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Pigeon-Gagné É, Hassan G, Yaogo M, Saïas T. Discrimination and Social Exclusion of People Experiencing Mental Disorders in Burkina Faso: A Socio-anthropological Study. Cult Med Psychiatry 2024:10.1007/s11013-024-09860-w. [PMID: 39017776 DOI: 10.1007/s11013-024-09860-w] [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] [Accepted: 05/05/2024] [Indexed: 07/18/2024]
Abstract
Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.
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Affiliation(s)
| | - Ghayda Hassan
- Department of Psychology, Université de Québec à Montréal, Montreal, Canada
| | - Maurice Yaogo
- Université Catholique de l'Afrique de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Thomas Saïas
- Department of Psychology, Université de Québec à Montréal, Montreal, Canada
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Bemme D, Roberts T, Ae-Ngibise KA, Gumbonzvanda N, Joag K, Kagee A, Machisa M, van der Westhuizen C, van Rensburg A, Willan S, Wuerth M, Aoun M, Jain S, Lund C, Mathias K, Read U, Taylor Salisbury T, Burgess RA. Mutuality as a method: advancing a social paradigm for global mental health through mutual learning. Soc Psychiatry Psychiatr Epidemiol 2024; 59:545-553. [PMID: 37393204 PMCID: PMC10944435 DOI: 10.1007/s00127-023-02493-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Calls for "mutuality" in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. METHODS We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. RESULTS Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators' needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. CONCLUSION Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.
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Affiliation(s)
| | | | | | | | | | - Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa
| | | | | | - André van Rensburg
- University of Kwazulu-Natal, Centre for Rural Health, Durban, South Africa
| | - Samantha Willan
- South African Medical Research Council, Cape Town, South Africa
| | | | - May Aoun
- Save the Children, New York, USA
| | | | - Crick Lund
- King's College London, London, UK
- University of Cape Town, Cape Town, South Africa
| | - Kaaren Mathias
- University of Canterbury, Christchurch, New Zealand
- Burans, Herbertpur Christian Hospital, Atten Bagh, India
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Dhiman V, Menon GR, Tiwari RR. A systematic review and meta-analysis of prevalence of seven psychiatric disorders in India. Indian J Psychiatry 2023; 65:1096-1103. [PMID: 38249146 PMCID: PMC10795670 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_539_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/29/2023] [Accepted: 10/28/2023] [Indexed: 01/23/2024] Open
Abstract
Background After the National Mental Health Survey in 2016, multiple individual studies showed inconsistencies in the prevalence rates of psychiatric disorders in India. We performed a meta-analysis to estimate an up-to-date pooled estimate of the prevalence of depression, alcohol use disorder (AUD), anxiety disorder (AD), intellectual disability, suicidal attempt/death, autism, and bipolar disorder (BD) in India. Materials and Methods We performed a systematic bibliographic search in Pub Med, Global Health Data Exchange (GHDx), and Google Scholar, along with a manual search for peer-reviewed epidemiological studies reporting the prevalence of depression, AUD, AD, MR, suicidal attempt/death, autism, and BD in India from January 1980 till March 2022. Adopting a random-effects model, we performed the meta-analysis using "MetaXL" software. Results A total of 79 studies were included: depression (n = 28), AUD (n = 14), AD (n = 12), intellectual disability (n = 8), suicidal attempt/death (n = 7), autism (n = 6) and BD (n = 4). The pooled prevalence of depression and AUD was 12.4% (95% CI 9.4-15.9) (P < 0.001, I2 = 100%) and 21.5% (95% CI 14.1-30.0) (P < 0.001, I2 = 100%), respectively. AD, intellectual disability and suicidal attempt/death showed a prevalence of 11.6% (95% CI 8.1-15.7) (P < 0.001, I2 = 99%), 1% (95% CI 0.5-1.6) (P < 0.001, I2 = 98%) and 0.5% (95% CI 0.3-0.8) (P < 0.001, I2 = 100%), respectively. The meta-analysis in autism and BD showed pooled prevalence of 0.3% (95% CI 0.1-0.6) (P < 0.001, I2 = 96%) and 0.3% (95% CI 0.2-0.4) (P < 0.001, I2 = 78%), respectively. Subgroup analysis showed an increased prevalence of AD in the urban [24.3% (95% CI 3.7-52.9)] and younger [16.7% (95% CI 5.1-32.7)] population. The prevalence of depression and AD increased during the last two decades on decadal prevalence analysis. Discussion The findings could be used for appropriate policy measures and guiding subsequent national mental health surveys.
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Affiliation(s)
- Vikas Dhiman
- Department of Environmental Health and Epidemiology, ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, Madhya Pradesh, India
| | - Geetha R. Menon
- ICMR-National Institute of Medical Statistics (NIMS), Ansari Nagar, New Delhi, Delhi, India
| | - Rajnarayan R. Tiwari
- Department of Environmental Health and Epidemiology, ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, Madhya Pradesh, India
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Abstract
Based on interviews with members of the Guideline Development Group (GDG) of the World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) Guidelines for Mental, Neurological and Substance Use Disorders, this article adds empirical depth to understanding the contingent and strategic nature of universality in relation to mental health. Differently from debating whether or not mental health is global, the article outlines the people, ideas, and processes involved in making it global. Thematic analysis of interviews carried out with nine (out of 21) members of the original mhGAP GDG identified six intersecting strategies that enable the construction of universality in global mental health (GMH): 1) processes and practices of assembling expertise; 2) decisions on what counts as evidence; 3) framing cultural relativism as nihilistic; 4) the delaying of complexity to prioritize action; 5) the narration of tensions as technical rather than epistemological; and 6) the ascription of messiness to local contexts rather than to processes of standardization. Interviews showed that differently from the public-facing consensus often presented in GMH, GDG members hold contrasting and contingent understandings of the nature of universality in relation to mental health diagnoses and interventions. Thus, the universality of mental health achieved through the mhGAP Guidelines is partial and temporary, requiring continuous (re)iteration. 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.
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Kong C, Campbell M, Kpobi L, Swartz L, Atuire C. The hermeneutics of recovery: Facilitating dialogue between African and Western mental health frameworks. Transcult Psychiatry 2023; 60:428-442. [PMID: 33761813 DOI: 10.1177/13634615211000549] [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] [Indexed: 11/16/2022]
Abstract
The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more 'local' perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more 'universalist' or 'relativist' approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health.
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van der Westhuizen C, Richter M, Kagee A, Roomaney R, Schneider M, Sorsdahl K. Stakeholders' perspectives on the development of an Africa-focused postgraduate diploma to address public mental health training needs in Africa: a qualitative study. BMC Psychiatry 2023; 23:288. [PMID: 37098496 PMCID: PMC10127172 DOI: 10.1186/s12888-023-04751-7] [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] [Received: 10/24/2022] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Despite the significant contribution of mental health conditions to the burden of disease, there is insufficient evidence from Africa to inform policy, planning and service delivery. Thus, there is a need for mental health research capacity building, led by African public mental health researchers and practitioners, to drive local research priorities. The aim of African mental health Researchers Inspired and Equipped (ARISE) was to develop a one-year postgraduate diploma (PGDip) in public mental health to address the current gaps in public mental health training. METHODS Thirty-six individual interviews were conducted online with three groups of participants: course convenors of related PGDips in South Africa, course convenors of international public mental health degree programmes and stakeholders active in public mental health in Africa. The interviewers elicited information regarding: programme delivery, training needs in African public mental health, and experiences of facilitators, barriers and solutions to successful implementation. The transcribed interviews were analysed by two coders using thematic analysis. RESULTS Participants found the Africa-focused PGDip programme acceptable with the potential to address public mental health research and operational capacity gaps in Africa. Participants provided several recommendations for the PGDip, including that: (i) the programme be guided by the principles of human rights, social justice, diversity and inclusivity; (ii) the content reflect African public mental health needs; (iii) PGDip faculty be skilled in teaching and developing material for online courses and (iv) the PGDip be designed as a fully online or blended learning programme in collaboration with learning designers. CONCLUSIONS The study findings provided valuable insight into how to communicate key principles and skills suited to the rapidly developing public mental health field while keeping pace with changes in higher education. The information elicited has informed curriculum design, implementation and quality improvement strategies for the new postgraduate public mental health programme.
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Affiliation(s)
- Claire van der Westhuizen
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Cape Town, 7700, South Africa.
| | - Marlise Richter
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Cape Town, 7700, South Africa
- African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Kagee
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Rizwana Roomaney
- Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Cape Town, 7700, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Cape Town, 7700, South Africa
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The WHO World Mental Health Report 2022: a new standard of care is emerging. Mol Psychiatry 2023; 28:4-5. [PMID: 36123421 DOI: 10.1038/s41380-022-01788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/07/2023]
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D’Orta I, Eytan A, Saraceno B. Improving mental health care in rural Kenya: A qualitative study conducted in two primary care facilities. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2041265] [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: 10/19/2022]
Affiliation(s)
- Isabella D’Orta
- Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - Ariel Eytan
- Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - Benedetto Saraceno
- Lisbon Institute of Global Mental Health, Universidade Nova de Lisboa, Lisbon, Portugal
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Global mental health should engage with the ethics of involuntary admission. Int J Ment Health Syst 2021; 15:20. [PMID: 33653347 PMCID: PMC7923659 DOI: 10.1186/s13033-021-00448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
Global mental health, as a field, has focused on both increasing access to mental health services and promoting human rights. Amidst many successes in engaging with and addressing various human rights violations affecting individuals living with psychosocial disabilities, one human rights challenge remains under-discussed: involuntary inpatient admission for psychiatric care. Global mental health ought to engage proactively with the debate on the ethics of involuntary admission and work to develop a clear position, for three reasons. Firstly, the field promotes models of mental healthcare that are likely to include involuntary admission. Secondly, the field aligns much of its human rights framework with the UN Convention on the Rights of Persons with Disabilities, which opposes the discriminatory use of involuntary admission on the basis of psychosocial disability or impairment. Finally, global mental health, as a field, is uniquely positioned to offer novel contributions to this long-standing debate in clinical ethics by collecting data and conducting analyses across settings. Global mental health should take up involuntary admission as a priority area of engagement, applying its own orientation toward research and advocacy in order to explore the dimensions of when, if ever, involuntary admission may be permissible. Such work stands to offer meaningful contributions to the challenge of involuntary admission.
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Using the CES-D-7 as a Screening Instrument to Detect Major Depression among the Inmate Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031361. [PMID: 33540929 PMCID: PMC7908588 DOI: 10.3390/ijerph18031361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
Major depression is one of the most prevalent mental health problems in the penitentiary context and has been related to different undesirable outcomes. The aim of the current research was to evaluate the utility of screening tools for major depression brief assessment in the jail context. We interviewed 203 male inmates and complimented the MCMI-III, the SCL-90-R, and the CES-D-7 self-informed scales. Major depression syndrome and disorder were determined based on MCMI-III criteria and the capability of SCL-90-R and CES-D-7 to identify true positives and true negatives when tested. SCL-90-R and CES-D-7 showed good sensitivity for major depression syndrome and disorder. The specificity of SCL-90-R was poor in all cases, but CES-D-7 showed good specificity depending on the cut-off score. Rigorous interviews are needed for better evaluation of major depression in jails, but screening tools like CES-D-7 are useful for rapid assessment considering the work overload of penitentiary psychologists.
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Purgato M, Uphoff E, Singh R, Thapa Pachya A, Abdulmalik J, van Ginneken N. Promotion, prevention and treatment interventions for mental health in low- and middle-income countries through a task-shifting approach. Epidemiol Psychiatr Sci 2020; 29:e150. [PMID: 32744223 PMCID: PMC7458538 DOI: 10.1017/s204579602000061x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 11/12/2022] Open
Abstract
Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic 'at risk', to experiencing 'mental distress', 'sub-syndromal symptoms' and finally 'mental disorders'. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.
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Affiliation(s)
- Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Rakesh Singh
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ambika Thapa Pachya
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Abstract
In recent years, efforts in Global Mental Health (GMH) have evolved alongside critical engagement with the field's claims and interventions. GMH has shifted its agenda and epistemological underpinnings, increased its evidence base, and joined other global policy platforms such as the Sustainable Development Goals. This editorial introduction to a thematic issue traces the recent shifts in the GMH agenda and discusses the changing construct of "mental health" as GMH moves away from a categorical biomedical model toward dimensional and transdiagnostic approaches and embraces digital technologies. We highlight persistent and emerging lines of inquiry and advocate for meaningful interdisciplinary engagement. Taken together, the articles in this special issue of Transcultural Psychiatry provide a snapshot of current interdisciplinary work in GMH that considers the socio-cultural and historical dimensions of mental health important and proposes reflexive development of interventions and implementation strategies.
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Affiliation(s)
- Dörte Bemme
- University of North Carolina at Chapel Hill, USA.,Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
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13
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Affiliation(s)
- C. Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - E. Albanese
- Department of Psychiatry, Faculty of Medicine, World Health Organization Collaborating Centre for Research and Training in Mental Health, University of Geneva, Geneva, Switzerland
- Faculty of Bio-Medical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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