisol indicates chronic hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis prior to the first seizure. This might have contributed to the epileptogenesis process and may help explain the higher incidence of antecedent somatic complaints in the first seizure group.
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Affiliation(s)
- Ioannis Stavropoulos
- The Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens and Biomedical Research Foundation, Academy of Athens, Soranou Ephessiou Str. 4, 11527 Athens, Greece; Department of Pediatric Neurology, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece.
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527, Athens, Greece
| | | | - Nomiki Loli
- Department of Pediatric Neurology, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Virginia Theodorou
- Department of Pediatric Neurology, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Aimilia Mantzou
- Unit on Clinical and Translational Research in Endocrinology, First Department of Pediatrics, School of Medicine, University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Faye Soukou
- Unit on Clinical and Translational Research in Endocrinology, First Department of Pediatrics, School of Medicine, University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - Olga Sinani
- Department of Pediatric Neurology, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
| | - George P Chrousos
- The Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens and Biomedical Research Foundation, Academy of Athens, Soranou Ephessiou Str. 4, 11527 Athens, Greece; Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, 11527, Athens, Greece; Unit on Clinical and Translational Research in Endocrinology, First Department of Pediatrics, School of Medicine, University of Athens, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece
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Cerutti R, Spensieri V, Valastro C, Presaghi F, Canitano R, Guidetti V. A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children. PLoS One 2017; 12:e0171867. [PMID: 28178333 PMCID: PMC5298337 DOI: 10.1371/journal.pone.0171867] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/26/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Somatic symptoms are frequently reported by children with significant impairment in functioning. Despite studies on adult populations that suggest somatic symptoms often co-occur with difficulties in identifying and describing feelings, little research has been done in childhood. This study aimed to investigate the prevalence and frequency of somatic symptoms as well as to investigate the functional impairment in children with high number of self reported somatic symptoms versus those with fewer somatic symptoms. Additionally the parental perception of their children's somatic symptoms and functioning was explored. Finally, we explored the direct and indirect effects of difficulties in identifying feelings in predicting somatic symptoms and functional disability among school-aged children. METHODS 356 Italian school-aged children and their mothers participated in this study. Children (mean age = 11.43; SD = 2.41) completed the Children's Somatization Inventory (CSI-24) to assess somatic symptoms, the Functional Disability Inventory (FDI) to assess physical and psychosocial functioning and the Alexithymia Questionnaire for Children (AQC) to evaluate alexithymic features. Mothers completed the parental forms of the CSI and the FDI. RESULTS Among children, 66.3% did not declare somatic symptoms and 33.7% reported one or more somatic symptoms in the last two weeks. A significant positive correlation emerged between children's and mothers' CSI total scores. Both children's and mothers' FDI total scores were significantly correlated with CSI scores. A significant correlation was observed between somatic symptoms and alexithymic features. Furthermore, the data showed that somatic symptoms mediated the relationship between difficulties in identifying feelings and functional impairment. Finally, it was showed that alexithymia facet of difficulty in identifying feelings contributed in large part to the prediction of the somatic symptomatology (b = 0.978, p < 0.001; R2 = 0.164, F(5, 350) = 10.32, p < 0.001). CONCLUSIONS Findings from this study provide evidence that a higher frequency of somatic symptoms is associated with functional disabilities and alexithymic facets in school-aged children.
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Affiliation(s)
- Rita Cerutti
- Department of Dynamic and Clinic Psychology, Sapienza University, Rome, Italy
- * E-mail:
| | - Valentina Spensieri
- Department of Dynamic and Clinic Psychology, Sapienza University, Rome, Italy
| | - Carmela Valastro
- Department of Dynamic and Clinic Psychology, Sapienza University, Rome, Italy
| | - Fabio Presaghi
- Department of Psychology of Developmental and Social Processes, Sapienza University, Rome, Italy
| | - Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Vincenzo Guidetti
- Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
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Imran N, Ashraf S, Shoukat R, Pervez MI. Mother's perceptions of child mental health problems and services: A cross sectional study from Lahore. Pak J Med Sci 2016; 32:778-81. [PMID: 27375732 PMCID: PMC4928441 DOI: 10.12669/pjms.323.9775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To assess the perceptions of mothers regarding child mental health problems, its causes, preferred treatment options, and to determine whom they would consult, if their child had a psychiatric illness. Methods: Following informed consent, a questionnaire covering perceptions regarding various aspects of child mental illness was used for data collection from mothers. They were asked to identify the symptoms and behaviours they considered psychopathological in children, which treatments they would prefer, where they would turn for help with a mentally ill child, and their understanding of the causes of child psychiatric disorders in addition to ways to increase awareness of child psychiatric issues in the society. Results: Ninety one mothers participated in the study. They equally perceived emotional, behavioural and cognitive symptoms as suggestive of mental ill health in childhood. Mothers perceived multiple causes of child mental health problems, including family problems, economic difficulties, social adversity and possession by evil spirits. A substantial proportion preferred medication, recitation of Holy Quran and psychotherapy as the preferred treatment options. Overall, mothers preferred consulting health professionals than religious scholars and faith healers. They were keen for steps to increase mental health awareness within their society. Conclusion: Despite different cultural perspective, mothers exhibit good understanding of symptoms of child mental health issues and appear open to various services and treatment options. Understanding parental perceptions and expectations from child psychiatric services are crucial in increasing families’ engagement in treatment.
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Affiliation(s)
- Nazish Imran
- Dr. Nazish Imran, MBBS; MRCPsych (London). Associate Professor, Child & Family Psychiatry Department, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Sania Ashraf
- Dr. Sania Ashraf, Resident Medical Officer. Child & Family Psychiatry Department, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Rabia Shoukat
- Miss Rabia Shoukat, Intern Psychologist, Department of Psychiatry & Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Muhammad Ijaz Pervez
- Dr. Muhammad Ijaz Pervez, MBBS. House Officer, Academic Department of Psychiatry & Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
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Bella-Awusah T, Ani C, Ajuwon A, Omigbodun O. Effectiveness of brief school-based, group cognitive behavioural therapy for depressed adolescents in south west Nigeria. Child Adolesc Ment Health 2016; 21:44-50. [PMID: 32680363 DOI: 10.1111/camh.12104] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is paucity of evidence-based psychological interventions for depressive disorders in Africa, more so among depressed children and adolescents. This study aimed to determine the effects of a school-based cognitive behavioural therapy programme (CBT) on depressed adolescents in South West Nigeria. METHODS Forty students who scored 18 or above on the Beck Depression Inventory (BDI) were recruited from two schools (20 from each school). One school was designated intervention and the other a wait-list control school. Five weekly sessions of group CBT programme were conducted in the intervention school. Primary outcome measure was the Beck Depression Inventory, and secondary outcome measures were the Short Mood and Feelings Questionnaire and the Impact Supplement of the Strengths and Difficulties Questionnaire. RESULTS Controlling for baseline scores and other confounders, the intervention group had significantly lower depressive symptoms scores on the BDI and SMFQ 1 week post intervention with large effect sizes. The intervention group maintained the treatment effect with significantly lower depression scores 16 weeks post intervention compared with their baseline scores. The effect sizes remained large. The intervention and control groups did not differ in their SDQ impact supplement scores post intervention, but the intervention group improved significantly on this measure at 16 weeks. CONCLUSIONS To our knowledge, this is the first study of a school-based group CBT programme for depressed adolescents in Africa. The programme showed good feasibility and promising effectiveness.
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Affiliation(s)
- Tolulope Bella-Awusah
- Centre for Child and Adolescent Mental Health, University of Ibadan, College of Medicine, University College Hospital, Ibadan, Nigeria.,Department of Psychiatry, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Cornelius Ani
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Ademola Ajuwon
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Omigbodun
- Centre for Child and Adolescent Mental Health, University of Ibadan, College of Medicine, University College Hospital, Ibadan, Nigeria.,Department of Psychiatry, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Basch MC, Chow ET, Logan DE, Schechter NL, Simons LE. Perspectives on the clinical significance of functional pain syndromes in children. J Pain Res 2015; 8:675-86. [PMID: 26504406 PMCID: PMC4605245 DOI: 10.2147/jpr.s55586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Functional pain syndromes (FPS) characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies.
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Affiliation(s)
- Molly C Basch
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston Children’s Hospital, Center for Pain and the Brain, PAIN Research Group, Boston University, Boston, MA, USA
| | - Erika T Chow
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Deirdre E Logan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Neil L Schechter
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston University, Boston, MA, USA
- Boston Children’s Hospital, Center for Pain and the Brain, PAIN Research Group, Boston University, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa: the Amagugu intervention. AIDS 2015; 29 Suppl 1:S67-79. [PMID: 26049540 DOI: 10.1097/qad.0000000000000668] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Increasingly, HIV-infected parents are surviving to nurture their children. Parental HIV disclosure is beneficial, but disclosure rates to younger children remain low. Previously, we demonstrated that the 'Amagugu' intervention increased disclosure to young children; however, effects on psychological outcomes have not been examined in detail. This study investigates the impact of the intervention on the maternal and child psychological outcomes. METHOD This pre-post evaluation design enrolled 281 HIV-infected women and their HIV-uninfected children (6-10 years) at the Africa Centre for Health and Population Studies, in rural South Africa. The intervention included six home-based counselling sessions delivered by lay-counsellors. Psychological outcomes included maternal psychological functioning (General Health Questionnaire, GHQ12 using 0,1,2,3 scoring); parenting stress (Parenting Stress Index, PSI36); and child emotional and behavioural functioning (Child Behaviour Checklist, CBCL). RESULTS The proportions of mothers with psychological distress reduced after intervention: GHQ threshold at least 12 (from 41.3 to 24.9%, P < 0.001) and GHQ threshold at least 20 (from 17.8 to 11.7%, P = 0.040). Parenting stress scores also reduced (Pre M = 79.8; Post M = 76.2, P < 0.001): two subscales, parental distress and parent-child relationship, showed significant improvement, while mothers' perception of 'child as difficult' was not significantly improved. Reductions in scores were not moderated by disclosure level (full/partial). There was a significant reduction in child emotional and behavioural problems (CBCL Pre M = 56.1; Post M = 48.9, P < 0.001). CONCLUSION Amagugu led to improvements in mothers' and children's mental health and parenting stress, irrespective of disclosure level, suggesting general nonspecific positive effects on family relationships. Findings require validation in a randomized control trial.
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