1
|
Pyo E, Weber MB, Sivaram J, Staimez LR, Mohan V, Anjana RM, Haardörfer R, Ranjani H. Construct validity of the 12-item Short Form Health Survey (SF-12) version 2 and the impact of lifestyle modifications on the health-related quality of life among Indian adults with prediabetes: results from the D-CLIP trial. Qual Life Res 2024; 33:1593-1603. [PMID: 38607494 DOI: 10.1007/s11136-024-03648-6] [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] [Accepted: 03/08/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE This study aimed to validate the factor structure of the 12-item Short-Form (SF-12) health-related quality of life (HRQOL) survey for Indian adults and assess the impact of lifestyle modification on the SF-12 of Indian adults with prediabetes. METHODS To validate the context-specific construct of the SF-12, two-factor confirmatory factor analysis (CFA) was performed using data from 1285 adults residing in Chennai, India, who screened for the Diabetes Community Lifestyle Improvement Program (D-CLIP). D-CLIP was a randomized controlled trial of 578 participants with prediabetes (283 treatment, 293 control), focusing on the effect of lifestyle modifications on the prevention of diabetes. Physical and mental component scores (PCS and MCS) were computed by using CFA standardized factor loadings. Multiple linear regression was subsequently conducted to estimate the effect of lifestyle modification on post-study changes of PCS and MCS among D-CLIP participants. RESULTS Cronbach's alpha and CFA fit indices demonstrated acceptable reliability and model fit of the SF-12 for Indian adults. The intervention group showed greater mean change in PCS after study participation compared to the controls (1.63 ± 0.82, p = 0.046); no significant difference was observed for MCS between two groups (1.00 ± 0.85, p = 0.242). CONCLUSION The study confirmed that the SF-12 is suitable for assessing the physical and mental health dimensions of HRQOL for Indian adults. Our findings suggest that the benefits of diabetes prevention lifestyle modification strategies may primarily enhance the physical well-being of adults with prediabetes. Further studies validating the SF-12 in a broader Asian Indian population are needed. TRIAL REGISTRATION Clinicaltrials.gov, NCT01283308.
Collapse
Affiliation(s)
- Euisun Pyo
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
| | - Mary Beth Weber
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | | | - Lisa R Staimez
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harish Ranjani
- Department of Preventive and Digital Health Research, Madras Diabetes Research Foundation, Chennai, India
| |
Collapse
|
2
|
Chan AY, Burrows K, Bell ML. Why They Stayed and Why They Left-A Case Study from Ellicott City, MD after Flash Flooding. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10636. [PMID: 36078354 PMCID: PMC9518097 DOI: 10.3390/ijerph191710636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Ellicott City, MD was devasted by flash flooding in 2016 and 2018. A lack of qualitative research has been conducted on topics related to sense of place and flash flooding, especially in the United States. In this study, we reveal reasons why some who experienced flash flooding continued to stay the flood zone and why some leave. We utilized a phenomenological approach to answer these research questions. Data were generated through in-depth interviews with 19 participants from the Historic District and adjacent neighborhoods in Ellicott City. The most common reasons participants stayed were: (1) Community Impact, (2) Historical Land, and (3) Financial Burden. The most common reasons participants left were: (1) Emotional Exhaustion and Frustration, (2) Fear/Anxiety, and (3) Financial Burden. The results of our study indicate that reasons individuals who experience flash flooding stay, or leave may include community/historical, environmental, emotional, and economic factors. This reveals the complexity of relocation and sense of place after natural/environmental disasters and supports previous literature that suggests tailored response efforts based on these unique set of burdens. This paper aims to identify burdens and understand flood victims' decisions to help policy makers improve flood response efforts.
Collapse
Affiliation(s)
- Alisha Yee Chan
- Chemical and Environmental Engineering, Yale University, New Haven, CT 06511, USA
| | - Kate Burrows
- Institute at Brown for Environment and Society, Brown University, Providence, RI 02903, USA
- School of the Environment, Yale University, New Haven, CT 06511, USA
| | - Michelle L. Bell
- School of the Environment, Yale University, New Haven, CT 06511, USA
| |
Collapse
|
3
|
Sharpe I, Davison CM. A Scoping Review of Climate Change, Climate-Related Disasters, and Mental Disorders among Children in Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052896. [PMID: 35270593 PMCID: PMC8910112 DOI: 10.3390/ijerph19052896] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023]
Abstract
Children, particularly those living in low- and middle-income countries (LMICs), are highly vulnerable to climate change and its impacts. Our main objective was to conduct a scoping literature review to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among children in LMICs. We also aimed to identify gaps in this area of scholarship. We included studies of children in LMICs that had a climate change or climate-related disaster exposure and mental disorder outcome. Twenty-three studies were included in the final synthesis. Fourteen studies were conducted in China, three in India, two each in Pakistan and the Philippines, and one each in Namibia and Dominica. All studies assessed the association between a climate-related disaster exposure and a mental disorder outcome, while none explored broader climate change-related exposures. Post-traumatic stress disorder (n = 21 studies) and depression (n = 8 studies) were the most common mental disorder outcomes. There was considerable between-study heterogeneity in terms of sample size, follow-up length, and outcome measurement. Overall, the literature in this area was sparse. Additional high-quality research is required to better understand the impacts of climate-related disasters and climate change on mental disorders within this population to ultimately inform future policies and interventions.
Collapse
|
4
|
Batterham PJ, Brown K, Trias A, Poyser C, Kazan D, Calear AL. Systematic review of quantitative studies assessing the relationship between environment and mental health in rural areas. Aust J Rural Health 2022; 30:306-320. [PMID: 35189016 PMCID: PMC9303895 DOI: 10.1111/ajr.12851] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Physical and natural environments might strongly influence mental health and well-being. Many studies have examined this relationship in urban environments, with fewer focused on rural settings. The aim of this systematic review was to synthesise quantitative evidence for the relationship between environmental factors (drought, climate and extreme weather events, land use/environmental degradation, green space/vegetation, engagement in natural resource management activities) and mental health or well-being in rural areas. DESIGN Following a systematic search of three databases (PsycINFO, MEDLINE and Web of Science), 4368 articles were identified, of which 28 met eligibility criteria for inclusion in the review. RESULTS Poorer mental health and well-being was typically found to have an association with extreme climate or weather events and environmental degradation. The observed relationships were largely assessed at area-wide or community levels. CONCLUSIONS Studies examining the relationship between the environmental condition of land and mental health at an individual level, particularly within farms, are lacking. Addressing this gap in research requires interdisciplinary expertise and diverse methodology. Few studies examined the effects of natural resource management practices/principles or biodiversity on mental health. While there is evidence that extreme climate or weather events have a negative impact on mental health in rural areas, there remain considerable gaps in our knowledge of how rural environments influence mental health and well-being.
Collapse
Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Kimberly Brown
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Angelica Trias
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Carmel Poyser
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Dominique Kazan
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
5
|
Smith KR, Grant S, Thomas RE. Testing the public's response to receiving severe flood warnings using simulated cell broadcast. NATURAL HAZARDS (DORDRECHT, NETHERLANDS) 2022; 112:1611-1631. [PMID: 35194319 PMCID: PMC8853016 DOI: 10.1007/s11069-022-05241-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
European Governments must implement a public alerting system to reach mobile phone users affected by major emergencies and disasters by June 2022. Cell Broadcast is used to issue emergency alerts in several countries but has not yet been introduced in the UK. This paper presents the results of a joint research exercise that explored recipients' responses to cell broadcast messages that warned of floods of varying certainty, severity, and urgency. We adopted a mixed-methods approach employing semi-structured questions and focus groups to assess the perceptions of 80 workshop participants who received simulated emergency alerts on pre-prepared handsets. Our results suggest that although emergency alerting is welcomed, it is necessary to provide accurate and verifiable information, address accessibility challenges, and state location clearly and understandably. This life-saving technology, if used aptly by not over-alerting, specifying the specific urgency, certainty, severity and location of the flood risk, has the real potential of upgrading flood warnings in the UK.
Collapse
Affiliation(s)
- Kate R. Smith
- Energy and Environment Institute, University of Hull, Cottingham Road, Hull, HU6 7RX UK
| | - Silvia Grant
- Head of User Research, Strategic Command, Ministry of Defence, Whitehall, London, SW1 2HB UK
| | - Robert E. Thomas
- Energy and Environment Institute, University of Hull, Cottingham Road, Hull, HU6 7RX UK
| |
Collapse
|
6
|
Public health implications of multiple disaster exposures. Lancet Public Health 2022; 7:e274-e286. [DOI: 10.1016/s2468-2667(21)00255-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/04/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
|
7
|
Sharpe I, Davison CM. Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review. BMJ Open 2021; 11:e051908. [PMID: 34649848 PMCID: PMC8522671 DOI: 10.1136/bmjopen-2021-051908] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Climate change and climate-related disasters adversely affect mental health. Low- and middle-income countries (LMICs) are particularly vulnerable to the impacts of climate change and climate-related disasters and often lack adequate mental healthcare infrastructure. We used the scoping review methodology to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among those living in LMICs. We also aimed to recognise existing gaps in this area of literature. METHODS This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify relevant studies, we searched five electronic databases (MEDLINE, EMBASE, Global Health, APA PsycInfo and Sociological Abstracts) from 1 January 2007 to 31 December 2019. We also searched the grey literature. Included studies had an adult-focused LMIC population, a climate change or climate-related disaster exposure and a mental disorder outcome. Relevant study information was extracted and synthesised. RESULTS Fifty-eight studies were identified, most of which (n=48) employed a cross-sectional design. The most commonly studied exposure-outcome combinations were flood-related post-traumatic stress disorder (PTSD) (n=28), flood-related depression (n=15) and storm-related PTSD (n=13). The majority of studies identified a positive exposure-outcome association. However, few studies included a baseline or comparator (ie, unexposed) group, thereby limiting our understanding of the magnitude or nature of this association. There was also great heterogeneity in this literature, making studies difficult to pool or compare. Several research gaps were identified including the lack of longitudinal studies and non-uniformity of geographic coverage. CONCLUSION To our knowledge, this was the first scoping review to investigate the relationship between climate change and climate-related disaster exposures and mental disorder outcomes in LMICs. Our findings support the need for further research, but also highlight that mental health should be a priority within LMIC climate change policy considerations.
Collapse
Affiliation(s)
- Isobel Sharpe
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
8
|
Marandi A, Main KL. Vulnerable City, recipient city, or climate destination? Towards a typology of domestic climate migration impacts in US cities. JOURNAL OF ENVIRONMENTAL STUDIES AND SCIENCES 2021; 11:465-480. [PMID: 34367871 PMCID: PMC8333152 DOI: 10.1007/s13412-021-00712-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 05/19/2023]
Abstract
Globally, the impacts of climate change will uproot and displace millions of individuals, and American cities are on the frontline of these future population shifts. Our analysis of empirical documentation of migration factors as well as theoretical demographic models shows three predominate types of US cities affected by climate migration pathways: (1) vulnerable cities-those that will suffer significant losses in population and tax revenue; (2) recipient cities-those that serve as unsuspecting or unwilling "receiving communities" from sudden-onset disasters without preparation; and (3) climate destinations-cities seeking to rebrand their communities as "climate havens" that welcome displaced residents through equitable planning and preparation. Despite the evidence of such migration trends, there currently is limited guidance for governments at any scale to plan and prepare for these changes. Forced or unplanned migrations will have a profound and disproportionate impact on communities of color, the elderly, and other at-risk populations that are already experiencing the compounding effects of climate and environmental injustices. A lack of adequate preparation and resources dedicated to minimizing the impacts of planned and unplanned migration pathways could exacerbate existing economic, environmental, and social inequalities. Drawing from case studies in cities across the country that illustrate the typology outlined above, this paper presents a framework with preliminary strategies for policy makers to bridge knowledge gaps and design responses for both short- and long-term planning initiatives. In particular, we encourage the use of typological frameworks for implementing scenario planning that can help cities navigate the challenges of planning for future climate-migration to plan for more sustainable, inclusive, and equitable cities for all.
Collapse
|
9
|
Riyad Fatema S. Women's health-related vulnerabilities in natural disaster-affected areas of Bangladesh: a mixed-methods study protocol. BMJ Open 2020; 10:e039772. [PMID: 33234637 PMCID: PMC7689102 DOI: 10.1136/bmjopen-2020-039772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Global climate change has produced growing natural disasters across the world especially in Global South. Different countries experience varied vulnerabilities depending on their geographical location, economic status and ability of management. In a highly disaster susceptible developing country like Bangladesh, many individuals experience a greater rate of natural disasters with devastating health effects. Compare with men, women have a higher incidence of mortality and health effects following natural disasters. The study aims to explore women's experience of physical and psychological health vulnerabilities with primary causes in natural disaster-affected areas of Bangladesh. METHODS AND ANALYSIS This is an exploratory mixed-method study comprising survey and in-depth interviews with equal priority to identify physical and psychological health vulnerabilities of women living in natural disaster-affected areas of Bangladesh. Quantitative data will be collected using self-administered sociodemographic and perceived severity instrument, 12-item Short-Form, Impact of Event Scale-Revised and Brief Coping Scale, while specific open-ended guidelines will be used for the qualitative part. The instruments will be translated into Bangla following the Brislin (1970) model of translation. The survey will be administered in paper copies, with at least 384 respondents, whereas 30 participants will be in-depth interviewed using an audio recorder. Survey data will be analysed using SPSS V.25 following descriptive and inferential statistics as required. The recorded open-ended responses will be transcribed and analysed using thematic analysis. Finally, both data sets will be integrated and synthesised according to the sequential mixed-method approach. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the University of New England. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, the internet and various community engagement activities.
Collapse
Affiliation(s)
- Syadani Riyad Fatema
- School of Health, University of New England, Armidale, New South Wales, Australia
- Department of Sociology, Noakhali Science and Technology University, Noakhali, Noakhali, Bangladesh
| |
Collapse
|
10
|
Chang Q, Peng C, Guo Y, Cai Z, Yip PS. Mechanisms connecting objective and subjective poverty to mental health: Serial mediation roles of negative life events and social support. Soc Sci Med 2020; 265:113308. [DOI: 10.1016/j.socscimed.2020.113308] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/04/2020] [Accepted: 08/16/2020] [Indexed: 01/02/2023]
|
11
|
Bhattacharya S, Ghosh D. Studying physical and mental health status among hijra, kothi and transgender community in Kolkata, India. Soc Sci Med 2020; 265:113412. [PMID: 33049438 DOI: 10.1016/j.socscimed.2020.113412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
Individuals with diverse sexual orientation and gender identities have historically experienced the major share of stigma, discrimination, and marginalization among all the LGTBIQ+ communities in India. Transgender, intersex, or queer individuals are deprived of their basic rights, self-dignity, bodily autonomy, and healthcare leading to significant negative health status. Recent legal reforms such as the decriminalization of Section 377 of the Indian Penal Code (prohibited same-sex activity) and amendments to the Transgender Persons (Protection of Rights) Bill may improve their health. In this context, the study has the following objectives: 1) to measure the physical and the mental health status of hijra, kothi, and transgender (HKT) individuals using the Short Form 12 (SF-12) questionnaire; 2) understand the variation in their health status by social determinants; and 3) identify spatial patterns of HKTs general, physical, and mental health. Data was collected using a Bengali version of SF-12 (N = 98). We calculated physical (PCS) and mental (MCS) health composite scores and conducted relevant statistical and spatial analysis. Findings revealed that HKT individuals had poor mental health (mean MCS = 42.3) compared to their physical health (mean PCS = 49.0). ANOVA tests showed statistically significant variation of PCS and MCS among HKTs by their age and income. Participants with both poor and good health conditions were evenly distributed in the study area, with no significant spatial clustering. This study was the first attempt to assess the health-related quality of life among the HKT individuals using SF-12, not previously adapted to gender-diverse communities in India. Results clearly indicate that there is a pressing need to address both physical and mental health among gender-diverse communities by not only improving awareness of their healthcare rights but by also removing social and structural barriers to health programs, increasing targeted health interventions, grassroot level activism, and government advocacy.
Collapse
Affiliation(s)
| | - Debarchana Ghosh
- Department of Geography, University of Connecticut, Storrs, CT, 06269, USA.
| |
Collapse
|
12
|
Fitzgerald KC, Pit SW, Rolfe M, McKenzie J, Matthews V, Longman J, Bailie R. Cross sectional analysis of depression amongst Australian rural business owners following cyclone-related flooding. J Occup Med Toxicol 2020; 15:12. [PMID: 32489395 PMCID: PMC7247252 DOI: 10.1186/s12995-020-00264-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Flooding is an increasingly prevalent natural hazard worldwide and can have a profound impact on the mental health of those directly and indirectly affected. Little is known about the impact on business owners, who may be particularly vulnerable to the mental health complications of flooding given the additional economic stressors. Methods A large cross-sectional survey was conducted six months after severe flooding in the rural Northern Rivers region of New South Wales, Australia in 2017. The survey assessed demographics, probable depression (using the Patient Health Questionnaire-2), flood exposure, flood-related financial factors, prior flood exposure and support from various organisations. Logistic regression was used to identify predictors of probable depression in 653 of the 745 participants who identified as business owners. Results The prevalence of probable depression in our sample was 17.0%. A quarter (25.1%) of business owners whose business was flooded suffered from probable depression, compared to 12.4% of non-flooded business owners. The multivariable model for probable depression demonstrated elevated adjusted odds ratios (AOR) for business owners who had to evacuate their business (AOR = 2.11, 95% Confidence Interval (CI) 1.25-3.57) compared to those who did not evacuate. Insurance disputes/rejections were a strong predictor for probable depression (AOR = 3.76, CI 1.86-7.60). Those whose income was reduced due to the flood and had not returned to normal six months post-flood demonstrated an increased AOR for probable depression (AOR 2.53, CI 1.26-5.07) compared to those whose income had returned to normal. The univariable analysis found elevated crude odds ratios (OR) for the cumulative effect of multiple flood exposures and unmet support needs by the state government (OR = 2.74, CI 1.12-6.68). The majority of business owners felt their needs were not met by most organisations providing flood-related support. Conclusion The impact of flood exposure and flood-related financial factors on probable depression was highly significant for the business owner population. Furthermore, business owners felt under-supported by flood-related services. These findings highlight the vulnerability of exposed business owners and the need for increased support. Disaster planning programs in conjunction with system level changes such as infrastructure and education are vital for disaster preparedness.
Collapse
Affiliation(s)
| | - Sabrina Winona Pit
- School of Medicine, Western Sydney University, University Centre for Rural Health, Sydney, Australia.,The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Margaret Rolfe
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - John McKenzie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Veronica Matthews
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Jo Longman
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Ross Bailie
- The University of Sydney, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| |
Collapse
|
13
|
Wei Q, Zhang X, Yi W, Pan R, Gao J, Duan J, Xu Z, Cheng Q, Bai L, Zhang Y, Su H. Association between floods and hospital admissions for schizophrenia in Hefei, China: The lag effects of degrees of floods and time variation. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 698:134179. [PMID: 31514040 DOI: 10.1016/j.scitotenv.2019.134179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/03/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Schizophrenia is a serious mental disorder, endangering 7.5 million patients in China. Floods, as the adverse consequence of temperature-rise, have a negative influence on mental health. However, the relationship between floods and schizophrenia is still insufficient. This study aimed to quantitative the relationship between floods and the admissions for schizophrenia in Hefei, China. METHODS A Poisson generalized linear model (GLM) combining a distributed lag non-linear model (DLNM) was used to quantify the lag effects of floods on schizophrenia and subgroups (male, female; ≤40 y, >40 y; the married, the unmarried) from 2005 to 2014, Hefei, China. We further explored the effects of different degrees (moderate and severe) of floods and their temporal changes on schizophrenia. RESULTS There was a significant association between floods and admissions risk for schizophrenia. And the lag effects for schizophrenia lasted ten days (lag 5-lag 14), with the greatest effect on lag 9 (RR = 1.036, 95% confidence interval (CI): 1.014-1.058). The married, ≤40 y were sensitive to floods. The significant difference wasn't found for genders. The effects of the severe flood were higher than moderate floods, with the largest RR of 1.073 (95%CI: 1.029-1.119). The adverse effects were found in the middle and late period with a decreasing trend in the later period. CONCLUSIONS This study suggests a significant association between floods and schizophrenia with ten days of lag effects in Hefei, China. Male, female, <40 y and the married are vulnerable to both moderate and severe floods. The findings might be used to allocate medical resources of mental health after floods.
Collapse
Affiliation(s)
- Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Xulai Zhang
- Department of Geriatric Psychology, Anhui Mental Health Center, Hefei, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Jiaojiao Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Jun Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Zihan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Qiang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Lijun Bai
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Yanwu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui 230032, China.
| |
Collapse
|
14
|
Chan EYY, Man AYT, Lam HCY. Scientific evidence on natural disasters and health emergency and disaster risk management in Asian rural-based area. Br Med Bull 2019; 129:91-105. [PMID: 30753325 PMCID: PMC6413858 DOI: 10.1093/bmb/ldz002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 01/04/2019] [Accepted: 01/11/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Disaster epidemiological studies indicate that Asia has the highest frequency of natural disasters. Rural communities are heavily impacted by natural disasters and have different healthcare needs to urban ones. Referencing Asian countries, this paper's objective is to provide an overview of health impacts and the current evidence for designing programmes and policies related to rural health emergency and disaster risk management (health-EDRM). SOURCES OF DATA This paper uses published English-only reports and papers retrieved from PubMed, Google Scholar, Embase, Medline and PsycINFO on rural disaster and emergency responses and relief, health impact and disease patterns in Asia (January 2000-January 2018). AREAS OF AGREEMENT Earthquakes are the most studied natural disasters in rural communities. The medical burden and health needs of rural communities were most commonly reported among populations of extreme age. Most of the existing research evidence for rural interventions was reported in China. There lacks published peer-reviewed reports of programme impacts on personal and community preparedness. AREAS OF CONTROVERSY There is a lack of evidence-based health-EDRM interventions to evaluate implementation effectiveness in rural areas despite vast volumes of health-related disaster literature. GROWING POINTS Climate change-related disasters are increasing in frequency and severity. Evidence is needed for disaster risk reduction interventions to address the health risks specific to rural populations. AREAS TIMELY FOR DEVELOPING RESEARCH To support global policy development, urgent evidence is needed on the intervention effectiveness, long-term health outcomes, local and cultural relevance as well as sustainability of health relief produced by Health-EDRM programmes in rural areas.
Collapse
Affiliation(s)
- E Y Y Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Division of Global Health and Humanitarian Medicine, The Jockey Club School of Public Health and Primary Care, Division of Global Health and Humanitarian Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- François-Xavier Bagnoud Center for Health & Human Rights, Harvard University, Boston, MA, USA
| | - A Y T Man
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Division of Global Health and Humanitarian Medicine, The Jockey Club School of Public Health and Primary Care, Division of Global Health and Humanitarian Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - H C Y Lam
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Division of Global Health and Humanitarian Medicine, The Jockey Club School of Public Health and Primary Care, Division of Global Health and Humanitarian Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
15
|
Wiedemann AA, Lawson JL, Cunningham PM, Khalvati KM, Lydecker JA, Ivezaj V, Grilo CM. Food addiction among men and women in India. EUROPEAN EATING DISORDERS REVIEW 2018; 26:597-604. [PMID: 30003654 DOI: 10.1002/erv.2613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to address a cultural gap in the food addiction (FA) literature by examining FA and associated clinical features in a nonclinical group of men and women residing in India. METHOD Participants (N = 415) were recruited from Amazon Mechanical Turk to complete an online survey about weight and eating. Participants completed self-report measures assessing FA (Yale Food Addiction Scale [YFAS]), eating-disorder psychopathology (Eating Disorder Examination-Questionnaire [EDE-Q]), health-related quality of life (Short Form Health Survey-12-item version [SF-12]), and depression (Patient Health Questionnaire-2). RESULTS The FA symptom mean was 3.53 (SD = 1.90); 32.5% (n = 129) met FA clinical threshold on the YFAS. Groups categorized with and without FA on the YFAS did not differ significantly in sex or body mass index. YFAS scores were significantly correlated with greater frequency of binge eating, higher severity scores on all EDE-Q subscales, higher depression, and poorer functioning scores on the SF-12 (all ps < 0.05). CONCLUSIONS FA, as conceptualized and measured by the YFAS, appears to be common among individuals residing in India.
Collapse
Affiliation(s)
- Ashley A Wiedemann
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jessica L Lawson
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paige M Cunningham
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn M Khalvati
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Janet A Lydecker
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA.,Yale University, New Haven, Connecticut, USA
| |
Collapse
|
16
|
Health-Related Quality of Life in the Aftermath of the L’Aquila Earthquake in Italy. Disaster Med Public Health Prep 2015; 10:11-5. [DOI: 10.1017/dmp.2015.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractObjectiveA recent article reported a reduction in the suicide rate in the inhabitants of L’Aquila (Italy) in 2009, when on the night of April 6, a devastating earthquake struck the city. The potential implications of the role of resilience in the aftermath of natural disasters, together with the limitations of existing evidence on this topic, suggest a need for more research. We aimed to retrospectively investigate the impact of the L’Aquila earthquake on a standardized self-reported measure of health-related quality of life (HRQoL).MethodsHRQoL data were collected through 2 separate cross-sectional surveys conducted during 2008 and 2010, before and after the earthquake that occurred in 2009, on 2 random samples of adults living in L’Aquila.ResultsThe data seemed to suggest no decrease in the inhabitants’ HRQoL level after the disaster, which may suggest the role of resilience in supporting survivors’ HRQoL. The findings were also consistent with previous observations of a reduction in the suicide rate in the same inhabitants after the earthquake.ConclusionsAfter a natural disaster, people likely activate personal resources and protective social factors that result in better subjective outcomes. (Disaster Med Public Health Preparedness. 2016;10:11-15)
Collapse
|
17
|
Becker C, Roos V, Coetzee H. Disaster recovery experiences of a South African rural farming community. JOURNAL OF PSYCHOLOGY IN AFRICA 2015. [DOI: 10.1080/14330237.2015.1065051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Christiaan Becker
- Africa Unit for Transdisciplinary Health Research, North-West University, South Africa
| | - Vera Roos
- Africa Unit for Transdisciplinary Health Research, North-West University, South Africa
| | - Hendri Coetzee
- Africa Unit for Transdisciplinary Health Research, North-West University, South Africa
| |
Collapse
|
18
|
Fernandez A, Black J, Jones M, Wilson L, Salvador-Carulla L, Astell-Burt T, Black D. Flooding and mental health: a systematic mapping review. PLoS One 2015; 10:e0119929. [PMID: 25860572 PMCID: PMC4393088 DOI: 10.1371/journal.pone.0119929] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Floods are the most common type of global natural disaster. Floods have a negative impact on mental health. Comprehensive evaluation and review of the literature are lacking. Objective To systematically map and review available scientific evidence on mental health impacts of floods caused by extended periods of heavy rain in river catchments. Methods We performed a systematic mapping review of published scientific literature in five languages for mixed studies on floods and mental health. PUBMED and Web of Science were searched to identify all relevant articles from 1994 to May 2014 (no restrictions). Results The electronic search strategy identified 1331 potentially relevant papers. Finally, 83 papers met the inclusion criteria. Four broad areas are identified: i) the main mental health disorders—post-traumatic stress disorder, depression and anxiety; ii] the factors associated with mental health among those affected by floods; iii) the narratives associated with flooding, which focuses on the long-term impacts of flooding on mental health as a consequence of the secondary stressors; and iv) the management actions identified. The quantitative and qualitative studies have consistent findings. However, very few studies have used mixed methods to quantify the size of the mental health burden as well as exploration of in-depth narratives. Methodological limitations include control of potential confounders and short-term follow up. Limitations Floods following extreme events were excluded from our review. Conclusions Although the level of exposure to floods has been systematically associated with mental health problems, the paucity of longitudinal studies and lack of confounding controls precludes strong conclusions. Implications We recommend that future research in this area include mixed-method studies that are purposefully designed, using more rigorous methods. Studies should also focus on vulnerable groups and include analyses of policy and practical responses.
Collapse
Affiliation(s)
- Ana Fernandez
- Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia
| | - John Black
- Faculty of Health Sciences, Ageing Work and Health Unit, The University of Sydney, Sydney, Australia
| | - Mairwen Jones
- Faculty of Health Sciences, Discipline of Behavioral and Social Sciences in Health, The University of Sydney, Sydney, Australia
| | - Leigh Wilson
- School of Science and Health, University of Western Sydney, Sydney, Australia
| | - Luis Salvador-Carulla
- Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Thomas Astell-Burt
- School of Science and Health, University of Western Sydney, Sydney, Australia
| | - Deborah Black
- Faculty of Health Sciences, Ageing Work and Health Unit, The University of Sydney, Sydney, Australia
| |
Collapse
|
19
|
Van Minh H, Tuan Anh T, Rocklöv J, Bao Giang K, Trang LQ, Sahlen KG, Nilsson M, Weinehall L. Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam. Glob Health Action 2014; 7:23007. [PMID: 25511879 PMCID: PMC4265642 DOI: 10.3402/gha.v7.23007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. OBJECTIVE This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. DESIGN This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. RESULTS 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease early-warning system. 6) Medical products and technology: Emergency treatment protocols were not available in every studied health facility. CONCLUSIONS The primary care system capacity in rural Vietnam is inadequate for responding to storm and flood-related health problems in terms of preventive and treatment healthcare. Developing clear facility preparedness plans, which detail standard operating procedures during floods and identify specific job descriptions, would strengthen responses to future floods. Health facilities should have contingency funds available for emergency response in the event of storms and floods. Health facilities should ensure that standard protocols exist in order to improve responses in the event of floods. Introduction of a computerized health information system would accelerate information and data processing. National and local policies need to be strengthened and developed in a way that transfers into action in local rural communities.
Collapse
Affiliation(s)
- Hoang Van Minh
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam;
| | - Tran Tuan Anh
- Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | - Joacim Rocklöv
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kim Bao Giang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | - Le Quynh Trang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | - Klas-Göran Sahlen
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maria Nilsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Weinehall
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
20
|
Tampubolon G, Hanandita W. Poverty and mental health in Indonesia. Soc Sci Med 2014; 106:20-7. [PMID: 24524962 DOI: 10.1016/j.socscimed.2014.01.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/28/2013] [Accepted: 01/09/2014] [Indexed: 11/30/2022]
Abstract
Community and facility studies in developing countries have generally demonstrated an inverse relationship between poverty and mental health. However, recent population-based studies contradict this. In India and Indonesia the poor and non-poor show no difference in mental health. We revisit the relationship between poverty and mental health using a validated measure of depressive symptoms (CES-D) and a new national sample from Indonesia - a country where widespread poverty and deep inequality meet with a neglected mental health service sector. Results from three-level overdispersed Poisson models show that a 1% decrease in per capita household expenditure was associated with a 0.05% increase in CES-D score (depressive symptoms), while using a different indicator (living on less than $2 a day) it was estimated that the poor had a 5% higher CES-D score than the better off. Individual social capital and religiosity were found to be positively associated with mental health while adverse events were negatively associated. These findings provide support for the established view regarding the deleterious association between poverty and mental health in developed and developing countries.
Collapse
Affiliation(s)
- Gindo Tampubolon
- Institute for Social Change, University of Manchester, Manchester M13 9PL, United Kingdom.
| | - Wulung Hanandita
- Institute for Social Change, University of Manchester, Manchester M13 9PL, United Kingdom
| |
Collapse
|
21
|
The impact of recurrent disasters on mental health: a study on seasonal floods in northern India. Prehosp Disaster Med 2013; 28:279-85. [PMID: 23611652 DOI: 10.1017/s1049023x13000290] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Very little is known on the impact of recurrent disasters on mental health. Aim The present study examines the immediate impact of a recurrent flood on mental health and functioning among an affected population in the rural district of Bahraich, Uttar Pradesh, India, compared with a population in the same region that is not affected by floods. METHODS The study compared 318 affected respondents with 308 individuals who were not affected by floods. Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25). Psychological and physical functioning was assessed by using the Short Form-12 (SF-12). RESULTS The affected group showed large to very large differences with the comparison group on symptoms of anxiety (D = .92) and depression (D = 1.22). The affected group scored significantly lower on psychological and physical functioning than the comparison group (respectively D = .33 and D = .80). However, hierarchical linear regressions showed no significant relationship between mental health and the domains of functioning in the affected group, whereas mental health and the domains of functioning were significantly related in the comparison group. CONCLUSION This study found a large negative impact of the recurrent floods on mental health outcomes and psychological and physical functioning. However, in a context with recurrent floods, disaster mental health status is not a relevant predictor of functioning. The findings suggest that the observed mental health status and impaired functioning in this context are also outcomes of another mechanism: Both outcomes are likely to be related to the erosion of the social and environmental and material context. As such, the findings refer to a need to implement psychosocial context-oriented interventions to address the erosion of the context rather than specific mental health interventions.
Collapse
|