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Stefana A, Mirabella F, Gigantesco A, Camoni L. The screening accuracy of the Edinburgh Postnatal Depression Scale (EPDS) to detect perinatal depression with and without the self-harm item in pregnant and postpartum women. J Psychosom Obstet Gynaecol 2024; 45:2404967. [PMID: 39319392 DOI: 10.1080/0167482x.2024.2404967] [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: 07/11/2024] [Revised: 08/28/2024] [Accepted: 09/08/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND This study aims to examine whether the Edinburgh Postnatal Depression Scale (EPDS), excluding the self-harm item (EPDS-9), performs as effectively as the full EPDS in identifying depression among perinatal women. METHODS A total of 3571 pregnant women and 3850 postpartum women participated in this observational study. Participants who scored ≥ 9 on the EPDS underwent further diagnostic evaluations by a clinical psychologist and/or psychiatrist. RESULTS The EPDS-9 and full EPDS demonstrated a near-perfect correlation in both the antepartum (r = 0.996) and postpartum (r = 0.998) cohorts. EPDS-9 showed exceptional precision in identifying depression as screened by the full EPDS at cutoff points ranging 9-14, with areas under the curve ≥0.998. The sensitivity of EPDS-9 and full EPDS to detect depression that requires psychotropic medications was poor. The highest accuracy for both versions was at a cutoff score of 9: sensitivity of 0.579 for the full EPDS and 0.526 for the EPDS-9. At the cutoff point of 9, EPDS-9 performed adequately in predicting the response of the participants to the self-harm item. CONCLUSION The EPDS-9 represents a solid and effective replacement for the full EPDS in clinical settings. If the presence of suicidal thoughts needs to be assessed, specialized scales should be used.
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Affiliation(s)
- Alberto Stefana
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Laura Camoni
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
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Limenih G, MacDougall A, Smith MWJ, Nouvet E. 'Impaired in life': Analyzing people's accounts of depression in Ethiopia - Implications for a cultural-eco social approach to global mental health. Int J Soc Psychiatry 2024:207640241280620. [PMID: 39422707 DOI: 10.1177/00207640241280620] [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] [Indexed: 10/19/2024]
Abstract
BACKGROUND Depression is a global crisis and a major concern in mental health interventions, particularly in low- and middle-income countries (LMICs), where it significantly impacts disability, quality of life, and economic stability. These chronic stressors have been used to argue for scaling up the detection and treatment of depression as a public health and development priority. AIM This study aimed to explore illness narratives of depression among patients' and to gain insights into multifaceted suffering, its impact on persons' lives, and help seeking. This study is part the broader study which examined global mental health, biopolitics, and depression in Ethiopia, conducted in hospice setting to explore the conception of depression in Bahirdar city, Northern Ethiopia, among patients and health care providers. In this study, we focus on patients' accounts of depression. METHOD We employed an ethnography method using in-depth interviews, fieldnotes, and observation to collect the data. A thematic analysis was used to analyze the data. Drawing from cross-cultural and critical psychiatry perspectives, we situate depression within its cultural-eco social framework. RESULTS The study revealed that patients' experiences and conception of depression are deeply intertwined with Ethiopia's sociocultural, economic, and spiritual context. Depression was often described as a state of being 'impaired in life', reflecting the complex interplay of individual struggles and societal pressures. Integrating quotes from patients, we demonstrated in this analysis the ways in which biographically specific challenges, societal pressures, and mental well-being are understood by study participants in accordance with Ethiopian cultural and religious norms. CONCLUSION The study suggests moving beyond narrow interpretative frameworks in GMH praxis to understand and address the complex dimensions of depression in Ethiopia and similar contexts. The study advocates for a cultural-ecosocial approach to depression, emphasizing the need for mental health interventions that consider the broader social and cultural factors contributing to mental distress.
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Affiliation(s)
- Gojjam Limenih
- Faculty of Health Sciences, Western University, London, ON, Canada
- St. Joseph Health Care, London, ON, Canada
- Lawson Health Research Institute, Finch Family Mental Health Care Building, London, ON, Canada
| | - Arlene MacDougall
- St. Joseph Health Care, London, ON, Canada
- Lawson Health Research Institute, Finch Family Mental Health Care Building, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Max Well J Smith
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Elysee Nouvet
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
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Viduani A, Arenas DL, Benetti S, Wahid SS, Kohrt BA, Kieling C. Systematic Review and Meta-Synthesis: How Is Depression Experienced by Adolescents? A Synthesis of the Qualitative Literature. J Am Acad Child Adolesc Psychiatry 2024; 63:970-990. [PMID: 38340896 DOI: 10.1016/j.jaac.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/29/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To systematically investigate how youth with lived experience report their experience of depression in terms of features of depression and in relation to themselves and their environment. METHOD We conducted a systematic review of qualitative research around the world that explored the subjective experience of depression among youth (age range, 10-24 years) who had self-reported, screened positive for, or received a formal diagnosis of the disorder. We used multiple databases to search for relevant studies published in any language up until March 2023. Studies were coded regarding features of depression reported by adolescents. We also used thematic synthesis to extract and synthesize descriptions of the lived experience of depression, and to develop analytic themes. The study was registered with PROSPERO, CRD42021218300. RESULTS We identified a total of 23,424 unique records, and included 39 studies in the final review, representing the views of 884 adolescents with lived experience of depression. Most of the studies were conducted in high-income countries (72.8%), and the majority of participants were female (65%). The most frequently reported features of depression were sadness (present in 92.3% of the studies), social withdrawal (76.9%), and loneliness (69.2%). In addition, we constructed 3 themes that aimed to synthesize youths' accounts of their perceptions and experiences of depression: (1) making sense; (2) factoring in culture and contextual influences; and (3) accessing support and care. CONCLUSION Some of the more commonly reported features of depression among youth are not explicitly included in the DSM/ICD diagnostic criteria but are highly relevant and closely connected to the experiences of adolescents. Moreover, contextual interpretations of depression may be more sensitive to capture representations and narratives of depression among youth. Thus, incorporating features of depression reported by adolescents could potentially increase accuracy of detection, promote collaborative work, and enhance therapeutic and care outcomes. PLAIN LANGUAGE SUMMARY In this systematic review, the authors investigated the experience of adolescent depression across the globe. Drawing from 39 qualitative studies representing the views of 884 adolescents from 16 different countries, the authors found that sadness, social withdrawal, and loneliness were the most frequently reported features of depression. The authors argue that contextual interpretations of depression may be more sensitive to capturing representations and narratives of depression than focusing solely on DSM/ICD criteria. The authors suggest that understanding personal narratives can create greater depth of understanding of youth experiences of depression. STUDY PREREGISTRATION INFORMATION The lived experience of depression in adolescence: a systematic review of the qualitative literature; https://www.crd.york.ac.uk/prospero/; CRD42021218300.
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Affiliation(s)
- Anna Viduani
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, and Prodia - Child & Adolescent Depression Program, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Daniel Luccas Arenas
- Hospital Materno-Infantil Presidente Vargas and Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Silvia Benetti
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, and Prodia - Child & Adolescent Depression Program, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | | | - Christian Kieling
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, and Prodia - Child & Adolescent Depression Program, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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Shinomiya S. The role of administrative categories in the globalisation of a psychiatric concept: Case studies of autism in Japan. Soc Sci Med 2024; 357:117223. [PMID: 39154434 DOI: 10.1016/j.socscimed.2024.117223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
This paper explores how what I call 'administrative categories' have been adopted by the Japanese government and experts in autism support and what roles these categories have played in local settings. Since support practices for children and adults with autism began in the 1950s in Japan, the Japanese government and people engaging in autism support have used Japanese-specific administrative categories, instead of relying on a medical concept of autism, such as 'severe moving disabilities' (SMD), 'emotional disturbance', and 'extremely disruptive behavioural disorders' (EDBD). To understand the emergence of these three autism-related administrative categories in Japan, historical materials published from the 1950s to the 1990s by Japanese authors (doctors, psychologists, teachers, educationalists, welfare workers, government officials, and parents) and interview data with 19 leading experts of autism in Japan were collected and analysed thematically. The analysis revealed that the governmental ministries aimed to focus on establishing administrative support by avoiding engaging in aetiological debates among doctors, and to describe the political agenda more vividly. Administrative categories filled the gap between local interests and international medical concepts, enabling the concept of autism to be rooted in Japan's administrative systems. Three roles of administrative categories were identified: i) separation from medicine, ii) describing local problems, and iii) claimsmaking to wider actors and the public. I concluded that looking purely at medical and specifically diagnostic concepts limits our understanding of the formation of practices regarding disabilities, and thus more focus should be placed on categorisation practices outside of medicine. In addition, to the literature on the globalisation of Euro-American psychiatric concepts, this study contributes to our knowledge of a form of locality that has not been central in the exploration of the influence of globalisation on local settings and the relationships between the local and the global.
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Affiliation(s)
- Sawako Shinomiya
- Department of Social and Political Sciences, Philosophy, and Anthropology, University of Exeter, UK.
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Yin J, Jia X, Li H, Zhao B, Yang Y, Ren TL. Recent Progress in Biosensors for Depression Monitoring-Advancing Personalized Treatment. BIOSENSORS 2024; 14:422. [PMID: 39329797 PMCID: PMC11430531 DOI: 10.3390/bios14090422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024]
Abstract
Depression is currently a major contributor to unnatural deaths and the healthcare burden globally, and a patient's battle with depression is often a long one. Because the causes, symptoms, and effects of medications are complex and highly individualized, early identification and personalized treatment of depression are key to improving treatment outcomes. The development of wearable electronics, machine learning, and other technologies in recent years has provided more possibilities for the realization of this goal. Conducting regular monitoring through biosensing technology allows for a more comprehensive and objective analysis than previous self-evaluations. This includes identifying depressive episodes, distinguishing somatization symptoms, analyzing etiology, and evaluating the effectiveness of treatment programs. This review summarizes recent research on biosensing technologies for depression. Special attention is given to technologies that can be portable or wearable, with the potential to enable patient use outside of the hospital, for long periods.
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Affiliation(s)
- Jiaju Yin
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China; (J.Y.); (B.Z.)
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Xinyuan Jia
- Xingjian College, Tsinghua University, Beijing 100084, China;
| | - Haorong Li
- Weiyang College, Tsinghua University, Beijing 100084, China;
| | - Bingchen Zhao
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China; (J.Y.); (B.Z.)
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Yi Yang
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China; (J.Y.); (B.Z.)
| | - Tian-Ling Ren
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China; (J.Y.); (B.Z.)
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
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Cruz-Riquelme T, Zevallos-Morales A, Carrión I, Otero-Oyague D, Patiño V, Lastra D, Valle R, Parodi JF, Pollard SL, Steinman L, Gallo JJ, Flores-Flores O. Pilot trial protocol: community intervention to improve depressive symptoms among Peruvian older adults. Pilot Feasibility Stud 2024; 10:112. [PMID: 39175082 PMCID: PMC11340061 DOI: 10.1186/s40814-024-01540-1] [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: 12/17/2023] [Accepted: 08/05/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Non-pharmacological interventions have proven effective at alleviating depression and anxiety symptoms in older adults. Methodological refinement and testing of these interventions in new contexts are needed on a small scale before their effectiveness and implementation can be evaluated. The purpose of this pilot study is to assess the feasibility of a future large-scale trial comparing an adapted mental health multi-component evidence-based intervention (VIDACTIVA) versus standard care for older adults experiencing depression symptoms in urban, resource-limited settings in Lima, Peru. Furthermore, this study will explore the acceptability, feasibility, and fidelity of implementing the intervention. METHODS We will conduct an open-label, mixed methods pilot feasibility study with two parallel groups. A total of 64 older adults, stratified by sex, will be randomized at a 1:1 ratio to either the "intervention" or "control." Participants will be followed for 22 weeks after enrollment. Those in the intervention group will receive eight VIDACTIVA sessions administered by community health workers (CHWs) over 14 weeks, with an additional eight weeks of follow-up. Participants in the control group will receive two psychoeducation sessions from a study fieldworker and will be directed to health care centers. Standard care does not involve CHWs. We will evaluate screening rates, recruitment strategies, retention rates, the acceptability of randomization, and assessments. Additionally, we will assess preliminary implementation outcomes-acceptability, feasibility, and fidelity-from the perspectives of CHWs (interventionists), older adults (main participants), older adults' relatives, and healthcare professionals. DISCUSSION If the findings from this feasibility trial are favorable, a fully powered randomized controlled trial will be conducted to evaluate `both the effectiveness and implementation of the intervention. This research will make a substantial contribution to the field of mental health in older adults, particularly by emphasizing a meticulous examination and documentation of the implementation process. By doing so, this study will offer valuable methodologies and metrics for adapting and assessing mental health interventions tailored to the unique needs of older adults in resource-constrained contexts and diverse cultural settings. TRIAL REGISTRATION The current trial registration number is NCT06065020, which was registered on 26th September 2023.
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Affiliation(s)
- Tatiana Cruz-Riquelme
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
| | - Alejandro Zevallos-Morales
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
| | - Ivonne Carrión
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
| | - Diego Otero-Oyague
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Peru
| | - Vanessa Patiño
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Peru
| | - Dafne Lastra
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
| | - Rubén Valle
- Facultad de Medicina Humana, Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Universidad de San Martin de Porres, Lima, Peru
| | - José F Parodi
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru
| | - Suzanne L Pollard
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Oscar Flores-Flores
- Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martin de Porres, Lima, Peru.
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Feliciano L, Erdal K, Sandal GM. Attitudes towards depression and its treatment among white, hispanic, and multiracial adults. BMC Psychol 2024; 12:441. [PMID: 39143581 PMCID: PMC11325710 DOI: 10.1186/s40359-024-01804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/21/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Depression is present in all societies and affects members of all racial and ethnic groups. However, attitudes about depression differ across groups and have been shown to impact help-seeking behaviors, preferences for treatments, and compliance with treatments. METHODS Taking a cross-cultural approach, this project used a case vignette of depression to examine race/ethnic group differences in attitudes about depression and its treatment among young adults in the U.S. RESULTS Data analyses revealed significant racial/ethnic group differences in attitudes as well as the treatments/strategies participants reported they would use. Gender x race/ethnicity interactions revealed that White and Multiracial/ethnic men were more likely to believe the vignette character should find a partner to help with symptoms, while White and Multiracial/ethnic women did not endorse those strategies. Hispanic men and women did not show a gender difference in that strategy, but gender differences were observed in other strategies. In a rare comparison, majority-minority Multiracial/ethnic participants (i.e., White selected as one of their races/ethnicities) rated identified helpers and treatments similarly to White participants and significantly higher than multiple-minority Multiracial participants (i.e., White not selected as one of their races/ethnicities). CONCLUSIONS Findings supported previous research that indicates different U.S. racial/ethnic group ideas of depression and its treatment are potentially linked with cultural values, and we suggest that investigating these more fine-grained group differences can help to inform treating professionals as well as public health messages.
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Affiliation(s)
- Leilani Feliciano
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
| | - Kristi Erdal
- Department of Psychology, Colorado College, 14 East Cache la Poudre Street, Colorado Springs, CO, 80903, USA
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Jovanović V. The Depression Anxiety Stress Scales for Youth (DASS-Y): evidence of validity and cross-national and gender measurement invariance. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02561-0. [PMID: 39141105 DOI: 10.1007/s00787-024-02561-0] [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: 04/03/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
The Depression Anxiety Stress Scales for Youth (DASS-Y) is a recently developed measure of unpleasant emotional experiences for children and adolescents; however, the evidence for its validity is still limited. The present study evaluated the evidence for the structural, convergent, and incremental validity of the DASS-Y on a sample of Serbian adolescents aged 15-19 years (N = 421; 48% female, mean age = 16.86). Measurement invariance across gender and two countries (Serbia and Australia) was also tested. The findings supported the bifactor exploratory structural equation modeling (bifactor-ESEM) representation of the DASS-Y, which includes the General factor of negative affect/emotional distress, and three specific factors of Depression, Anxiety, and Stress. The DASS-Y factors showed evidence of incremental validity in predicting global externalizing symptoms and demonstrated convergent validity in relation to measures of global internalizing and externalizing symptoms as well as subjective well-being. The bifactor-ESEM model of the DASS-Y was found to be invariant across gender and two countries. The present study findings highlight the importance of distinguishing between general and specific components of unpleasant emotional states.
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Affiliation(s)
- Veljko Jovanović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Dr Zorana Đinđića 2, Novi Sad, 21 000, Serbia.
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McKay S, Meza JI. Culturally contextualized suicide prevention for international students: new opportunities for research and practice. Front Psychol 2024; 15:1418185. [PMID: 39165758 PMCID: PMC11333360 DOI: 10.3389/fpsyg.2024.1418185] [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: 04/16/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
The rising incidence of suicide-related thoughts and behaviors among international students presents a significant public health challenge and growing concern among college campuses. Current intervention strategies often rely on Western-centric and colonized approaches developed and tested with primarily Western, Educated, Industrialized, Rich and Democratic (WEIRD) samples. Exclusion and historical underrepresentation of ethnoracially minoritized groups in suicide prevention treatment trials create gaps in advancing our science because they often miss the cultural contextualization crucial for effective prevention and intervention in diverse groups from different countries of origin. To address the limitations of these Western-centric strategies, we explored existing prevention recommendations and approaches through the lens of an expanded version of the newly developed Protective Factors Framework, tailored for non-Western cultural perspectives. We propose significant opportunities for enhancing current practices and point to promising future directions. The primary areas for development include: (1) bolstering community empowerment and ownership, (2) refining mechanisms of change to encompass multicultural viewpoints, and (3) focusing on effective implementation and thorough evaluation for ongoing refinement. This methodology not only shows promise for enhancing international student suicide prevention but also offers insights for broader application in suicide prevention among other culturally diverse populations.
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Affiliation(s)
- Samuel McKay
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jocelyn I. Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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West NS, Namuganga LP, Isabirye D, Nakubulwa R, Ddaaki W, Nakyanjo N, Nalugoda F, Murray SM, Kennedy CE. Cognitive interviewing to assess and adapt three measures of mental health symptoms among people living with HIV in Rakai, Uganda: the Thinking a Lot Questionnaire, the Patient Health Questionnaire 9 (PHQ-9), and the Hopkins Symptoms Checklist (HSCL). RESEARCH SQUARE 2024:rs.3.rs-4697900. [PMID: 39041027 PMCID: PMC11261958 DOI: 10.21203/rs.3.rs-4697900/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Mental health is conceptualized differently across cultures, making cross-cultural validation of screening tools critical. In Uganda, we used cognitive interviewing to assess and adapt three scales for measuring psychological distress: the Thinking a Lot Questionnaire, the Patient Health Questionnaire 9 (PHQ-9), and the Hopkins Symptoms Checklist (HSCL). We recruited 12 people living with HIV from the Rakai Community Cohort Study (RCCS) and interviewed seven potential users of the scales (four RCCS survey interviewers and three local health workers). Data were analyzed systematically using a team-based matrix approach. The HSCL was generally well understood, with minor clarifications needed. The Thinking a Lot Questionnaire was also well understood, though differences between "how much" and "how often" required specificity. Both included local idioms of distress from prior adaptations. The PHQ-9 performed less well, with many questions interpreted variably or showing unclear local applicability, especially among people living with HIV. For example, questions about trouble concentrating were misunderstood, focusing on examples like newspapers rather than the broader issue of concentration. Future research should explore the validity and utility of commonly used instruments as mental health research expands in Africa.
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West NS, Nakubulwa R, Murray SM, Ddaaki W, Mayambala D, Nakyanjo N, Nalugoda F, Hutton HE, Surkan PJ, Kennedy CE. Okweraliikirira and Okwenyamira: Idioms of Psychological Distress Among People Living with HIV in Rakai, Uganda. RESEARCH SQUARE 2024:rs.3.rs-4656465. [PMID: 39011105 PMCID: PMC11247927 DOI: 10.21203/rs.3.rs-4656465/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Introduction Health and illness experiences are positioned within social and cultural contexts. Understanding the mental health and psychological distress of people living with HIV in highly affected communities is critical to addressing their needs and to ensure programming and interventions are targeted and appropriate. Methods Grounded in the ethnomedical theoretical perspective, we conducted qualitative interviews to understand the experience and expression of psychological distress by people living with HIV in Rakai, Uganda. Participants included adults living with HIV (n=20), health workers (counselors, peer health workers, nurses, n=10), and key informants (n=12). Interviews were audio recorded, transcribed/translated, coded, and analyzed using thematic analysis. Results Two idioms of distress, okweraliikirira (worry/apprehension) and okwenyamira (deep/manythoughts/lots of thoughts) were described as impacting people living with HIV. Both idioms were said to be alleviated by social support or counseling, but if left unaddressed could lead to more severe mental health problems and poor ART adherence. Conclusion People living with HIV understand their psychological distress through culturally specific idioms; such distress can have deleterious impacts on well-being. Incorporating idioms of distress into screening and treatment for people living with HIV may improve identification of individuals in need and overall health services to address this need.
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Affiliation(s)
- Nora S West
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine
| | | | - Sarah M Murray
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health
| | | | | | | | | | - Heidi E Hutton
- Johns Hopkins School of Medicine, Division of Psychiatry and Behavioral Sciences
| | - Pamela J Surkan
- Johns Hopkins Bloomberg School of Public Health, Department of International Health
| | - Caitlin E Kennedy
- Johns Hopkins Bloomberg School of Public Health, Department of International Health
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Ametaj AA, Denckla CA, Stevenson A, Stroud RE, Hall J, Ongeri L, Milkias B, Hoffman J, Naisanga M, Akena D, Kyebuzibwa J, Kwobah EK, Atwoli L, Gichuru S, Teferra S, Alemayehu M, Zingela Z, Stein DJ, Pretorius A, Newton CR, Mwema RM, Kariuki SM, Koenen KC, Gelaye B. Cross-cultural equivalence of the Kessler Psychological Distress Scale (K10) across four African countries in a multi-national study of adults. SSM - MENTAL HEALTH 2024; 5:100300. [PMID: 38706931 PMCID: PMC11064105 DOI: 10.1016/j.ssmmh.2024.100300] [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] [Indexed: 05/07/2024] Open
Abstract
The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all. Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confirmatory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries. Monte Carlo simulations showed a correlation of 0.998, a good replication of population values, indicating minimal noninvariance, or variation. Items "so nervous," "lack of energy/effortful tasks," and "tired" were consistently equivalent for intercepts and factor loadings, respectively. However, items "depressed" and "so depressed" consistently differed across study countries (R2 = 0) for intercepts and factor loadings for both items. The K10 scale likely functions equivalently across the four countries for most items, except "depressed" and "so depressed." Differences in K10 items were more common in Kenya and Ethiopia, suggesting cultural context may influence the interpretation of some items and the potential need for cultural adaptations in these countries.
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Affiliation(s)
- Amantia A. Ametaj
- Institute of Health Equity and Social Justice, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rocky E. Stroud
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jasmine Hall
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Barkot Milkias
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jacob Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Molly Naisanga
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | - Edith K. Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Stella Gichuru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkam Alemayehu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zukiswa Zingela
- Executive Dean’s Office, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Adele Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charles R.J.C. Newton
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rehema M. Mwema
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
| | - Symon M. Kariuki
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bizu Gelaye
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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13
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Heim E, Burchert S, Shala M, Hoxha A, Kaufmann M, Cerga Pashoja A, Morina N, Schaub MP, Knaevelsrud C, Maercker A. Effect of Cultural Adaptation of a Smartphone-Based Self-Help Programme on Its Acceptability and Efficacy: Randomized Controlled Trial. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e2743. [PMID: 39119053 PMCID: PMC11303917 DOI: 10.32872/cpe.2743] [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] [Indexed: 08/10/2024] Open
Abstract
Background Research on cultural adaptation of psychological interventions indicates that a higher level of adaptation is associated with a higher effect size of the intervention. However, direct comparisons of different levels of adaptations are scarce. Aims This study used a smartphone-based self-help programme called Step-by-Step (Albanian: Hap-pas-Hapi) for the treatment of psychological distress among Albanian-speaking immigrants in Switzerland and Germany. Two levels of cultural adaptation (i.e., surface vs. deep structure adaptation) were compared. We hypothesised that the deep structure adaptation would enhance the acceptance and efficacy of the intervention. Method We conducted a two-arm, single-blind randomised controlled trial. Inclusion criteria were good command of the Albanian language, age above 18, and elevated psychological distress (Kessler Psychological Distress Scale score above 15). Primary outcome measures were the total score of the Hopkins Symptom Checklist and the number of participants who completed at least three (out of five) sessions. Secondary outcomes were global functioning, well-being, post-traumatic stress, and self-defined problems. Results Two-hundred-twenty-two participants were included, of which 18 (8%) completed the post-assessments. The number of participants who completed the third session was equal in both conditions, with N = 5 (5%) and N = 6 (6%) respectively. Discussion Drop-out rates were high in both conditions, and no group difference was found regarding the acceptance of the intervention. The high drop-out rate stands in contrast with other trials testing Step-by-Step. Future research should examine cultural factors impacting recruitment strategies, as insights could help to reduce participant drop-out rates in clinical trials.
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Affiliation(s)
- Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mirëlinda Shala
- Department of Economics, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Anna Hoxha
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Arlinda Cerga Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- St Marys University, Twickenham, London, United Kingdom
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
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14
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Weisenburger RL, Mullarkey MC, Labrada J, Labrousse D, Yang MY, MacPherson AH, Hsu KJ, Ugail H, Shumake J, Beevers CG. Conversational assessment using artificial intelligence is as clinically useful as depression scales and preferred by users. J Affect Disord 2024; 351:489-498. [PMID: 38290584 DOI: 10.1016/j.jad.2024.01.212] [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: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Depression is prevalent, chronic, and burdensome. Due to limited screening access, depression often remains undiagnosed. Artificial intelligence (AI) models based on spoken responses to interview questions may offer an effective, efficient alternative to other screening methods. OBJECTIVE The primary aim was to use a demographically diverse sample to validate an AI model, previously trained on human-administered interviews, on novel bot-administered interviews, and to check for algorithmic biases related to age, sex, race, and ethnicity. METHODS Using the Aiberry app, adults recruited via social media (N = 393) completed a brief bot-administered interview and a depression self-report form. An AI model was used to predict form scores based on interview responses alone. For all meaningful discrepancies between model inference and form score, clinicians performed a masked review to determine which one they preferred. RESULTS There was strong concurrent validity between the model predictions and raw self-report scores (r = 0.73, MAE = 3.3). 90 % of AI predictions either agreed with self-report or with clinical expert opinion when AI contradicted self-report. There was no differential model performance across age, sex, race, or ethnicity. LIMITATIONS Limitations include access restrictions (English-speaking ability and access to smartphone or computer with broadband internet) and potential self-selection of participants more favorably predisposed toward AI technology. CONCLUSION The Aiberry model made accurate predictions of depression severity based on remotely collected spoken responses to a bot-administered interview. This study shows promising results for the use of AI as a mental health screening tool on par with self-report measures.
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Affiliation(s)
- Rachel L Weisenburger
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States of America.
| | | | | | - Daniel Labrousse
- Department of Psychiatry, Georgetown University Medical Center, United States of America
| | - Michelle Y Yang
- Department of Psychiatry, Georgetown University Medical Center, United States of America
| | - Allison Huff MacPherson
- Department of Family and Community Medicine, College of Medicine, University of Arizona, United States of America
| | - Kean J Hsu
- Department of Psychiatry, Georgetown University Medical Center, United States of America; Department of Psychology, National University of Singapore, Singapore
| | - Hassan Ugail
- Centre for Visual Computing, University of Bradford, United Kingdom of Great Britain and Northern Ireland
| | | | - Christopher G Beevers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States of America
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15
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Limenih G, MacDougall A, Wedlake M, Nouvet E. Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:95-107. [PMID: 38105446 PMCID: PMC10955781 DOI: 10.1177/27551938231220230] [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: 03/09/2023] [Revised: 09/09/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.
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Affiliation(s)
- Gojjam Limenih
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Arlene MacDougall
- Department of Pyschiatry, Western University Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Marnie Wedlake
- School of Health Studies, Western University, London, ON, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, London, ON, Canada
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16
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Ashley-Norman T, Fellmeth G, Brummaier T, Nosten S, Oo MM, Phichitpadungtham Y, Wai K, Khirikoekkong N, Plugge E, McGready R. Persistent depression in pregnant refugee and migrant women living along the Thai-Myanmar Border: a secondary qualitative analysis. Wellcome Open Res 2024; 7:231. [PMID: 39381722 PMCID: PMC11459118 DOI: 10.12688/wellcomeopenres.17744.2] [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] [Accepted: 03/26/2024] [Indexed: 10/10/2024] Open
Abstract
Background Antepartum depression affects around 15% of pregnant women worldwide, and may negatively impact their infants' physical, cognitive and social development, and confer a greater risk of emotional dysregulation in their children. Risk factors for antepartum depression disproportionately affect women from resource-sparse settings. In particular, pregnant refugee and migrant women face many barriers to diagnosis and care of mental health conditions, yet this group is under-represented in the literature. This study explores what refugee and migrant women living along the Thai-Myanmar border perceive as being contributory and protective factors to their antepartum depression, through secondary qualitative analysis of responses to clinical interviews for depression. Methods Previous research investigating perinatal depression in pregnant refugee and migrant women on the Thai-Myanmar border involved assessing 568 women for depression, using the Structured Clinical Interview for the diagnosis of DSM-IV Disorders (SCID). This study analyses a subsample of 32 women, diagnosed with persistent depression during the antepartum period. Thematic analysis of responses to the SCID and social and demographic surveys was undertaken to investigate factors which contribute towards, or protect against, persistent antepartum depression. Results Major themes which women described as contributing towards persistent antepartum depression were financial problems, interpersonal violence, substance misuse among partners, social problems and poor health. Factors women considered as protecting mental wellbeing included social support, accessible healthcare and distractions, highlighting the need for focus on these elements within refugee and migrant settings. Commonly expressed phrases in local Karen and Burmese languages were summarised. Conclusions Knowledge of factors affecting mental wellbeing in the study population and how these are phrased, may equip stakeholders to better support women in the study area. This study highlighted the limitations of contextually generic diagnostic tools, and recommends the development of tools better suited to marginalised and non-English speaking groups.
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Affiliation(s)
- Tabitha Ashley-Norman
- School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
| | - Gracia Fellmeth
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
- Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Tobias Brummaier
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
- Swiss Tropical and Public Health Institute, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, CH-4001, Switzerland
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
| | - May May Oo
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
| | - Yuwapha Phichitpadungtham
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
| | - Kerry Wai
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
| | - Napat Khirikoekkong
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
| | - Emma Plugge
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Oxford Tropical Medical Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63100, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
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17
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Nazarova A, Drobinin V, Helmick CA, Schmidt MH, Cookey J, Uher R. Intracortical Myelin in Youths at Risk for Depression. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100285. [PMID: 38323155 PMCID: PMC10844807 DOI: 10.1016/j.bpsgos.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 02/08/2024] Open
Abstract
Background Major depressive disorder (MDD) is a leading cause of disability. To understand why depression develops, it is important to distinguish between early neural markers of vulnerability that precede the onset of MDD and features that develop during depression. Recent neuroimaging findings suggest that reduced global and regional intracortical myelination (ICM), especially in the lateral prefrontal cortex, may be associated with depression, but it is unknown whether it is a precursor or a consequence of MDD. The study of offspring of affected parents offers the opportunity to distinguish between precursors and consequences by examining individuals who carry high risk at a time when they have not experienced depression. Methods We acquired 129 T1-weighted and T2-weighted scans from 56 (25 female) unaffected offspring of parents with depression and 114 scans from 63 (34 female) unaffected offspring of parents without a history of depression (ages 9 to 16 years). To assess scan quality, we calculated test-retest reliability. We used the scan ratios to calculate myelin maps for 68 cortical regions. We analyzed data using mixed-effects modeling. Results ICM did not differ between high and low familial risk youths in global (B = 0.06, SE = 0.03, p = .06) or regional (B = 0.05, SE = 0.03, p = .08) analyses. Our pediatric sample had high ICM reliability (intraclass correlation coefficient = 0.79; 95% CI, 0.55-0.88). Conclusions Based on our results, reduced ICM does not appear to be a precursor of MDD. Future studies should examine ICM in familial high-risk youths across a broad developmental period.
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Affiliation(s)
- Anna Nazarova
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Vladislav Drobinin
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Carl A. Helmick
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Matthias H. Schmidt
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacob Cookey
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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18
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Bunkley EN, Asante C, Burack S, Kaufman L, Miti S, Hunleth J. A Heart for the Care: Affect, Kin, and Care Work in a Zambian Hospital. Med Anthropol Q 2024; 38:54-66. [PMID: 38112051 PMCID: PMC10922508 DOI: 10.1111/maq.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/21/2023] [Indexed: 12/20/2023]
Abstract
At the only standalone pediatric hospital in Zambia, patient wellbeing often rests in the hands of bedsiders. Bedsiders are caregivers, often family, who sit at the patient's bedside, feeding, cleaning them, and running medical errands. Bedsiders are critical human infrastructure for the hospital and its staff. In our research, we heard repeatedly that bedsiders must have a "heart" for caregiving, taking on unremunerated and exhausting informal labor. We draw on Wendland's "heart for the work," a phrase commonly used among healthcare workers in Malawi and Zambia describing the medical profession, to explore what this metaphor reveals about care.
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Affiliation(s)
- Emma Nelson Bunkley
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, USA
| | - Comfort Asante
- Ndola Teaching Hospital, Ndola, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Sarah Burack
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Lindsey Kaufman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Sam Miti
- Department of Pediatrics and Child Health, Arthur Davison Children's Hospital, Ndola, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Jean Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
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19
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Martin P, Haroz EE, Lee C, Bolton P, Martin K, Meza R, McCarthy E, Dorsey S. A qualitative study of mental health problems among children living in New Delhi slums. Transcult Psychiatry 2024:13634615231202098. [PMID: 38389504 DOI: 10.1177/13634615231202098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Children living in urban slums in India are exposed to chronic stressors that increase their risk of developing mental disorders, but they remain a neglected group. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived and prioritized locally to tailor interventions for this population. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of children living in Indian slums, including local descriptions, perceived causes, impact, and coping behavior. Local Hindi-speaking interviewers conducted 77 free-list interviews and 33 key informant interviews with children and adults (N = 107) from two slums in New Delhi. Results identified a range of internalizing and externalizing symptoms consistent with depression, anxiety, and conduct problems in children. Findings included both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., "madness or anger," "pain in the heart and mind") not typically included on western standardized measures of psychopathology. Mental health problems appeared to be highly interconnected, with experiences such as harassment and fighting often described as both causes and impacts of mental health symptoms in children. Community perspectives indicated that even in the face of several unmet basic needs, mental health problems were important to the community and counseling interventions were likely to be acceptable. We discuss implications for adapting mental health interventions and assessing their effectiveness to reduce the burden of mental illness among children living in urban slums in India.
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Affiliation(s)
- Prerna Martin
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Emily E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Lee
- UNICEF New York Child Protection in Humanitarian Action, New York, NY, USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- USAID, Washington, DC, USA
| | - Kiran Martin
- Asha Community Health and Development Society, New Delhi, India
| | - Rosemary Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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20
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Wallin MI, DeMarinis V, Nevonen L, Bäärnhielm S. A qualitative analysis of the documentation of DSM-5 Cultural Formulation Interviews with non-native speaking patients in a Swedish mental health care setting. Front Psychiatry 2024; 15:1298920. [PMID: 38455521 PMCID: PMC10918747 DOI: 10.3389/fpsyt.2024.1298920] [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: 09/22/2023] [Accepted: 01/19/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients. Materials and methods The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients. Results We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms. Discussion Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians' identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.
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Affiliation(s)
- Malin Idar Wallin
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) & Stockholm Health Care Services, Stockholm, Sweden
- Transcultural Centre, Region Stockholm, Stockholm, Sweden
| | - Valerie DeMarinis
- Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Västerbotten, Sweden
- Division Mental Health Care, Innlandet Hospital Trust, Hamar, Norway
| | - Lauri Nevonen
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Aleris Psychiatry Täby, Stockholm, Sweden
| | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) & Stockholm Health Care Services, Stockholm, Sweden
- Transcultural Centre, Region Stockholm, Stockholm, Sweden
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Krys K, Kostoula O, van Tilburg WAP, Mosca O, Lee JH, Maricchiolo F, Kosiarczyk A, Kocimska-Bortnowska A, Torres C, Hitokoto H, Liew K, Bond MH, Lun VMC, Vignoles VL, Zelenski JM, Haas BW, Park J, Vauclair CM, Kwiatkowska A, Roczniewska M, Witoszek N, Işık İ, Kosakowska-Berezecka N, Domínguez-Espinosa A, Yeung JC, Górski M, Adamovic M, Albert I, Pavlopoulos V, Fülöp M, Sirlopu D, Okvitawanli A, Boer D, Teyssier J, Malyonova A, Gavreliuc A, Serdarevich U, Akotia CS, Appoh L, Mira DMA, Baltin A, Denoux P, Esteves CS, Gamsakhurdia V, Garðarsdóttir RB, Igbokwe DO, Igou ER, Kascakova N, Klůzová Kracˇmárová L, Kronberger N, Barrientos PE, Mohoricć T, Murdock E, Mustaffa NF, Nader M, Nadi A, van Osch Y, Pavlović Z, Polácˇková Šolcová I, Rizwan M, Romashov V, Røysamb E, Sargautyte R, Schwarz B, Selecká L, Selim HA, Stogianni M, Sun CR, Wojtczuk-Turek A, Xing C, Uchida Y. Happiness Maximization Is a WEIRD Way of Living. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024:17456916231208367. [PMID: 38350096 DOI: 10.1177/17456916231208367] [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: 02/15/2024]
Abstract
Psychological science tends to treat subjective well-being and happiness synonymously. We start from the assumption that subjective well-being is more than being happy to ask the fundamental question: What is the ideal level of happiness? From a cross-cultural perspective, we propose that the idealization of attaining maximum levels of happiness may be especially characteristic of Western, educated, industrial, rich, and democratic (WEIRD) societies but less so for others. Searching for an explanation for why "happiness maximization" might have emerged in these societies, we turn to studies linking cultures to their eco-environmental habitat. We discuss the premise that WEIRD cultures emerged in an exceptionally benign ecological habitat (i.e., faced relatively light existential pressures compared with other regions). We review the influence of the Gulf Stream on the Northwestern European climate as a source of these comparatively benign geographical conditions. We propose that the ecological conditions in which WEIRD societies emerged afforded them a basis to endorse happiness as a value and to idealize attaining its maximum level. To provide a nomological network for happiness maximization, we also studied some of its potential side effects, namely alcohol and drug consumption and abuse and the prevalence of mania. To evaluate our hypothesis, we reanalyze data from two large-scale studies on ideal levels of personal life satisfaction-the most common operationalization of happiness in psychology-involving respondents from 61 countries. We conclude that societies whose members seek to maximize happiness tend to be characterized as WEIRD, and generalizing this across societies can prove problematic if adopted at the ideological and policy level.
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Affiliation(s)
- Kuba Krys
- Institute of Psychology, Polish Academy of Sciences
| | - Olga Kostoula
- Institute of Psychology, Johannes Kepler University Linz
| | | | - Oriana Mosca
- Department of Education, Psychology, and Philosophy, University of Cagliari
| | - J Hannah Lee
- Department of Psychology, Indiana University Northwest
| | | | | | | | | | | | - Kongmeng Liew
- Graduate School of Human and Environmental Studies, Kyoto University
- School of Psychology, Speech and Hearing, University of Canterbury
| | - Michael H Bond
- Department of Management and Marketing, Faculty of Business, Hong Kong Polytechnic University
| | | | | | | | | | - Joonha Park
- Graduate School of Management, NUCB Business School
| | - Christin-Melanie Vauclair
- Centre for Psychological Research and Social Intervention (CIS-Iscte), Iscte-Instituto Universitário de Lisboa
| | | | - Marta Roczniewska
- SWPS University
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet
| | - Nina Witoszek
- Centre for Development and the Environment, University of Oslo
| | - İdil Işık
- Psychology Department, Bahçeşehir University
| | | | | | | | - Maciej Górski
- Institute of Psychology, Polish Academy of Sciences
- Faculty of Psychology, University of Warsaw
| | | | - Isabelle Albert
- Department of Behavioural and Cognitive Sciences, University of Luxembourg
| | | | - Márta Fülöp
- Institute of Psychology, Károli Gáspár University of the Reformed Church
- Research Centre of Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Eötvös Loránd Research Network, Budapest, Hungary
| | - David Sirlopu
- Faculty of Psychology and Humanities, Universidad San Sebastián, Concepción
| | | | - Diana Boer
- Institute of Psychology, University of Koblenz
| | - Julien Teyssier
- Département Psychologie Clinique Du Sujet, Université Toulouse II
| | - Arina Malyonova
- Department of General and Social Psychology, Dostoevsky Omsk State University
| | | | | | - Charity S Akotia
- Department of Psychology, School of Social Sciences, University of Ghana
| | - Lily Appoh
- Faculty of Nursing and Health Sciences, Nord University
| | | | - Arno Baltin
- School of Natural Sciences and Health, Tallinn University
| | - Patrick Denoux
- Département Psychologie Clinique Du Sujet, Université Toulouse II
| | - Carla Sofia Esteves
- Universidade Católica Portuguesa, Católica Lisbon School of Business and Economics, Católica Lisbon Research Unit in Business and Economics
| | | | | | | | - Eric R Igou
- Department of Psychology, University of Limerick
| | - Natalia Kascakova
- Olomouc University Social Health Institute, Palacky University
- Psychiatric Clinic Pro Mente Sana, Bratislava, Slovakia
| | | | | | | | - Tamara Mohoricć
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka
| | - Elke Murdock
- Department of Behavioural and Cognitive Sciences, University of Luxembourg
| | - Nur Fariza Mustaffa
- Department of Business Administration, International Islamic University Malaysia
| | - Martin Nader
- Department of Psychological Studies, Universidad ICESI
| | - Azar Nadi
- Institute of Psychology, Polish Academy of Sciences
| | - Yvette van Osch
- Department of Social Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University
| | - Zoran Pavlović
- Department of Psychology, Faculty of Philosophy University of Belgrade
| | | | | | | | | | - Ruta Sargautyte
- Institute of Psychology, Faculty of Philosophy, Vilnius University
| | - Beate Schwarz
- Department of Applied Psychology, Zurich University of Applied Sciences
| | | | | | | | - Chien-Ru Sun
- Department of Psychology, National Chengchi University
| | | | - Cai Xing
- Department of Psychology, Renmin University of China
| | - Yukiko Uchida
- Institute for the Future of Human Society, Kyoto University
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22
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Martinez AB, Lau JYF, Morillo HM, Brown JSL. 'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom. Soc Psychiatry Psychiatr Epidemiol 2024; 59:385-401. [PMID: 36575338 PMCID: PMC9794465 DOI: 10.1007/s00127-022-02405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK). METHODS Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions. RESULTS The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group. CONCLUSION By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.
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Affiliation(s)
- Andrea B Martinez
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Behavioral Science, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines.
| | - Jennifer Y F Lau
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hannah Misha Morillo
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - June S L Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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23
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Guerrero Z, Civišová D, Winkler P. Mental health and access to care among the Roma population in Europe: A scoping review. Transcult Psychiatry 2024; 61:118-130. [PMID: 37769608 DOI: 10.1177/13634615231200853] [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: 10/03/2023]
Abstract
The Roma are Europe's largest ethnic minority group, and often face discrimination and social exclusion. Social strife and lack of access to healthcare are associated with increased symptoms of psychopathology. We aimed to review evidence on mental health outcomes and on access to mental healthcare among the Roma population in Europe. We systematically searched five databases (PsycINFO, Global Health, Social Policy and Practice, Web of Science and PubMed) and conducted a grey literature search in August 2020. We identified 133 studies, 26 of which were included for final analysis. We present the results using a narrative synthesis. The available literature indicates a relatively high prevalence of anxiety, depression and substance abuse among Roma, and females seem to be more affected than males. Roma children exhibit more externalizing and internalizing disorders when compared with non-Roma children. Mental health and perceived well-being among the Roma population are strongly linked to social determinants of health such as housing or economic income. Access to mental healthcare is limited for Roma people because of several barriers pertaining to language, lack of information regarding available services, and the insurance and economic status of Roma people. Roma people report mainly negative experiences with mental health services, including a lack of understanding from healthcare providers, and instances of racism and discrimination. There is a need for more research on mental health and access to healthcare in Roma people. Future studies should be participatory in order to provide guidelines for mental healthcare that addresses the needs of the Roma population.
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Affiliation(s)
- Zoe Guerrero
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
| | - Dagmar Civišová
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
| | - Petr Winkler
- National Institute of Mental Health, Czech Republic
- WHO Collaborating Center for Public Mental Health Research and Service Development
- King's College London
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24
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Choe R, Lardier DT, Hess JM, Blackwell MA, Amer S, Ndayisenga M, Deewa S, Isakson B, Goodkind JR. Measuring culturally and contextually specific distress among Afghan, Iraqi, and Great Lakes African refugees. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2024; 94:246-261. [PMID: 38227460 PMCID: PMC11234504 DOI: 10.1037/ort0000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Culturally and contextually valid measurement of psychological distress is critical, given the increasing numbers of forcibly displaced people and transnational migration. This study replicates an inductive process that elicited culturally specific expressions, understandings, and idioms of distress among Afghans to develop culturally specific measures of distress for Great Lakes Africans and Iraqis and expands this methodology to include a focus on the contexts of refugees resettled in the United States. To create the measures, we adapted Miller et al.'s (2006) model for the Afghan Symptom Checklist (ASCL) and conducted 18 semistructured qualitative interviews that attended to refugees' multiple settings; the impact of potentially traumatic events initially and postresettlement; and the experiences and impact of resettlement stressors. We tested the newly developed measures and existing ASCL with 280 recently resettled refugees (< 3 years) from Afghanistan, the Great Lakes region of Africa, and Iraq to assess factor structure, reliability, and construct validity. We successfully replicated and adapted a process for creating culturally specific measures of distress to create reliable and valid scales that consider culturally and contextually specific distress among several groups of forcibly displaced people. Our results highlight the salience of individuals' social contexts and how they are manifested as idioms of distress, bringing together two key areas of research: the social construction of mental health and social determinants of mental health. These findings have implications for improving measurement of psychological distress and for developing multilevel interventions that are culturally resonant and address factors beyond the individual level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Ryeora Choe
- Department of Sociology, University of New Mexico
| | - David T Lardier
- Department of Psychiatry and Behavioral Sciences, University of New Mexico
| | | | | | | | | | | | - Brian Isakson
- Department of Psychiatry and Behavioral Sciences, University of New Mexico
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25
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Rodriguez J, Radjack R, Moro MR, Lachal J. Migrant adolescents' experience of depression as they, their parents, and their health-care professionals describe it: a systematic review and qualitative meta-synthesis. Eur Child Adolesc Psychiatry 2024; 33:1-19. [PMID: 35301589 DOI: 10.1007/s00787-022-01971-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
Migrant youth are vulnerable and face a risk of internalised disorders such as depression. This qualitative meta-synthesis explores migrant adolescents' experience of depression. 14 studies (7 qualitative studies and 7 case reports) were selected after a systematic search of PubMed, Embase, Scopus and PsycInfo. Their quality was assessed with the Critical Appraisal Tool (CASP) for qualitative studies and the Joanna Briggs Institute (JBI) checklist for case reports. The analysis identified six themes describing the experience of depression among migrant adolescents: (1) the vulnerability factors underlying depressive distress, before, during and after migration; (2) the subjective experience of depression, combining symptoms associated with a form of depression common in the West with symptoms more common in other cultures; (3) two types of aetiological hypotheses to make sense of their distress; (4) attitudes adopted in response to distress; (5) experience of care, especially reasons discouraging investment in care; and (6) impairment of identity construction by breaks in cultural transmission and intergenerational conflicts. The threat of losing their connections both at the interpersonal (connection to family, peers and community) and intrapsychic levels (construction of identity) is inherently linked to migrant adolescents' experience of depression. We propose to adapt Brandenberger's 3C model (communication, continuity of care, and confidence) for the care of young migrants to promote a therapeutic alliance, foster construction of a coherent bicultural identity, and support the family.
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Affiliation(s)
- Juliette Rodriguez
- APHP, Hôpital Cochin, Maison de Solenn, 75014, Paris, France.
- Université de Paris, Paris, France.
| | - Rahmeth Radjack
- APHP, Hôpital Cochin, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Jonathan Lachal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Université Clermont Auvergne, 63000, Clermont-Ferrand, France
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26
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Klein DN. Assessment of Depression in Adults and Youth. Assessment 2024; 31:110-125. [PMID: 37081793 DOI: 10.1177/10731911231167446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.
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27
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Wang X, Wang Y. Association between digital engagement and urban-rural disparities in Chinese women's depressive symptoms: A national-level cross-sectional study. Digit Health 2024; 10:20552076241239246. [PMID: 38577314 PMCID: PMC10993679 DOI: 10.1177/20552076241239246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women. Methods Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method. Results Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms. Conclusion There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.
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Affiliation(s)
- Xiaochen Wang
- Faculty of Education, Southwest University, Chongqing, China
| | - Yangyang Wang
- School of Communication, Soochow University, Suzhou, China
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28
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Akhter-Khan SC, van Es W, Prina M, Lawrence V, Piri I, Rokach A, Heu LC, Mayston R. Experiences of loneliness in lower- and middle-income countries: A systematic review of qualitative studies. Soc Sci Med 2024; 340:116438. [PMID: 38016310 DOI: 10.1016/j.socscimed.2023.116438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
Loneliness is understood as a subjective experience resulting from unmet social relationship expectations. As most loneliness research has been conducted in higher-income-countries, there is limited understanding of loneliness in relation to diverse cultural, economic, and socio-political factors. To address this gap, the present review systematically synthesises existing qualitative studies on the experience of loneliness and social relationship expectations in lower- and middle-income countries (LMICs). Between June and July 2022, six online databases (Embase, Ovid Medline, APA PsycINFO, Global Health, Web of Science, Google Scholar) were searched for peer-reviewed studies from LMICs on loneliness using qualitative methods. There were no restrictions on publication date, language, or study setting. Studies that solely focused on social isolation or were conducted with children (<16 years) were excluded. Risk of bias was assessed with the Critical Appraisal Skills Programme. After deduplication, a total of 7866 records were identified and screened for inclusion, resulting in 24 studies published between 2002 and 2022. The included studies represent data from 728 participants in 15 countries across West Africa (Ghana, Nigeria, Niger, Mali), East Africa (Uganda, Kenya), North Africa (Egypt), West Asia (Iran), South Asia (India, Pakistan, Sri Lanka) and Southeast Asia (Myanmar, Cambodia, Indonesia, Philippines). Data were analysed combining inductive and deductive coding, summarised using narrative synthesis, and examined by geographical region. Common features of loneliness included rejection, overthinking, and pain. Loneliness was related to depression across regions. Whereas loneliness tended to be distinguished from social isolation in studies from Africa, it tended to be related with being alone in studies from Asia. Poverty and stigma were common barriers to fulfilling social relationship expectations. This review illustrates how loneliness and expectations are contextually embedded, with some expectations possibly being specific to a certain culture or life stage, having implications for assessment of and interventions for loneliness worldwide.
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Affiliation(s)
- Samia C Akhter-Khan
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom.
| | - Willemijn van Es
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vanessa Lawrence
- Department of Health Service & Population Research, King's College London, London, United Kingdom
| | - Ilayda Piri
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Ami Rokach
- Department of Psychology, York University, Toronto, Canada
| | - Luzia C Heu
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Rosie Mayston
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom
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29
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Karimli L, Nabunya P, Ssewamala FM, Dvalishvili D. Combining Asset Accumulation and Multifamily Group Intervention to Improve Mental Health for Adolescent Girls: A Cluster-Randomized Trial in Uganda. J Adolesc Health 2024; 74:78-88. [PMID: 37715767 PMCID: PMC10840800 DOI: 10.1016/j.jadohealth.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health. METHODS Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14-17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools). RESULTS We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion (χ2 (4) =21.43; p = .000), frequency of family communication (χ2 (4) =9.65; p = .047), and quality of child-caregiver relationship (χ2 (4) =11.12; p = .025). Additionally, the intervention effect on depression was moderated by the comfort of family communication (χ2 (4) =10.2; p = .037). DISCUSSION The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.
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Affiliation(s)
- Leyla Karimli
- Social Welfare Department, Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California.
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Darejan Dvalishvili
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
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30
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Osborn TL, Ndetei DM, Sacco PL, Mutiso V, Sommer D. An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents. EClinicalMedicine 2023; 66:102288. [PMID: 38192586 PMCID: PMC10772152 DOI: 10.1016/j.eclinm.2023.102288] [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: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 01/10/2024] Open
Abstract
Background Mental health problems are prevalent among youth in low-resource countries and are further compounded by stigma and limited access to traditional treatments. The need for scalable, accessible, and stigma-free mental health interventions is urgent. We developed and tested Pre-Texts, an arts-literacy intervention that targets adolescent depression and anxiety, in Kenya. Methods We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N = 235, ages 13-19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts involves the use of a text-such an excerpt from a novel, a physics lesson, or a technical manual-to inspire art-making that is followed by collective reflection on the process of interpretation through artmaking. Participants met daily for a week in groups of 6-12 youths for 1-h sessions. Groups were facilitated by high school graduates trained as lay-providers. This study was pre-registered at the Pan African Clinical Trials Registry (PACTR; registration number: PACTR202111497122432). The trial took place between August 11th 2021 and December 18th 2021. Findings Pre-Texts produced a greater reduction in depression (d = 0.52, 95% CI [0.19, 0.84]) and anxiety (d = 0.51, 95% CI [0.20, 0.81]) symptoms from baseline to 1-month follow-up compared to the control group. Similarly, in a sub-sample of participants with elevated depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression (d = 1.10, 95% CI [0.46, 1.75]) and anxiety (d = 0.54, 95% CI [-0.07, 1.45]) symptoms. Interpretation Our findings suggest that a brief arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Future replication trials with larger sample sizes with extended follow-ups will help assess the strength and sustainability of these effects. Funding The study was funded by grants from the Mind, Brain, and Behaviour (MBB) Initiative at Harvard University and the Center for African Studies at Harvard University.
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Affiliation(s)
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pier Luigi Sacco
- DiSFiPEQ, University of Chieti-Pescara, Italy
- metaLAB (at) Harvard, Cambridge, MA, USA
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Doris Sommer
- Department of Romance Languages and Literatures, Harvard University, Cambridge, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
- Cultural Agents, Inc., Boston, MA, USA
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31
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Raya-Tena A, Martín-Royo J, Bellido-Pérez M, Sauch Valmaña G, Berenguera Ossó A, Soria-García MD, Ruíz-Serrano S, Lacasta-Tintorer N, Jiménez Herrera MF. A primary care psychoeducational group intervention for patients with depression and physical comorbidity: A qualitative study with a gender perspective. Int J Nurs Pract 2023; 29:e13157. [PMID: 37127403 DOI: 10.1111/ijn.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 03/07/2023] [Accepted: 03/28/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To explore the experiences and emotions of individuals with depression and physical comorbidity within the context of psychoeducational group interventions led by primary care nurses in Catalunya (Spain). METHOD A psychoeducational group intervention was conducted in the first semester of 2019 with 13 primary care teams (rural/urban) and 95 participants with depression and physical comorbidity. The qualitative research and phenomenological perspective were based on 13 field diaries and 7 semi-structured interviews carried out with the observer nurses. The interviews were recorded and transcribed. Codes were identified by segmenting the text into citations/verbatim accounts and emerging categories/subcategories by regrouping the codes. The results were triangulated among the researchers to identify and compare similarities and differences. RESULTS Four major themes were found: (a) gender differences; (b) coping strategies and changes observed during the intervention; (c) functions of the group as a therapeutic element; and (d) the nurses' perceptions of the group experience. Gender differences were identified in relation to experiences and emotions. CONCLUSIONS As some patients acquired skills/behaviours during the intervention that helped them initiate changes and the nurses were satisfied with the intervention, it is important to include this information when planning effective interventions for patients with this profile.
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Affiliation(s)
- Antonia Raya-Tena
- Primary Health Care Center Raval Nord, Institut Català de la Salut, Barcelona, Spain
- Nursing Department, Faculty of Nursing, Rovira and Virgili University, Tarragona, Spain
| | - Jaume Martín-Royo
- Unitat Bàsica de Prevenció, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona ciutat, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPGol), Barcelona, Spain
| | - Mercedes Bellido-Pérez
- Primary Health Care Center Esparreguera, Institut Català de la Salut, Barcelona, Spain
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gloria Sauch Valmaña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPGol), Barcelona, Spain
| | - Anna Berenguera Ossó
- Unitat de Suport a la Recerca Barcelona ciutat, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | | | - Sonia Ruíz-Serrano
- Primary Health Care Center Adrià, Institut Català de la Salut, Barcelona, Spain
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Lee J, Kim EJ, Park GS, Kim J, Kim TE, Lee YJ, Park J, Kang J, Koo JW, Choi TY. Lactobacillus reuteri ATG-F4 Alleviates Chronic Stress-induced Anhedonia by Modulating the Prefrontal Serotonergic System. Exp Neurobiol 2023; 32:313-327. [PMID: 37927130 PMCID: PMC10628864 DOI: 10.5607/en23028] [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: 09/04/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Mental health is influenced by the gut-brain axis; for example, gut dysbiosis has been observed in patients with major depressive disorder (MDD). Gut microbial changes by fecal microbiota transplantation or probiotics treatment reportedly modulates depressive symptoms. However, it remains unclear how gut dysbiosis contributes to mental dysfunction, and how correction of the gut microbiota alleviates neuropsychiatric disorders. Our previous study showed that chronic consumption of Lactobacillus reuteri ATG-F4 (F4) induced neurometabolic alterations in healthy mice. Here, we investigated whether F4 exerted therapeutic effects on depressive-like behavior by influencing the central nervous system. Using chronic unpredictable stress (CUS) to induce anhedonia, a key symptom of MDD, we found that chronic F4 consumption alleviated CUS-induced anhedonic behaviors, accompanied by biochemical changes in the gut, serum, and brain. Serum and brain metabolite concentrations involved in tryptophan metabolism were regulated by CUS and F4. F4 consumption reduced the elevated levels of serotonin (5-HT) in the brain observed in the CUS group. Additionally, the increased expression of Htr1a, a subtype of the 5-HT receptor, in the medial prefrontal cortex (mPFC) of stressed mice was restored to levels observed in stress-naïve mice following F4 supplementation. We further demonstrated the role of Htr1a using AAV-shRNA to downregulate Htr1a in the mPFC of CUS mice, effectively reversing CUS-induced anhedonic behavior. Together, our findings suggest F4 as a potential therapeutic approach for relieving some depressive symptoms and highlight the involvement of the tryptophan metabolism in mitigating CUS-induced depressive-like behaviors through the action of this bacterium.
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Affiliation(s)
- Jiyun Lee
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
- Department of Brain Sciences, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Korea
| | - Eum-Ji Kim
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
| | | | - Jeongseop Kim
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
- Department of Brain Sciences, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Korea
| | - Tae-Eun Kim
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
- Department of Brain Sciences, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Korea
| | - Yoo Jin Lee
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
| | - Juyi Park
- AtoGen Co., Ltd., Daejeon 34015, Korea
| | | | - Ja Wook Koo
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
- Department of Brain Sciences, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Korea
| | - Tae-Yong Choi
- Emotion, Cognition, and Behavior Research Group, Korea Brain Research Institute (KBRI), Daegu 41062, Korea
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Fusar-Poli P, Estradé A, Stanghellini G, Esposito CM, Rosfort R, Mancini M, Norman P, Cullen J, Adesina M, Jimenez GB, da Cunha Lewin C, Drah EA, Julien M, Lamba M, Mutura EM, Prawira B, Sugianto A, Teressa J, White LA, Damiani S, Vasconcelos C, Bonoldi I, Politi P, Vieta E, Radden J, Fuchs T, Ratcliffe M, Maj M. The lived experience of depression: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2023; 22:352-365. [PMID: 37713566 PMCID: PMC10503922 DOI: 10.1002/wps.21111] [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] [Indexed: 09/17/2023] Open
Abstract
We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Cecilia Maria Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, University of Chieti and Pescara "G. d'Annunzio", Chieti, Italy
| | - Peter Norman
- Recovery College, South London and Maudsley NHS Foundation Trust, London, UK
- Mosaic Clubhouse Brixton, London, UK
| | | | - Miracle Adesina
- Global Mental Health Peer Network, Ibadan, Nigeria
- Slum and Rural Health Initiative, Ibadan, Nigeria
| | - Gema Benavides Jimenez
- Global Mental Health Peer Network, Madrid, Spain
- Utrecht University, Utrecht, The Netherlands
- Instituto Superior de Estudios Psicológicos, Madrid, Spain
| | - Caroline da Cunha Lewin
- Global Mental Health Peer Network, London, UK
- Patient and Public Involvement Team, NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | | | - Marc Julien
- Global Mental Health Peer Network, Douala, Cameroon
| | | | - Edwin M Mutura
- Global Mental Health Peer Network, Nairobi, Kenya
- Mentally Unsilenced, Nairobi, Kenya
- Psychiatric Disability Organization of Kenya, Nakuru, Kenya
| | - Benny Prawira
- Global Mental Health Peer Network, Jakarta, Indonesia
- Into The Light Indonesia, Jakarta, Indonesia
| | - Agus Sugianto
- Global Mental Health Peer Network, Jakarta, Indonesia
- Indonesian Community Care for Schizophrenia, Jakarta, Indonesia
- University of Manchester, Manchester, UK
| | - Jaleta Teressa
- Global Mental Health Peer Network, Nekemte, Ethiopia
- Nekemte Specialized Hospital, Nekemte, Ethiopia
| | - Lawrence A White
- Global Mental Health Peer Network, Yellowknife, Canada
- Centre for Learning & Teaching Innovation, Aurora College, Yellowknife, Canada
- Advanced Graduate Student, Unicaf University, Lusaka, Zambia
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Candida Vasconcelos
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jennifer Radden
- Philosophy Department, University of Massachusetts, Boston, MA, USA
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Maj M. Understanding depression beyond the "mind-body" dichotomy. World Psychiatry 2023; 22:349-350. [PMID: 37713548 PMCID: PMC10503906 DOI: 10.1002/wps.21142] [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: 09/17/2023] Open
Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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35
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Stefana A, Langfus JA, Palumbo G, Cena L, Trainini A, Gigantesco A, Mirabella F. Comparing the factor structures and reliabilities of the EPDS and the PHQ-9 for screening antepartum and postpartum depression: a multigroup confirmatory factor analysis. Arch Womens Ment Health 2023; 26:659-668. [PMID: 37464191 PMCID: PMC10491522 DOI: 10.1007/s00737-023-01337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023]
Abstract
To evaluate and compare the factor structure and reliability of EPDS and PHQ in antepartum and postpartum samples. Parallel analysis and exploratory factor analysis were conducted to determine the structure of both scales in the entire sample as well as in the antepartum and postpartum groups. McDonald's omega statistics examined the utility of treating items as a single scale versus multiple factors. Multigroup confirmatory factor analysis (MCFA) was utilized to test the measurement invariance between the antepartum and postpartum groups. Two-factor models fit best for the EPDS in both the antepartum and postpartum groups; however, the most reliable score variance was attributable to a general factor for each scale. MCFA provided evidence of weak invariance across groups regarding factor loadings and partial invariance regarding item thresholds. PHQ-9 showed a two-factor model in the antepartum group; however, the same model did not fit well in the postpartum group. EPDS should be preferred to PHQ-9 for measuring depressive symptoms in peripartum populations. Both scales should be used as a single-factor scale. Caution is required when comparing the antepartum and postpartum scores.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Joshua A Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Loredana Cena
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, Brescia, Italy
| | - Alice Trainini
- Department of Clinical and Experimental Sciences, Section of Neuroscience, Observatory of Perinatal Clinical Psychology, University of Brescia, Brescia, Italy
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Rome, Italy
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Karimli L, Ssewamala FM, Neilands TB. The impact of poverty-reduction intervention on child mental health mediated by family relations: Findings from a cluster-randomized trial in Uganda. Soc Sci Med 2023; 332:116102. [PMID: 37506487 DOI: 10.1016/j.socscimed.2023.116102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Reviews that synthesize global evidence on the impact of poverty reduction interventions on child and adolescent mental health (CAMH) report inconclusive results and highlight the need to unpack the mechanisms that connect poverty-reduction to CAMH. To address this gap, we examine the proposition that family relations is an important relational factor transmitting effect of poverty on CAMH, and test whether family relations mediate the effect of poverty-reduction intervention on depression, hopelessness, and self-concept among AIDS orphans in Uganda. We use longitudinal data collected over the course of 48 months in a cluster-randomized controlled trial conducted among N = 1410 AIDS orphans from n = 48 schools in Uganda. To examine the relationship between intervention, latent mediator (family relations and support) and CAMH outcomes (Beck Hopelessness Scale (BHS), Tennessee Self-Concept Scale (TSCS), and Depression), we ran structural equation models adjusting for clustering of individuals within schools. Relative to the control group, participants in both treatment arms reported lower levels of hopelessness and depression, and significantly higher levels of self-concept. They also report significantly higher levels of latent family relationship in all three models. In both treatment arms, the direct effect of the intervention on all three outcomes is still significant when the latent family relations mediator is included in the analyses. This suggests partial mediation. In other words, in both treatment arms, the significant positive effect of the intervention on children's depression, hopelessness, and self-concept is partially mediated by their family relationship quality. Our findings support the argument put forward by the Family Stress Model showing that the poverty-reduction program improves children's mental health functioning by improving family relationships. The implications of our study extend beyond the narrow focus of poverty reduction, suggesting that asset-building interventions have broader impacts on family dynamics and child mental health.
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Affiliation(s)
- Leyla Karimli
- University of California, Los Angeles (UCLA), Luskin School of Public Affairs, Social Welfare Department, USA.
| | - Fred M Ssewamala
- Washington University in St. Louis, George Warren Brown School of Social Work, USA.
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Sharma NK, Mishra K. Exploration of diacerein as a neuroprotective adjuvant to Adenium obesum: An in-vivo study. J Ayurveda Integr Med 2023; 14:100761. [PMID: 37506605 PMCID: PMC10405303 DOI: 10.1016/j.jaim.2023.100761] [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: 01/27/2023] [Revised: 05/27/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Since the dawn of civilization, medicinal plants have been essential in the treatment of numerous human ailments. Medicinal plants have been the reliable sources to treat various diseases. Over 25% of prescription medications on the market today are made from natural resources. In the present study the selected medicinal plant, is Adenium obesum, of family Apocynaceae. The plant contains various chemical groups, including carbohydrate, cardiac glycoside, flavonoid, polyphenols, terpenoids, pregnanes, etc. OBJECTIVE: Millions of peoples worldwide are affected with neurodegenerative diseases. Parkinson's disease, Alzheimer's disease & Huntingtons disease are important among them. Since ancient times, medicinal herbs have been used to treat illnesses. The objective of present study is to prepare an effective & safe drug formulation to treat neurological diseases. MATERIAL & METHODS Methanolic extract of A. obesum (200 mg/kg, 400 mg/kg) alone as well as with diacerein (100 mg/kg) is used to treat the haloperidol (1 mg/kg) & iron (10 mg/kg) induced Parkinsonism & Isotretinoin induced depression in albino wistar rats. The efficacy of plant extract as well as diacerein were measured by various behavioral models, with the help of histopathological studies & antioxidant assay like GSH, SOD, CAT, and LPO. RESULTS A. obesum alone & with diacerein is effective to treat neurological complications like Parkinson's disease & depression which can be seen in various behavioral models like, staircase test, rotarod test, forced swim test, hole board test etc. Histopathological evidences also suggest the significance of plant extract alone & with diacerein. CONCLUSION The findings of present research work revealed the neuroprotective effect of both A. obesum extract as well as diacerein.
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Affiliation(s)
- Neeraj Kumar Sharma
- Faculty of Medical & Paramedical Sciences, Madhyanchal Professional University, Bhopal 462044, India
| | - Kislaya Mishra
- Department of Pharmacology, Hygia Institute of Pharmaceutical Education and Research, Lucknow 226020, India.
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Doran-Sherlock R, Devitt S, Sood P. An integrative review of the evidence for Shinrin-Yoku (Forest Bathing) in the management of depression and its potential clinical application in evidence-based osteopathy. J Bodyw Mov Ther 2023; 35:244-255. [PMID: 37330777 DOI: 10.1016/j.jbmt.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/04/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
There is growing interest in the idea of integrating Nature Therapies into the multidisciplinary management of complex conditions such as depression. Shinrin-Yoku (Forest Bathing), a practice involving spending time in a forested environment while paying attention to multi-sensory stimuli has been proposed as one such modality. The objectives of this review were to critically analyse the current evidence base on the efficacy of Shinrin-Yoku for the treatment of depression, and to examine how the findings may reflect and/or inform osteopathic principles and clinical practice. An integrative review of the evidence for Shinrin-Yoku in the management of depression published between 2009 and 2019 was conducted resulting in n = 13 peer-reviewed studies meeting inclusion criteria. Two themes emerged from the literature, the positive effect of Shinrin-Yoku on self-reported mood scores, and physiological changes arising from forest exposure. However, the methodological quality of the evidence is poor and experiments may not be generalisable. Suggestions were made for improving the research base via mixed-method studies in a biopsychosocial framework, and aspects of the research which may be applicable to evidence-based osteopathy were noted.
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Tekola B, Mayston R, Eshetu T, Birhane R, Milkias B, Hanlon C, Fekadu A. Understandings of depression among community members and primary healthcare attendees in rural Ethiopia: A qualitative study. Transcult Psychiatry 2023; 60:412-427. [PMID: 34939463 PMCID: PMC10486165 DOI: 10.1177/13634615211064367] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Available evidence in Africa suggests that the prevalence of depression in primary care settings is high but it often goes unrecognized. In this study, we explored how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection. We conducted individual interviews with purposively selected primary care attendees with depression (n = 28; 16 females and 12 males) and focus group discussions (FGDs) with males, females, and priests (n = 21) selected based on their knowledge of their community. Data were analyzed using thematic analysis. None of the community members identified depression as a mental illness. They considered depressive symptoms presented in a vignette as part of a normal reaction to the stresses of life. They considered medical intervention only when the woman's condition in the vignette deteriorated and "affected her mind." In contrast, participants with depression talked about their condition as illness. Symptoms spontaneously reported by these participants only partially matched symptoms listed in the current diagnostic criteria for depressive disorders. In all participants' accounts, spiritual explanations and traditional healing were prominent. The severity of symptoms mediates the decision to seek medical help. Improved detection may require an understanding of local conceptualizations in order to negotiate an intervention that is acceptable to affected people.
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Affiliation(s)
| | | | | | | | | | | | - Abebaw Fekadu
- Addis Ababa University
- Brighton and Sussex Medical School
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Greene MC, Ventevogel P, Likindikoki SL, Bonz AG, Turner R, Rees S, Misinzo L, Njau T, Mbwambo JKK, Tol WA. Why local concepts matter: Using cultural expressions of distress to explore the construct validity of research instruments to measure mental health problems among Congolese women in Nyarugusu refugee camp. Transcult Psychiatry 2023; 60:496-507. [PMID: 36114647 PMCID: PMC10260259 DOI: 10.1177/13634615221122626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools-anxiety, depression, and post-traumatic stress disorder-adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local "cultural fit" of globally used tools for measuring mental health in cross-cultural research.
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Affiliation(s)
- M. Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, N Y, USA
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Samuel L. Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Rachael Turner
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Susan Rees
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Lusia Misinzo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tasiana Njau
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie K. K. Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wietse A. Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Tomczyk S, Heineck S, McLaren T, Peter LJ, Schomerus G, Schmidt S, Muehlan H. Yes, I can! Development and validation of the self-efficacy for self-help scale. J Affect Disord 2023; 331:279-286. [PMID: 36933667 DOI: 10.1016/j.jad.2023.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Self-help interventions for health complaints promise alleviation, for instance, of depressive symptoms, and have become increasingly popular. However, despite constant progress regarding digitally supported self-help, real-world uptake is low and motivational processes, like task-specific self-efficacy, are rarely investigated. Therefore, this study developed and tested the Self-Efficacy for Self-Help Scale (SESH). METHODS In a randomized controlled trial of a positive psychological online intervention to foster self-help, 344 adults (mean age = 49.26 years, SD = 27.85; 61.9 % female) completed SESH at three time points (pretest, posttest, 2-week follow-up). Psychometric testing included factorial validity, reliability (internal consistency, split-half), convergent validity (via depression coping self-efficacy), discriminant validity (via depression severity, depression literacy), sensitivity to change (due to the intervention), and predictive validity (via a theory of planned behavior questionnaire on self-help). RESULTS The unidimensional scale showed excellent reliability, construct validity, and predictive validity regarding self-help (the theory of planned behavior explained 49 % of variance in self-help intentions). The analysis did not clearly support sensitivity to change, however, as SESH scores did not change in the intervention group but were lower in the control group at posttest. LIMITATIONS The study was not representative of the population, and the intervention was not previously tested. Studies with longer follow-ups and more diverse samples are needed. CONCLUSIONS This study closes a gap in current self-help research by presenting a psychometrically sound measure to capture self-efficacy for self-help that can be used in epidemiological studies as well as clinical practice.
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Affiliation(s)
- Samuel Tomczyk
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany.
| | - Sascha Heineck
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Thomas McLaren
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Lina-Jolien Peter
- University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy, Germany
| | - Georg Schomerus
- University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy, Germany
| | - Silke Schmidt
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
| | - Holger Muehlan
- University of Greifswald, Institute of Psychology, Department Health and Prevention, Germany
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Longstreth GF, Attix C, Kuck J. Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives. Am J Med 2023; 136:244-251. [PMID: 36370801 DOI: 10.1016/j.amjmed.2022.10.014] [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: 09/30/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
Torture occurs worldwide. Survivors seeking asylum are detained and must complete a complicated legal process to prove a "well-founded fear of persecution" if returned to their home countries. Forensic evaluations guided by the United Nations Istanbul Protocol increase asylum grant rates. Medical evaluation emphasizes skin examination, which can provide strong evidence of torture. Female genital mutilation and cutting, a basis for asylum, is classified according to the World Health Organization. Many resettled refugees and foreign-born immigrants at urban health care facilities have been tortured, but few report it to physicians due to factors affecting both survivors and physicians. Specific torture methods can cause characteristic long-term sequelae. Painful somatic disorders of mind-body interaction and psychological disorders are common. Practices derived from cultural factors and traumatized individuals' feedback enhance management of survivors. Individual and group psychotherapy provide modest proven benefit, but assessment is limited. Physicians and psychotherapists should coordinate care.
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Affiliation(s)
- George F Longstreth
- Survivors of Torture International, San Diego, Calif; Veterans Administration San Diego Healthcare System, San Diego, Calif.
| | | | - Julie Kuck
- Survivors of Torture International, San Diego, Calif
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Wahid SS, Raza WA, Mahmud I, Kohrt BA. Climate-related shocks and other stressors associated with depression and anxiety in Bangladesh: a nationally representative panel study. Lancet Planet Health 2023; 7:e137-e146. [PMID: 36754469 DOI: 10.1016/s2542-5196(22)00315-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Climate change has major implications for common mental disorders including depression and anxiety in vulnerable nations such as Bangladesh. However, knowledge gaps exist around national estimations of depression and anxiety, and the associations between the prevalence of these disorders with climate-related and sociodemographic risk factors. To address these gaps, this study analysed data from a nationally representative panel study in Bangladesh that examined climate-related and sociodemographic correlates of depression and anxiety. METHODS Two rounds of nationally representative household panel data were collected from urban and rural areas between August and September, 2019, and January and February, 2020. Households were selected for inclusion across 150 enumeration areas as the primary sampling units with use of a two-stage stratified random sampling design, and survey instruments were administered to the available adult member of the household. Depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales, respectively, and weighted prevalence estimates were calculated on the basis of the 2011 national population census. Data on temperature and humidity were collected from 43 weather stations and constructed as mean values for the 2-month period preceding each round of the survey. Self-reported exposure to flooding was collected for a 12-month recall period. We applied a weighted population average logistic model on the pooled sample of both surveys to analyse the associations between ambient temperature, humidity, exposure to flooding, seasonality, sociodemographic variables, and three outcome conditions (depression, anxiety, and co-occurring depression and anxiety; at the level of p<0·1). The models accounted for temporal and spatial heterogeneity. Standard errors were clustered at the level of each primary sampling unit. FINDINGS 3606 individuals were included with 3·5% dropout in the second survey round (pooled sample n=7086; age range 15-90 years; 2898 [40·9%] men and 4188 [59·1%] women). National weighted prevalence estimates were 16·3% (95% CI 14·7-17·8) for depression, 6·0% (4·7-7·3) for anxiety, and 4·8% (3·7-5·9) for co-occurring depression and anxiety. We observed no significant associations between overall seasonality (summer vs winter) and the odds of depression (adjusted odds ratio 3·14 [95% CI 0·52-19·13], p=0·22), anxiety (0·16 [0·02-1·41], p=0·10), or co-occurring depression and anxiety (0·13 [0·01-1·49], p=0·10). An increase in mean temperature of 1°C within the 2 months preceding the surveys was associated with increased odds of anxiety (1·21 [1·00-1·47], p=0·046) and increased odds of co-occurring depression and anxiety (1·24 [1·00-1·53], p=0·045), whereas increased temperature was not associated with depression (0·90 [0·77-1·04], p=0·15). An increase in mean humidity of 1 g/m3 was not associated with depression (0·99 [0·96-1·02], p=0·60) or anxiety (1·04 [0·99-1·09], p=0·13), but was associated with co-occurring depression and anxiety (1·06 [1·00-1·12], p=0·064). Exposure to flooding within the 12 months preceding the survey rounds was associated with increased odds of all outcome conditions (depression, 1·31 [1·00-1·70], p=0·047; anxiety, 1·69 [1·21-2·36], p=0·0020; and co-occurring depression and anxiety, 1·87 [1·31-2·68], p=0·0006). INTERPRETATION Climate-related shocks and other stressors have an important association with the burden of depression and anxiety in Bangladesh. Community-level interventions for common mental disorders need to be developed and assessed for safety, feasibility, and effectiveness in a Bangladeshi context. Further research on climate-related stressors is needed over different timespans and time intervals. FUNDING The World Bank.
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Affiliation(s)
- Syed Shabab Wahid
- Department of Global Health, Georgetown University, Washington, DC, USA
| | - Wameq Azfar Raza
- Health, Nutrition and Population Global Practice, The World Bank, Dhaka, Bangladesh.
| | - Iffat Mahmud
- Health, Nutrition and Population Global Practice, The World Bank, Dhaka, Bangladesh
| | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington, DC, USA
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Narayan S, Mok H, Ho K, Kealy D. "I don't think they're as culturally sensitive": a mixed-method study exploring e-mental health use among culturally diverse populations. J Ment Health 2023; 32:241-247. [PMID: 35770901 DOI: 10.1080/09638237.2022.2091762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Culturally diverse populations (CDPs), such as visible minorities, face challenges, such as lack of culturally tailored resources, when accessing mental health services. These barriers may be addressed by e-mental health (eMH) technologies. However, little attention has been devoted to understanding the cultural responsiveness of these services among CDPs. AIMS This study explores CDPs experience of eMH for anxiety and depressive disorders in an urban area and gauge its cultural responsiveness. METHODS In this mixed methods study, participants (N = 136) completed a survey regarding their eMH use, mental health status, and socio-demographic characteristics. Subsequently, participants (N = 14) shared their experiences through semi-structured focus groups. RESULTS The majority of participants (68%) indicated that the eMH resources used were not culturally tailored. However, most participants (65%) agreed that the resource was available in their preferred language. Focus group discussions revealed key experiences around limited language diversity, cultural representation and cultural competency, and culturally linked stigma. eMH recommendations suggested by participants focused on including culturally tailored content, graphics and phrases, and lived experiences of CDPs. CONCLUSIONS The findings showcase the need for more culturally responsive eMH beyond language translation, while providing healthcare professionals with a greater and nuanced understanding of treatment needs in cultural groups.
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Affiliation(s)
- Shawna Narayan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hiram Mok
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendall Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- University of British Columbia, Vancouver, British Columbia, Canada
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Tang Q, Takashima K, Zeng W, Okano H, Zou X, Takahashi Y, Ojiro R, Ozawa S, Koyanagi M, Maronpot RR, Yoshida T, Shibutani M. Amelioration of lipopolysaccharides-induced impairment of fear memory acquisition by alpha-glycosyl isoquercitrin through suppression of neuroinflammation in rats. J Toxicol Sci 2023; 48:121-137. [PMID: 36858638 DOI: 10.2131/jts.48.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
This study investigated the role of neuroinflammation in a lipopolysaccharides (LPS)-induced cognitive dysfunction model in rats using an antioxidant, α-glycosyl isoquercitrin (AGIQ). Six-week-old rats were dietary treated with 0.5% (w/w) AGIQ for 38 days, and LPS at 1 mg/kg body weight was administered intraperitoneally once daily on Days 8 and 10. On Day 11, LPS alone increased or tended to increase interleukin-1β and tumor necrosis factor-α in the hippocampus and cerebral cortex. Immunohistochemically, LPS alone increased the number of Iba1+ and CD68+ microglia, and GFAP+ astrocytes in the hilus of the hippocampal dentate gyrus (DG). AGIQ treatment decreased or tended to decrease brain proinflammatory cytokine levels and the number of CD68+ microglia in the DG hilus. In the contextual fear conditioning test during Day 34 and Day 38, LPS alone impaired fear memory acquisition, and AGIQ tended to recover this impairment. On Day 38, LPS alone decreased the number of DCX+ cells in the neurogenic niche, and AGIQ increased the numbers of PCNA+ cells in the subgranular zone and CALB2+ hilar interneurons. Additionally, LPS alone decreased or tended to decrease the number of synaptic plasticity-related FOS+ and COX2+ granule cells and AGIQ recovered them. The results suggest that LPS administration induced acute neuroinflammation and subsequent impairment of fear memory acquisition caused by suppressed synaptic plasticity of newborn granule cells following disruptive neurogenesis. In contrast, AGIQ exhibited anti-inflammatory effects and ameliorated LPS-induced adverse effects. These results suggest that neuroinflammation is a key factor in the development of LPS-induced impairment of fear memory acquisition.
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Affiliation(s)
- Qian Tang
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Kazumi Takashima
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Wen Zeng
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology
| | - Hiromu Okano
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Xinyu Zou
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Yasunori Takahashi
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Ryota Ojiro
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Shunsuke Ozawa
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Mihoko Koyanagi
- Global Scientific and Regulatory Affairs, San-Ei Gen F.F.I., Inc
| | | | - Toshinori Yoshida
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology
| | - Makoto Shibutani
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology.,Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology.,Institute of Global Innovation Research, Tokyo University of Agriculture and Technology
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Peerenboom N, Aryal S, Blankenship JM, Swibas T, Zhai Y, Clay I, Lyden K. The Case for the Patient-Centric Development of Novel Digital Sleep Assessment Tools in Major Depressive Disorder. Digit Biomark 2023; 7:124-131. [PMID: 37901365 PMCID: PMC10601929 DOI: 10.1159/000533523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023] Open
Abstract
Background Depression imposes a major burden on public health as the leading cause of disability worldwide. Sleep disturbance is a core symptom of depression that affects the vast majority of patients. Nonetheless, it is frequently not resolved by depression treatment and may even be worsened through some pharmaceutical interventions. Disturbed sleep negatively impact patients' quality of life, and persistent sleep disturbance increases the risk of recurrence, relapse, and even suicide. However, the development of novel treatments that might improve sleep problems is hindered by the lack of reliable low-burden objective measures that can adequately assess disturbed sleep in this population. Summary Developing improved digital measurement tools that are fit for use in clinical trials for major depressive disorder could promote the inclusion of sleep as a focus for treatment, clinical drug development, and research. This perspective piece explores the path toward the development of novel digital measures, reviews the existing evidence on the meaningfulness of sleep in depression, and summarizes existing methods of sleep assessments, including the use of digital health technologies. Key Messages Our objective was to make a clear call to action and path forward for the qualification of new digital outcome measures which would enable assessment of sleep disturbance as an aspect of health that truly matters to patients, promoting sleep as an important outcome for clinical development, and ultimately ensure that disturbed sleep will not remain the forgotten symptom of depression.
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Affiliation(s)
| | | | | | | | - Yaya Zhai
- Vivosense Inc., Newport Coast, CA, USA
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Kokou-Kpolou CK, Park S, Bet Q, Iorfa SK, Chinweuba DC, Chukwuorji JC. Towards a more comprehensive understanding of depressive symptoms among young adults using Gaussian graphical and directed acyclic graph models. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kaiser BN, Ticao C, Anoje C, Boglosa J, Gafaar T, Minto J, Kohrt BA. Challenges in simultaneous validation of mental health screening tools in multiple languages: Adolescent assessments in Hausa and Pidgin in Nigeria. SSM - MENTAL HEALTH 2022; 2:100168. [PMID: 36712479 PMCID: PMC9878994 DOI: 10.1016/j.ssmmh.2022.100168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background With growing global recognition of the need to address mental health, a key challenge is determining who needs mental health services. Most self-report screening tools were developed in English-speaking high-income settings, and this cultural milieu influences the types and content of items, the manner in which items are asked, and the options for responding to items. Approaches have been developed for transcultural translation and validation. However, these approaches are typically applied in one language at a time, which is of limited utility in linguistically diverse settings. Methods To address challenges in cross-cultural validation, we undertook a unique process of simultaneously validating tools in two languages in Nigeria. Through this dual-language validation, we explored how cultural and contextual differences may influence what is considered valid for a mental health tool. We validated the Depression Self Rating Scale, Child PTSD Symptom Scale (CPSS), and Disruptive Behavior Disorders Rating Scale with a community sample of 330 adolescents aged 12-17. Validity was assessed in Hausa and Pidgin, two languages commonly spoken in Nigeria. Clinical psychologists used the Kiddie-Schedule for Affective Disorders and Schizophrenia to establish caseness. Results Most items had good discriminant validity, except on the CPSS, on which only 8 of 17 items discriminated by caseness. Findings indicate the influence of culture (e.g., linguistic differences in translatability of items) and context (e.g., items that reflect experiences of hunger or foodborne illness; different PTSD caseness by language might reflect differential trauma exposure between populations). We also identified items that operated differently between languages. Conclusion We identified shortcomings in cross-cultural validation procedures with regard to determining whether language, context, or or other differences influence performance of items. For future validation efforts, we recommend systematically collecting information on context and stressful/traumatic exposures as a way to contextualize interpretation of the validity findings. Acronyms Depression Self Rating Scale (DSRS), Child PTSD Symptom Scale (CPSS), Disruptive Behavior Disorders Rating Scale (DBDRS), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Area Under the Curve (AUC), Diagnostic Odds Ratio (DOR), Low- and Middle-Income Countries (LMICs), Posttraumatic Stress Disorder (PTSD).
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Affiliation(s)
- Bonnie N. Kaiser
- University of California San Diego, United States,Duke Global Health Institute, United States,Corresponding author. 9500 Gilman Road #0532, La Jolla, CA, 92093, United States. (B.N. Kaiser)
| | | | | | | | | | | | - Brandon A. Kohrt
- Duke Global Health Institute, United States,George Washington University, United States
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Lasater ME, Beebe M, Warren NE, Winch PJ, Soucko F, Keita M, Doumbia S, Murray SM. Reliability and validity of a perinatal depression screening instrument in rural Mali. SSM - MENTAL HEALTH 2022; 2:100059. [PMID: 36644110 PMCID: PMC9835090 DOI: 10.1016/j.ssmmh.2021.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background In order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali. Methods We administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument's psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale. Results The full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach's alpha = 0.92). Women who self-identified as suffering from dusukasi (n = 87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p < 0.0001) and functional impairment scores (p < 0.0001) compared to women not reporting dusukasi (n = 93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi. Conclusions Construct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.
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Affiliation(s)
- Molly E. Lasater
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA,Corresponding author. 615 N. Wolfe St, Baltimore, MD, USA, 21205. (M.E. Lasater)
| | - Madeleine Beebe
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Nicole E. Warren
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Peter J. Winch
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Fatoumata Soucko
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Mariam Keita
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Seydou Doumbia
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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Mielke MM, Aggarwal NT, Vila‐Castelar C, Agarwal P, Arenaza‐Urquijo EM, Brett B, Brugulat‐Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani J, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement 2022; 18:2707-2724. [PMID: 35394117 PMCID: PMC9547039 DOI: 10.1002/alz.12662] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/31/2023]
Abstract
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.
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Affiliation(s)
- Michelle M. Mielke
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Neelum T. Aggarwal
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Clara Vila‐Castelar
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
| | - Puja Agarwal
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Eider M. Arenaza‐Urquijo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Benjamin Brett
- Department of NeurosurgeryMedical College of WisconsinWisconsinMilwaukeeUSA
| | - Anna Brugulat‐Serrat
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Atlantic Fellow for Equity in Brain HealthThe University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lyndsey E. DuBose
- Department of Medicine, Division of GeriatricsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Willem S. Eikelboom
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jason Flatt
- Social and Behavioral Health Program, School of Public HealthUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate CenterCity University of New YorkNew YorkUSA
- Department of PsychiatryNew York University Long Island School of MedicineNew YorkUSA
| | - Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of ResearchOaklandCaliforniaUSA
| | - Wei Li
- Department of Clinical and Diagnostic SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alison J. McManus
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Debora Melo van Lent
- UT Health San AntonioGlenn Biggs Institute for Alzheimer's and Neurodegenerative diseasesSan AntonioTexasUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sadaf Arefi Milani
- Division of Geriatrics & Palliative Medicine, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shana D. Stites
- Department of PsychiatryPerlman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Sundermann
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Vidyani Suryadevara
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jean‐Francoise Trani
- Department of Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Arlener D. Turner
- Department of Psychiatry & Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Julius Center for Health Sciences and Primary CareDepartment of EpidemiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Yakeel T. Quiroz
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
- Grupo de Neurociencias de Antioquia of Universidad de AntioquiaMedellinColumbiaUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University in St. LouisSt. LouisMississippiUSA
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
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