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Tadesse G, Yitayih S, Gashaw F, Fentahun S, Amare A, Kibralew G, Amare Zeleke T. Magnitude and factors associated with post-traumatic stress disorder among war-affected internally displaced people in northwest Ethiopia, 2022. SAGE Open Med 2024; 12:20503121241259629. [PMID: 39086554 PMCID: PMC11289820 DOI: 10.1177/20503121241259629] [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: 12/04/2023] [Accepted: 05/19/2024] [Indexed: 08/02/2024] Open
Abstract
Background A large number of people are often directly involved in armed conflict and, therefore, are at greater risk of developing a wide range of mental disorders, including post-traumatic stress disorder. Despite this, few have been reported about it in low- and middle-income countries, including Ethiopia. Objective This study was carried out to assess the magnitude and factors associated with post-traumatic stress disorder among war-affected internally displaced people in northwest Ethiopia, 2022. Methods Cross-sectional study design was conducted from May 23 to June 22, 2022, and simple random sampling was used to select a sample of 412 participants. Data were collected by structured interviewer-administered questionnaires. The post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with extended criteria-A was used to assess post-traumatic stress disorder. Multivariable logistic regression analysis was done to identify factors associated with post-traumatic stress disorder. Results A total of 412 participants were interviewed with the response rate of 100%. The mean age of the respondents was 34.7 (±10.9) years. The prevalence of post-traumatic stress disorder was found to be 60.98% (95% CI: 56.1%, 65.5%) with an estimated prevalence of 23.5% and 76.5% among males and females, respectively. In multivariable analysis, female sex (AOR = 2.39; 95% CI: 1.48, 3.86), having depression (AOR = 2.86; 95% CI: 1.78, 4.60), family history of mental illness (AOR = 3.67; 95% CI: 1.43, 9.42), and poor social support (AOR = 3.61; 95% CI: 1.74, 7.47) were factors significantly associated with post-traumatic stress disorder at p-value < 0.05. Conclusion and recommendation Based on this study, at least 6 out of 10 war-affected populations have experienced post-traumatic stress disorder. Especially females, those who had depression, family history of mental illness, and poor social support, were more vulnerable to post-traumatic stress disorder. Therefore, it is recommended to do on-site screening and provide treatment for all displaced populations suffering from post-traumatic stress disorder by giving special concern for females, individuals having depression, poor social support, and family history of mental illness.
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Affiliation(s)
- Gebresilassie Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewbesew Yitayih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fanuel Gashaw
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agegnehu Amare
- Department of Psychiatry, School of Medicine, Health Science College, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Getasew Kibralew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare Zeleke
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Desrosiers A, Carrol B, Ritsema H, Higgins W, Momoh F, Betancourt TS. Advancing sustainable implementation of an evidence-based mental health intervention in Sierra Leone's schools: protocol for a hybrid type 3 implementation-effectiveness trial. BMC Public Health 2024; 24:362. [PMID: 38310232 PMCID: PMC10837990 DOI: 10.1186/s12889-024-17928-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] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Mental health disorders among youth contribute substantially to the global burden of disease, which is exacerbated in low- and middle-income countries (LMICs) due to large mental health treatment gaps. In Sierra Leone, a West African country with a long history of complex adversity, the mental health treatment gap is estimated at 98%. Implementing innovative mental health interventions that can be sustained at scale is a priority. The Youth Readiness Intervention (YRI) is an evidence-based mental health intervention for youth that can be delivered feasibly by lay health workers/nonspecialists. Using mobile-based technologies to assist implementation could improve the reach and sustainability of the YRI in Sierra Leone. This study aims to train teachers to deliver the YRI in Sierra Leone's secondary schools and test the feasibility, acceptability, cost, and fidelity to the YRI of a mobile-based supervision model compared with standard, in-person supervision. METHODS We will conduct a hybrid type 3 implementation-effectiveness cluster randomized trial to assess the feasibility, acceptability, costs and fidelity to the YRI implemented by teachers receiving mobile-based supervision vs. standard supervision. Enrolled schools (N = 50) will be randomized to YRI + mobile supervision (N = 20), YRI + standard supervision (N = 20) or waitlist control (N = 10). We will recruit and enroll four teachers per intervention-condition school (N = 160) and 1200 youth. We will collect data on implementation outcomes among teachers, principals and youth via a mixed methods approach at baseline and post-intervention. We will also collect quantitative data on youth mental health and functioning as secondary outcomes at baseline and post-intervention, as well as cost-effectiveness data at 12-month follow-up. DISCUSSION Study findings have the potential to expand the reach of mental health services among youth in low-resource settings via a teacher workforce. The use of mobile tools, if successful, could support further scale out and sustainment of the YRI to other regions of Sierra Leone and West Africa more broadly, which could help address the mental health treatment gap. TRIAL REGISTRATION Clinical Trial Network: NCT05737667.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA.
| | - Bidemi Carrol
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Haley Ritsema
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA
| | - Walker Higgins
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Fatoma Momoh
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02496, USA
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Sheira LA, Ryan KP, Fahey CA, Katabaro ED, Sabasaba AN, Njau PF, McCoy SI. The impact of cash incentives on mental health among adults initiating antiretroviral therapy in Tanzania. AIDS Care 2024; 36:195-203. [PMID: 37321981 PMCID: PMC10721724 DOI: 10.1080/09540121.2023.2222576] [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: 04/11/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Mental illness is prevalent among people living with HIV (PLHIV) and hinders engagement in HIV care. While financial incentives are effective at improving mental health and retention in care, the specific effect of such incentives on the mental health of PLHIV lacks quantifiable evidence. We evaluated the impact of a three-arm randomized controlled trial of a financial incentive program on the mental health of adult antiretroviral therapy (ART) initiates in Tanzania. Participants were randomized 1:1:1 into one of two cash incentive (combined; provided monthly conditional on clinic attendance) or the control arm. We measured the prevalence of emotional distress, depression, and anxiety via a difference-in-differences model which quantifies changes in the outcomes by arm over time. Baseline prevalence of emotional distress, depression, and anxiety among the 530 participants (346 intervention, 184 control) was 23.8%, 26.6%, and 19.8%, respectively. The prevalence of these outcomes decreased substantially over the study period; additional benefit of the cash incentives was not detected. In conclusion, poor mental health was common although the prevalence declined rapidly during the first six months on ART. The cash incentives did not increase these improvements, however they may have indirect benefit by motivating early linkage to and retention in care.Clinical Trial Number: NCT03341556.
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Affiliation(s)
- Lila Aziz Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Kyle Patrick Ryan
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Carolyn Anne Fahey
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | | | | | | | - Sandra Irene McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
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Skogen V, Langseth R, Rohde GE, Rysstad O, Sørlie T, Lie B. Prevalence of mental distress and factors associated with symptoms of major depression among people living with HIV in Norway. AIDS Care 2024; 36:173-180. [PMID: 37909108 DOI: 10.1080/09540121.2023.2275043] [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: 03/10/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
For people living with HIV (PLHIV) who can access lifesaving treatment, HIV has become a chronic lifelong condition; however, PLHIV have more mental and somatic comorbidities than their HIV-negative peers. In this cross-sectional study, we assessed the prevalence of mental distress and identified factors associated with major depression among 244 well-treated PLHIV residing in Norway. Participants completed validated questionnaires covering mental and somatic health. The prevalence of mental distress, defined as a score on the Hopkins Symptom Check List-25 >1.75, was 32%, and that of symptoms of major depression, defined as a score on the Beck Depression Inventory-II ≥20, was 15%. The factors associated with major depressive symptoms identified using logistic regression were risk of drug abuse (adjusted odds ratio (AOR) 15.1, 95% confidence interval (CI) 3.28, 69.3), fatigue (AOR 12.5, 95% CI 3.90, 40.0), trouble sleeping (AOR 7.90, 95% CI 2.85, 21.9), African origin (AOR 3.90, 95% CI 1.28, 11.9), low education (AOR 3.31, 95% CI 1.18, 9.30), and non-disclosure (AOR 3.22, 95% CI 1.04, 10.0). Our findings indicate that the prevalence rates of mental distress and major depressive symptoms are higher among well-treated PLHIV residing in Norway than in the general population. These conditions are under-diagnosed and under-treated, and increased awareness is needed.
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Affiliation(s)
- Vegard Skogen
- Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromso, Norway
- Institute for Clinical Medicine, University of Tromso - The Arctic University of Norway, Tromso, Norway
| | - Ranveig Langseth
- Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromso, Norway
| | - Gudrun E Rohde
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
- Faculty of Health & Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ole Rysstad
- Department of Internal Medicine, Hospital of Southern Norway, Kristiansand, Norway
| | - Tore Sørlie
- Institute for Clinical Medicine, University of Tromso - The Arctic University of Norway, Tromso, Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromso, Norway
| | - Birgit Lie
- Department of Psychosomatic and Trauma, Hospital of Southern Norway, Kristiansand, Norway
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Falgas-Bague I, Melero-Dominguez M, de Vernisy-Romero D, Tembo T, Chembe M, Lubozha T, Paul R, Parkerson D, Rockers PC, Sikazwe D, Fink G. Testing the feasibility, acceptability, and exploring trends on efficacy of the problem management plus for moms: Protocol of a pilot randomized control trial. PLoS One 2024; 19:e0287269. [PMID: 38181004 PMCID: PMC10769019 DOI: 10.1371/journal.pone.0287269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/24/2023] [Indexed: 01/07/2024] Open
Abstract
Mental health disorders are one of the most common causes that limit the ability of mothers to care for themselves and for their children. Recent data suggest high rates of distress among women in charge of young children in Zambia. Nevertheless, Zambia's public healthcare offers very limited treatment for common mental health distress. To address this treatment gap, this study aims to test the feasibility, acceptability, and potential efficacy of a context-adapted psychosocial intervention. A total of 265 mothers with mental health needs (defined as SRQ-20 scores above 7) were randomly assigned with equal probability to the intervention or control group. The intervention group will receive a locally adapted version of the Problem-Management Plus and "Thinking Healthy" interventions developed by the World Health Organization (WHO), combined with specific parts of the Strong Minds-Strong Communities intervention. Trained and closely supervised wellbeing-community health workers will provide the psychosocial intervention. Mental health distress and attendance to the intervention will be assessed at enrollment and 6 months after the intervention. We will estimate the impact of the intervention on mental health distress using an intention-to-treat approach. We previously found that there is a large necessity for interventions that aim to address mother anxiety/depression problems. In this study, we tested the feasibility and efficacy of an innovative intervention, demonstrating that implementing these mental health treatments in low-income settings, such as Zambia, is viable with an adequate support system. If successful, larger studies will be needed to test the effectiveness of the intervention with increased precision. Trial registration: This study is registered at clinicaltrials.gov as NCT05627206.
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Affiliation(s)
- Irene Falgas-Bague
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Economics, University of Basel, Basel, Switzerland
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine. Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Melero-Dominguez
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Daniela de Vernisy-Romero
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Global Health. Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Mpela Chembe
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Theresa Lubozha
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Ravi Paul
- Department of Psychiatry, University of Zambia, Lusaka, Zambia
| | - Doug Parkerson
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Peter C. Rockers
- Department of Global Health. Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Günther Fink
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Economics, University of Basel, Basel, Switzerland
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Saleh A, Perumal N, Muhihi A, Duggan CP, Ulenga N, Al-Beity FMA, Aboud S, Fawzi WW, Manji KP, Sudfeld CR. Associations Between Social Support and Symptoms of Antenatal Depression with Infant Growth and Development Among Mothers Living with HIV in Tanzania. AIDS Behav 2023; 27:3584-3595. [PMID: 37140717 PMCID: PMC10592034 DOI: 10.1007/s10461-023-04073-5] [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: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Children born to mothers living with HIV may experience greater risk of poor growth and development outcomes than their HIV-unexposed peers. Few studies have examined the relationship between maternal depression and social support with infant growth and development in the context of HIV. We conducted a prospective cohort study of 2,298 pregnant women living with HIV in Dar es Salaam, Tanzania, assessing antenatal depression (Hopkins Symptoms Checklist-25) and social support (Duke-UNC Functional Social Support Questionnaire) at 12-27 weeks of gestation. At one-year age, infant anthropometry and caregiver-reported infant development were assessed. Generalized estimating equations were used to assess mean differences (MD) and relative risks (RR) for growth and developmental outcomes. Symptoms consistent with maternal antenatal depression had 67% prevalence and were associated with infant wasting (RR 2.61; 95% confidence interval (CI) 1.03-6.65; z = 2.02; p = 0.04), but no other growth or developmental outcomes. Greater maternal social support was not associated with infant growth outcomes. Greater affective support was associated with better cognitive (MD 0.18; CI 0.01-0.35; z = 2.14; p = 0.03) and motor (MD 0.16; CI 0.01-0.31; z = 2.04; p = 0.04) development scores. Greater instrumental support was associated with better cognitive (MD 0.26; CI 0.10-0.42; z = 3.15; p < 0.01), motor (MD 0.17; CI 0.02-0.33; z = 2.22; p = 0.03), and overall (MD 0.19; CI 0.03-0.35; z = 2.35; p = 0.02) development scores. Depressive symptoms were associated with greater risk of wasting, while social support was associated with better infant development scores. Strategies to improve mental health and social support for mothers living with HIV during the antenatal period may benefit infant growth and development.
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Affiliation(s)
- Arvin Saleh
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alfa Muhihi
- Africa Academy for Public Health, Dar es Salaam, Tanzania
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher P Duggan
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M Alwy Al-Beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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ALLRED RACHELP, MBAYE NDÈYEAMINATA, DIAGNE FATOUMATA, MCCURDY SHERYLA, HARRELL MELISSAB, BUNKLEY EMMANELSON. Food insecurity increases risk of depression and anxiety among women in Senegal living with diabetes and/or hypertension. J Public Health Afr 2023; 14:2467. [PMID: 38020273 PMCID: PMC10658468 DOI: 10.4081/jphia.2023.2467] [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: 01/14/2023] [Accepted: 06/23/2023] [Indexed: 12/01/2023] Open
Abstract
Food insecurity affects close to half the population of Senegal, West Africa, a country simultaneously affected by the ongoing global diabetes pandemic. Diabetes and food insecurity are associated with adverse mental health, yet research exploring the relationship between chronic physical illness, food insecurity, and mental illness in Senegal is currently lacking. The objective of this study was to investigate the association between food insecurity and depression and anxiety, separately, in Senegalese women living with diabetes and hypertension. Food insecurity was measured using the Household Food Insecurity Access Scale. Occurrence of depression and anxiety symptoms was assessed using the Modified Hopkins Symptoms Checklist Survey (HSCL-25). A sensitivity analysis examining the relationship between food insecurity and depression and anxiety was performed by comparing two previously validated cutoff values (1.75 and 2.25) on the HSCL-25. Most participants (83%) had some level of food insecurity. More than 80% of the sample were depressed or anxious using 1.75 as the cutoff, while 42 and 60% were depressed or anxious, respectively, using 2.25 as the cutoff. Food insecurity increased relative risk for depression (RRR: 1.40, 95% CI: 1.05-1.31, 1.75 as cutoff; RRR: 1.06, 95% CI: 0.99-1.14, 2.25 as cutoff) and anxiety (RRR: 1.17, 95% CI: 1.05-1.31, 1.75 as cutoff; RRR: 1.11, 95% CI: 1.04-1.19, 2.25 as cutoff). These findings demonstrate that among populations suffering from diabetes and hypertension, food insecurity is a modifiable risk factor for depression and anxiety and a potential intervention target in this setting.
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Affiliation(s)
- RACHEL P. ALLRED
- University of Texas at Houston Health Science Center, United States
| | | | - FATOUMATA DIAGNE
- L'Université Gaston Berger
- West African Research Association, Senegal
| | | | | | - EMMA NELSON BUNKLEY
- West African Research Association, Senegal
- University of Colorado, Denver, United States
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Regan M, Muhihi A, Saleh A, Duggan CP, Ulenga N, Alwy Al-Beity FM, Aboud S, Fawzi WW, Manji KP, Sudfeld CR. Antenatal depression and adverse birth outcomes among pregnant women living with HIV in Dar es Salaam, Tanzania. J Affect Disord 2023; 339:82-88. [PMID: 37437720 PMCID: PMC10538406 DOI: 10.1016/j.jad.2023.07.047] [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: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Women who experience antenatal depression may be at increased risk of adverse birth outcomes. Few studies have examined this association among women living with HIV (WHIV). METHODS We conducted a prospective cohort study of 2298 pregnant WHIV on antiretroviral therapy (ART) in Dar es Salaam, Tanzania, who were participants in a randomized trial of vitamin D3 supplementation. Depressive symptoms were assessed at 12-27 weeks gestation using the Hopkins Symptoms Checklist (HSCL-25). Generalized estimating equations to account for twins were used to assess the relative risks of adverse birth outcomes. RESULTS Approximately 67 % of the women in our study population reported symptoms consistent with depression. We observed a 4.0 % prevalence of stillbirth and a 25.1 % prevalence of preterm birth. We found that low social support, higher education, and more recent initiation of ART were associated with a greater risk of antenatal depression. There was no association of antenatal depression with risk of fetal loss, stillbirth, low birth weight, birth weight, preterm birth, gestational age at delivery, or small-for-gestational age. LIMITATIONS Depression was self-reported and only collected at one timepoint in pregnancy. Our findings may not be generalizable to all WHIV. CONCLUSIONS Our findings illustrate the high risk of both depression and adverse birth outcomes among WHIV and underscore the need for interventions to improve their mental health and the health of their infants; however, the relationship between depression and birth outcomes remains unclear. Further research on this topic is merited, particularly examining the chronicity and timing of depression in pregnancy.
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Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Arvin Saleh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M Alwy Al-Beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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Winters S, Sabasaba A, Fahey CA, Packel L, Katabaro E, Ndungile Y, Njau PF, McCoy SI. Increased prevalence of depression and anxiety among adults initiating antiretroviral therapy during the COVID-19 pandemic in Shinyanga region, Tanzania. AIDS Res Ther 2023; 20:36. [PMID: 37301833 PMCID: PMC10256977 DOI: 10.1186/s12981-023-00534-y] [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: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Concerns about the interconnected relationship between HIV and mental health were heightened during the COVID-19 pandemic. This study assessed whether there were temporal changes in the mental health status of people living with HIV presenting for care in Shinyanga region, Tanzania. Specifically, we compared the prevalence of depression and anxiety before and during COVID-19, with the goal of describing the changing needs, if any, to person-centered HIV services. METHODS We analyzed baseline data from two randomized controlled trials of adults initiating ART in Shinyanga region, Tanzania between April-December 2018 (pre-COVID-19 period, n = 530) and May 2021-March 2022 (COVID-19 period, n = 542), respectively. We compared three mental health indicators that were similarly measured in both surveys: loss of interest in things, hopelessness about the future, and uncontrolled worrying. We also examined depression and anxiety which were measured using the Hopkins Symptom Checklist-25 in the pre-COVID-19 period and the Patient Health Questionnaire-4 in the COVID-19 period, respectively, and classified as binary indicators per each scale's threshold. We estimated prevalence differences (PD) in adverse mental health status before and during the COVID-19 pandemic, using stabilized inverse probability of treatment weighting to adjust for underlying differences in the two study populations. RESULTS We found significant temporal increases in the prevalence of feeling 'a lot' and 'extreme' loss of interest in things ['a lot' PD: 38, CI 34,41; 'extreme' PD: 9, CI 8,12)], hopelessness about the future [' a lot' PD: 46, CI 43,49; 'extreme' PD: 4, CI 3,6], and uncontrolled worrying [' a lot' PD: 34, CI 31,37; 'extreme' PD: 2, CI 0,4] during the COVID-19 pandemic. We also found substantially higher prevalence of depression [PD: 38, CI 34,42] and anxiety [PD: 41, CI 37,45]. CONCLUSIONS After applying a quasi-experimental weighting approach, the prevalence of depression and anxiety symptoms among those starting ART during COVID-19 was much higher than before the pandemic. Although depression and anxiety were measured using different, validated scales, the concurrent increases in similarly measured mental health indicators lends confidence to these findings and warrants further research to assess the possible influence of COVID-19 on mental health among adults living with HIV. Trial Registration NCT03351556, registered November 24, 2017; NCT04201353, registered December 17, 2019.
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Affiliation(s)
- Solis Winters
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, 94704, USA.
| | - Amon Sabasaba
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | - Carolyn A Fahey
- School of Public Health, University of Washington, Seattle, USA
| | - Laura Packel
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, 94704, USA
| | | | | | | | - Sandra I McCoy
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, 94704, USA
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10
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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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11
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Li ZY, Frounfelker RL, Miconi D, Levinsson A, Rousseau C. Violent Radicalization, Mental Health, and Gender Identity: Considerations for Future Research. J Nerv Ment Dis 2023; 211:244-247. [PMID: 36827636 DOI: 10.1097/nmd.0000000000001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
ABSTRACT This study examines the association between gender identity, mental health, social adversity, and sympathy for violent radicalization (VR). Data were collected through an online survey in Canada. A total of 6003 eligible participants who were residents of Montreal, Toronto, Calgary, or Edmonton and aged from 18 to 35 years were included. We used Fisher exact test to assess gender differences in gender-based discrimination and we used analysis of variance tests to assess differences in scores on bullying, mental health, and sympathy for VR. We used linear regression to assess the relationship between mental health, social adversities, and sympathy for VR. Individuals who self-identified as trans and gender diverse had greater sympathy for VR than females did, experienced online victimization more frequently, and reported higher levels of psychological distress than both male and female participants. Our findings indicate that more research is needed on the association between social adversity and support for VR among this vulnerable population.
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Affiliation(s)
- Zhi Yin Li
- Department of Epidemiology, Biostatistics, and Occupational Health
| | | | - Diana Miconi
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Anna Levinsson
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
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12
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Skogen V, Rohde GE, Langseth R, Rysstad O, Sørlie T, Lie B. Factors associated with health-related quality of life in people living with HIV in Norway. Health Qual Life Outcomes 2023; 21:14. [PMID: 36793070 PMCID: PMC9930362 DOI: 10.1186/s12955-023-02098-x] [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: 11/24/2021] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Despite the advances in the treatment of HIV, people living with HIV (PLHIV) still experience impairment of health-related quality of life (HRQOL). The aim of the study was to explore factors associated with HRQOL in a well-treated Norwegian HIV population. METHODS Two hundred and forty-five patients were recruited from two outpatient clinics to participate in this cross-sectional study of addiction, mental distress, post-traumatic stress disorder, fatigue, somatic health, and HRQOL. The latter was measured using the 36-Item Short Form Health Survey (SF-36). Stepwise multiple linear regression analysis was used to examine the adjusted associations between demographic and disease-related variables and HRQOL. RESULTS The study population was virologically and immunologically stable. Their mean age was 43.8 (SD = 11.7) years, 131 (54%) were men, and 33% were native Norwegians. Compared with the general population (published in previous studies), patients reported worse SF-36 scores for five of eight domains: mental health, general health, social function, physical role limitation, and emotional role limitation (all p < 0.001). Compared with men, women reported better SF-36 scores within the domains vitality (63.1 (23.6) vs. 55.9 (26.7), p = 0.026) and general health (73.4 (23.2) vs. 64.4 (30.1), p = 0.009). In the multivariate analyses, higher SF-36- physical component score values were independently associated with young age (p = 0.020), being employed, student, or pensioner (p = 0.009), low comorbidity score (p = 0.015), low anxiety and depression score (p = 0.015), being at risk of drug abuse (p = 0.037), and not being fatigued (p < 0.001). Higher SF-36-mental component score values were independently associated with older age (p = 0.018), being from a country outside Europe or from Norway (p = 0.029), shorter time since diagnosis, low anxiety and depression score (p < 0.001), answering 'no' regarding alcohol abuse (p = 0.013), and not being fatigued (p < 0.001). CONCLUSIONS HRQOL was poorer in PLHIV than in the general population in Norway. It is important to focus on somatic and mental comorbidities when delivering health-care services in the ageing population of PLHIV to improve HRQOL even among a well-treated group of PLHIV as found in Norway.
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Affiliation(s)
- Vegard Skogen
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Breivika, 9037, Tromsø, Norway.
| | - Gudrun E Rohde
- Department of Clinical Research, Sørlandet Hospital, Kristiansand, Norway.,Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ranveig Langseth
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ole Rysstad
- Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
| | - Tore Sørlie
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Breivika, 9037, Tromsø, Norway.,Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Birgit Lie
- Department of Psychosomatic and Trauma, Sørlandet Hospital, Kristiansand, Norway
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13
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Jones MC, Byun JY, Billings R, Shorten A, Kempf MC, Vance DE, Puga F. Tools for Screening and Measuring Anxiety Among Women Living with HIV of Reproductive Age: A Scoping Review. AIDS Behav 2023:10.1007/s10461-023-03990-9. [PMID: 36757556 DOI: 10.1007/s10461-023-03990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
Emerging evidence suggests that women living with HIV (WLWH) may experience higher rates of anxiety than men living with HIV and women living without HIV. To date, relatively little knowledge exists on valid anxiety screening and diagnostic tools and how they are used among WLWH, specifically WLWH of reproductive age. Thus, the purpose of this scoping review was to describe what is known in the published literature about anxiety among WLWH and the tools used to measure and screen for anxiety in clinical and research contexts. The Arksey and O'Malley methodological framework was used to guide a scoping review of published articles in PsycINFO, Scopus, Sociological Abstracts, and PubMed databases. Twenty-one measures of anxiety were used across the 52 articles identified in the search. Most measures used were self-report. Inconsistencies in standardized screening tools and cutoff scores were observed across studies. Further, measures to assess anxiety varied among studies focused on WLWH. Based on the results from this review, there is a need for consistent, valid measures of anxiety to advance research and clinical practice to support the well-being of WLWH.
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Affiliation(s)
- Meghan C Jones
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA.
| | - Jun Y Byun
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
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14
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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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15
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Perumal N, Saleh A, Muhihi A, McCoy D, Seiden J, Bakari M, Ndesangia V, Ulenga N, Sudfeld CR, Manji KP. School readiness among children born to women living with HIV in Dar es Salaam, Tanzania: a cohort study protocol. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001572. [PMID: 36645758 PMCID: PMC9628665 DOI: 10.1136/bmjpo-2022-001572] [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: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children who are born to women living with HIV are at a greater risk of suboptimal neurodevelopment; however, evidence from sub-Saharan Africa is limited and functional developmental outcomes are rarely assessed in this vulnerable population. The School Readiness among HIV-Exposed Children (SRHEC) cohort study aims to assess the school readiness of preschool aged children born to women living with HIV and to identify the biological, environmental and social factors that contribute to school readiness in this population. METHODS AND ANALYSIS The SRHEC cohort is an observational follow-up study of children born to HIV-infected pregnant women who were previously enrolled in a maternal vitamin D supplementation randomised, placebo-controlled trial in Dar es Salaam, Tanzania. This parent trial enrolled 2300 pregnant women and followed mothers and infants up to 1-year postpartum. Mother/caregiver and child pairs will be eligible for the SRHEC follow-up study if the child is between 3 and 6.5 years of age at assessment, and the mother/caregiver provides informed consent. The International Development and Early Learning Assessment tool will be used to assess children's school readiness, including their early literacy, early numeracy, motor, socialemotional, and executive function skills. Data on maternal and child health and nutritional status (eg, anthropometry, blood pressure and diet) will be collected using standardised instruments and survey-based questionnaires. Data on maternal/caregiver depression and anxiety, maternal exposure to intimate partner violence, and HIV-related stigma will also be collected. Generalised linear and logistic regressions will be used to assess the relationship between child school readiness and biological, social, environmental factors. ETHICS AND DISSEMINATION This study received ethical clearance from the Tanzanian National Institute of Medical Research, the Muhimbili University of Health and Allied Sciences, and the Harvard T.H. Chan School of Public Health. We will disseminate our results in the form of scientific conference presentations and peer-reviewed publications.
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Affiliation(s)
- Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Arvin Saleh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alfa Muhihi
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Management and Development for Health, Dar es Salaam, Tanzania
| | - Dana McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Jonathan Seiden
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Mohamed Bakari
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Veneranda Ndesangia
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusettes, USA
| | - Karim P Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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16
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Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fokoua AR, Koomson A, Torbi J, Olorunnado SE, Lewu FS, Yusha'u Y, Keji-Taofik ST, Biney RP, Tagoe TA. Depression in Sub-Saharan Africa. IBRO Neurosci Rep 2022; 12:309-322. [PMID: 35746974 PMCID: PMC9210463 DOI: 10.1016/j.ibneur.2022.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Mood disorders can be considered among the most common and debilitating mental disorders. Major depression, as an example of mood disorders, is known to severely reduce the quality of life as well as psychosocial functioning of those affected. Its impact on the burden of disease worldwide has been enormous, with the World Health Organisation projecting depression to be the leading cause of mental illness by 2030. Despite several studies on the subject, little has been done to contextualise the condition in Africa, coupled with the fact that there is still much to be understood on the subject. This review attempts to shed more light on the prevalence of depression in Sub-Saharan Africa (SSA), its pathophysiology, risk factors, diagnosis and the experimental models available to study depression within the sub-region. It also evaluates the contribution of the sub-region to the global research output of depression as well as bottlenecks associated with full exploitation of the sub region's resources to manage the disorder.
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Affiliation(s)
- Ismail Temitayo Gbadamosi
- Department of Anatomy, University of Ilorin, Nigeria
- Laboratory for Translational Research in Neuropsychiatric Disorders, BRAINCITY Nencki-EMBL Center of Excellence for Neural Plasticty and Brain Disorders, Warsaw, Poland
| | - Isaac Tabiri Henneh
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
| | - Oritoke Modupe Aluko
- Department of Physiology, School of Basic Medical Sciences, Federal University of Technology, Akure, Nigeria
| | | | | | - Awo Koomson
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | - Joseph Torbi
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | | | | | - Yusuf Yusha'u
- Department of Human Physiology Ahmadu Bello University, Zaria, Nigeria
| | | | - Robert Peter Biney
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
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17
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Muhihi A, Fawzi WW, Aboud S, Nagu TJ, Ulenga N, Wang M, Mugusi F, Sudfeld CR. Cholecalciferol Supplementation Does Not Affect the Risk of HIV Progression, Viral Suppression, Comorbidities, Weight Loss, and Depression among Tanzanian Adults Initiating Antiretroviral Therapy: Secondary Outcomes of a Randomized Trial. J Nutr 2022; 152:1983-1990. [PMID: 35460249 PMCID: PMC9361733 DOI: 10.1093/jn/nxac096] [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: 01/23/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies suggest that blood concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with morbidity, viral suppression, and mortality among adults living with HIV. OBJECTIVES We evaluated the effect of cholecalciferol (vitamin D3) supplementation on the risk of HIV disease progression, HIV-1 viral suppression, comorbidities, weight change, and depression among HIV-infected individuals that were initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. METHODS We conducted a randomized, double-blind, placebo-controlled trial of vitamin D3 supplementation among 4000 HIV-infected adult men and nonpregnant women initiating ART with insufficient serum 25(OH)D concentrations (<30 ng/mL). Participants were randomly assigned to receive either weekly 50,000-IU doses for 4 wk followed by daily 2000 IU vitamin D3 until 1 y or a matching placebo regimen given in weekly followed by daily doses until 1 y. Participants were followed up at weekly visits for the first month followed by monthly visits thereafter. We conducted intent-to-treat analyses to assess the effect of vitamin D3 supplementation on the secondary trial outcomes of HIV progression or death, viral suppression, comorbidities, change in BMI, >10% weight loss, incident wasting, and depression. RESULTS During follow-up, 345 participants (17.2%) in the vitamin D3 group and 371 participants (18.6%) in the placebo group experienced HIV disease progression or death and there was no difference in risk between groups (RR: 0.91; 95% CI: 0.79, 1.06). Vitamin D3 supplementation did not affect the risk of an unsuppressed HIV-1 viral load (>1000 copies/mL) after 6 mo (RR: 1.10; 95% CI: 0.87, 1.41) and there was also no effect on change in BMI, risk of >10% weight loss, wasting, comorbidities, and depression (P values >0.05). CONCLUSIONS Vitamin D supplementation did not affect the risk of HIV progression, viral suppression, common morbidities, weight-related indicators, or depression among adults initiating ART in Tanzania.This trial was registered at clinicaltrials.gov as NCT01798680.
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Affiliation(s)
- Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania,Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tumaini J Nagu
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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18
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Is there an optimal screening tool for identifying perinatal depression within clinical settings of sub-Saharan Africa? SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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19
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Regan M, Muhihi A, Nagu T, Aboud S, Ulenga N, Kaaya S, Fawzi MCS, Yousafzai AK, Mugusi F, Fawzi WW, Saxena S, Koenen K, Sudfeld CR. Depression and Viral Suppression Among Adults Living with HIV in Tanzania. AIDS Behav 2021; 25:3097-3105. [PMID: 33598866 DOI: 10.1007/s10461-021-03187-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 01/09/2023]
Abstract
Limited information is available on the association between depression and viral suppression among people living with HIV (PLH) in sub-Saharan Africa. We conducted a prospective cohort study of 3996 adults initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. Log-binomial models were used to assess the association between depression and the risk of an unsuppressed viral load (> 400 copies/mL) after 6 months of ART. Women who had depression at both initiation and after 6 months of treatment had 1.94 times (95% CI 1.22, 3.09; z = 2.78, p < 0.01) the risk of an unsuppressed viral load after 6 months of treatment as compared to women who did not have depression at either time point. Men with the top tertile of depressive symptoms after 6 months of treatment had 1.58 times the risk of an unsuppressed viral load (95% CI 1.04, 2.38; z = 2.15, p = 0.03) as compared to the lowest tertile. Research should be pursued on interventions to prevent and address depression among adults initiating ART to potentially support achievement of viral suppression.
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Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA.
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Tumaini Nagu
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
| | - Karestan Koenen
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
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20
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Chipanta D, Stöckl H, Toska E, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Estill J, Keiser O. Facing the quality of life: physical illness, anxiety, and depression symptoms among people living with HIV in rural Zambia - a cross-sectional study. AIDS Care 2021; 34:957-965. [PMID: 34383600 DOI: 10.1080/09540121.2021.1966693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Widespread access to ART has not improved the quality of life (QoL) for people living with HIV (PLHIV). We used the United Nations Disability project (UNPRPD) evaluation data to examine how physical illness, anxiety, and depression shape the QoL of PLHIV in households receiving the social cash transfers safety nets in Luapula, Zambia. We explored associations between each outcome - physical illness, anxiety, depression symptoms - and age, gender, poverty, hunger and disability, using univariable and multivariable regressions. We adjusted p-values for multiple hypothesis testing with sharpened Qs. The sample comprised 1925 respondents 16-55 years old, median age 31 (IQR 22-42 years), majority women (n = 1514, 78.6%). Two-thirds (1239, 64.4%) reported having a physical illness, a third (671, 34.9%) anxiety, and nine per cent (366) depression symptoms. More HIV positive people had a disability (34.6%, 53 versus 28.3%, 502; Q = 0.033), were physically ill (72.5%, 111 versus 63.7%, 1128; Q = 0.011), and two-fold (aOR 1.97 95% CI 1.31-2.94) more likely to report depression symptoms than HIV negative peers. Food insecurity and disability among PLHIV may worsen their physical illnesses, anxiety, depression symptoms, and other QoL domains. More research on the quality of life of PLHIV in poverty is required.
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Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology Medical Faculty, Ludwig Maximilians University, München, Germany
| | - Elona Toska
- Department of Sociology, University of Cape Town, Rondebosch, South Africa
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, International Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia.,Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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21
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Saasa SK, Rai A, Malazarte N, Yirenya-Tawiah AE. Mental health service utilization among African immigrants in the United States. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2144-2161. [PMID: 34033683 DOI: 10.1002/jcop.22602] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/12/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
This study utilized Andersen's model of health behavior to explore factors associated with mental health service utilization. We also examine rates for mental health service use, treatment preferences, and barriers to care. Data were collected utilizing web-based surveys. The sample consisted of first and second-generation African immigrants who had struggled with emotional or behavioral problems in the past 12 months (N = 323). Hierarchical logistic regression analyses were conducted to examine predictors of mental health service utilization. The majority of participants (79.5%) met criteria for probable major depression, and 63% sought mental health services. Findings showed that mental health service utilization was more significantly predicted by enabling and need factors. Age (odds ratio [OR] = 1.03), religiosity (OR = 1.11), acculturative stress (OR = 1.68), neighborhood risk (OR = 0.54), and work-productivity loss (OR = 2.93) were associated with increased likelihood of mental health service use (p < 0.05). Most common barriers to service use were hopes of self-healing (56.3%) followed by financial barriers (46.2%). Findings highlight the need for public health initiatives to increase mental health literacy and financial accessibility to mental health services in response to the high mental health need and identified barriers to care in this population.
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Affiliation(s)
- Sherinah K Saasa
- School of Social Work, Brigham Young University, Provo, Utah, USA
| | - Abha Rai
- School of Social Work, Loyola University Chicago, Chicago, Illinois, USA
| | - Nikki Malazarte
- School of Social Work, Loyola University Chicago, Chicago, Illinois, USA
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22
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Bliznashka L, Yousafzai AK, Asheri G, Masanja H, Sudfeld CR. Effects of a community health worker delivered intervention on maternal depressive symptoms in rural Tanzania. Health Policy Plan 2021; 36:473-483. [PMID: 33313814 PMCID: PMC8128007 DOI: 10.1093/heapol/czaa170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/21/2023] Open
Abstract
Maternal depression affects one in four women in sub-Saharan Africa, yet evidence on effective and scalable interventions is limited. Our objective was to evaluate the effect of a community health worker (CHW) delivered home visit responsive stimulation, health and nutrition intervention, and conditional cash transfers (CCTs) for antenatal care and child growth monitoring attendance on maternal depressive symptoms. We conducted a cluster-randomized controlled trial in 12 villages in rural Ifakara, Tanzania (September 2017 to May 2019). Study villages were randomly assigned to one of three arms: (1) CHW, (2) CHW + CCT and (3) Control. Pregnant women and mothers with a child <12 months were enrolled. Maternal depressive symptoms were assessed using a Tanzanian-adapted version of the Hopkins Symptoms Checklist-25 (HSCL-25) after 18 months of follow-up. We used linear mixed-effects models to estimate intervention effects on HSCL-25 scores. Results showed that the CHW intervention significantly reduced HSCL-25 scores as compared with control [unadjusted mean difference (MD) −0.31, 95% confidence interval (CI) −0.47, −0.15]. The CHW + CCT intervention also appeared to lower HSCL-25 scores (MD −0.17, 95% CI −0.33, −0.01), but results were not statistically significant. Our findings showed that a low-intensity CHW-delivered home visit responsive stimulation, health and nutrition intervention, which did not explicitly aim to improve mental health, reduced maternal depressive symptoms, though the precise mechanisms of action remain unknown. CCTs for antenatal care and child growth monitoring appeared to provide limited to no additional benefit. Community-based integrated interventions that broadly consider maternal and child health, development and well-being have the potential to promote maternal mental health in rural Tanzania and similar settings.
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Affiliation(s)
- Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA
| | - Geofrey Asheri
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA
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23
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Sudfeld CR, Bliznashka L, Ashery G, Yousafzai AK, Masanja H. Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania. BMJ Glob Health 2021; 6:bmjgh-2021-005086. [PMID: 33906847 PMCID: PMC8088247 DOI: 10.1136/bmjgh-2021-005086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Evidence on the effects of community health worker (CHW) interventions and conditional cash transfers (CCTs) on child growth and development in sub-Saharan Africa remains sparse. Methods We conducted a single-blind, cluster-randomised controlled trial of an integrated home-visiting health, nutrition and responsive stimulation intervention alone and in combination with CCTs to promote antenatal and child clinic attendance from 2017 to 2019 in rural Morogoro Region, Tanzania. Pregnant women and caregivers with a child <1 year of age were enrolled. Twelve villages were randomised to either (1) CHW (n=200 participants), (2) CHW+CCT (n=200) or (3) control (n=193). An intention-to-treat analysis was conducted for the primary trial outcomes of child cognitive, language and motor development assessed with the Bayley Scales of Infant and Toddler Development and child length/height-for-age z-scores (HAZ) at 18 months of follow-up. Results The CHW and CHW+CCT interventions had beneficial effects on child cognitive development as compared with control (standardised mean difference (SMD): 0.15, 95% CI 0.05 to 0.24, and SMD: 0.18, 95% CI 0.07 to 0.28, respectively). The CHW+CCT intervention also had positive effects on language (SMD: 0.08, 95% CI 0.01 to 0.15) and motor (SMD: 0.16, 95% CI 0.03 to 0.28) development. Both CHW and CHW+CCT interventions had no effect on HAZ in the primary analysis; however, there were statistically significant positive effects in multivariable analyses. The CHW+CCT group (mean difference: 3.0 visits, 95% CI 2.1 to 4.0) and the CHW group (mean difference: 1.5 visits, 95% CI 0.6 to 2.5) attended greater number of child health and growth monitoring clinic visits as compared to the control group. Conclusion Integrated CHW home-visiting interventions can improve child cognitive development and may have positive effects on linear growth. Combining CHW with CCT may provide additional benefits on clinic visit attendance and selected child development outcomes. Trial registration number ISRCTN10323949.
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Affiliation(s)
- Christopher R Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA .,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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24
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Arabic validation of the hopkins symptom checklist-25 (HSCL) in a Lebanese sample of adults and older adults. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00240-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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McNaughton Reyes HL, Maman S, Chen MS, Groves AK, Moodley D. Patterns of Intimate Partner Violence Victimization Among South African Women and Their Relation to Emotional Distress During Pregnancy and Postpartum. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP4230-NP4249. [PMID: 29991312 PMCID: PMC6361715 DOI: 10.1177/0886260518786738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although numerous studies have established a link between intimate partner violence (IPV) victimization and maternal mental health, extant research examining this association has not considered heterogeneity in the forms of IPV that women experience. This is an important gap given that typological perspectives suggest that mental health consequences of IPV victimization may depend on the particular pattern of IPV that is experienced. The current study used latent class analysis to (a) identify and characterize distinct patterns of physical, psychological, and sexual IPV and male controlling behavior in a sample of pregnant South African women (n = 1,480) and (b) examine associations between IPV patterns and emotional distress during pregnancy (baseline) and 9 months postpartum (follow-up). Latent class analysis identified a three-class solution wherein the largest class demonstrated a low probability of IPV victimization across all indicators (nonvictims; 72% of the sample) and the smallest class demonstrated high probabilities of having experienced moderate and severe forms of IPV victimization as well as male controlling behavior (multiform severe controlling IPV; 4% of the sample). A third class (moderate IPV) was identified for which there was a high probability of experiencing moderate, but not severe, physical and psychological IPV (24% of the sample). Age, education, cohabitation status, experience of childhood abuse, and forced first sex were associated with class membership. Multiform severe controlling IPV victims reported significantly greater emotional distress than moderate IPV victims and nonvictims at baseline and follow-up. The results contribute to understanding heterogeneity in the patterns of IPV that women experience that may reflect distinct etiological processes and warrant distinct prevention and treatment approaches.
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Affiliation(s)
| | - Suzanne Maman
- The University of North Carolina at Chapel Hill, USA
| | - May S Chen
- The University of North Carolina at Chapel Hill, USA
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26
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Marten MG. The Countersyndemic Potential of Medical Pluralism among People Living with HIV in Tanzania. Glob Public Health 2021; 17:957-970. [PMID: 33571067 DOI: 10.1080/17441692.2021.1882529] [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: 10/22/2022]
Abstract
HIV and emotional distress often co-occur and interact in syndemic clusters with social, political, and economic factors that amplify the 'syndemic suffering' of individuals. In this paper, I describe how HIV+ women seeking antiretroviral therapy (ART) at a hospital in northern Tanzania engaged with plural methods of healing to ease suffering and address the multiple dimensions of illness. I explain the case of a famous faith healer at the time of research from 2011-12, 'Babu wa Loliondo,' from whom a third of the women interviewed - 25 of 75 - sought care in addition to their ART. These women experienced significantly fewer symptoms of emotional distress compared with those women who did not, suggesting that either those who sought his care were already healthier, or one strategy for coping - engagement with medical pluralism - played a role in buffering against syndemic HIV and emotional distress.
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Affiliation(s)
- Meredith G Marten
- Department of Anthropology, University of West Florida, Pensacola, FL, USA
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27
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Jakobsen IS, Madsen LMR, Mau M, Hjemdal O, Friborg O. The relationship between resilience and loneliness elucidated by a Danish version of the resilience scale for adults. BMC Psychol 2020; 8:131. [PMID: 33303037 PMCID: PMC7727155 DOI: 10.1186/s40359-020-00493-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background Research on the relationship between resilience and loneliness is sparse. The construct of resilience has been conceptualized in multiple ways, including the measurement of resilience. The Resilience Scale for Adults (RSA) is a measure of protective factors. The present study examined whether resiliency moderates any negative relationship between loneliness and mental health and additionally examined the psychometric properties of the Danish translation of the RSA. Methods A Danish sample (N = 422) completed the UCLA Loneliness Scale, Hopkins Symptom Check List-25 (HSCL-25), the Sense of Coherence (SOC-13), and the RSA, Resilience Scale for Adults. Results The measure of loneliness correlated significantly and negatively with most facets of the RSA, except the subscales of family cohesion and structured style. The strongest correlation was the negative one between loneliness and SOC. The results indicated that people feeling lonely also experience their life as less meaningful. Conclusion The study supports the existing six-factor structure of the Resilience Scale for Adults (RSA) in a Danish sample. The results indicate that all facets of resiliency were negatively related to loneliness. Also, the facets of perception of self and family coherence could explain a substantial amount of the variance associated with symptoms of depression in relation to loneliness.
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Affiliation(s)
- Ida Skytte Jakobsen
- Health, Social Work and Welfare Research, UCL University College, Odense, Denmark
| | | | - Martin Mau
- Health, Social Work and Welfare Research, UCL University College, Odense, Denmark. .,Department of Psychology, University of Southern Denmark, Odense, Denmark. .,Health Sciences Research Centre, UCL University College, Odense, Denmark.
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddgeir Friborg
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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28
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Khawaja NG, Pekin C, Schweitzer RD. Factor structure and psychometric properties of the Hopkins Symptom Checklist: An investigation with culturally and linguistically diverse youth in Australia. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nigar G. Khawaja
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia,
| | - Clare Pekin
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia,
| | - Robert D. Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia,
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29
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Remmert JE, Mosery N, Goodman G, Bangsberg DR, Safren SA, Smit JA, Psaros C. Breastfeeding Practices Among Women Living with HIV in KwaZulu-Natal, South Africa: An Observational Study. Matern Child Health J 2020; 24:127-134. [PMID: 31832911 DOI: 10.1007/s10995-019-02848-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Exclusive breastfeeding (EBF) is the safest infant feeding option in resource-limited settings, though women living with HIV have the lowest rates of EBF. Barriers to EBF in the absences of a formal intervention in women living with HIV in KwaZulu-Natal, where the prevalence of HIV among pregnant women is among the highest in the world, are understudied. Thus, this study sought to describe barriers to EBF and examine differences in social support, disclosure status, mood, and HIV-related stigma among women with different feeding methods. METHODS Women living with HIV enrolled in preventing mother-to-child transmission treatment (n = 156) were interviewed postpartum (M = 13.1 weeks) at a district hospital and self-reported infant feeding method, reasons not breastfeeding (if applicable), and HIV disclosure status. Mood, HIV-related stigma, functional social support, and HIV-related social support were also assessed. RESULTS No participants reported mixed feeding, 30% reported EBF, and 70% reported exclusive formula feeding. Commonly reported reasons for not breastfeeding included fear of HIV transmission to the infant and being away from the infant for extended periods of time. Social support (p = 0.02) and HIV-related social support (p < 0.01) were significantly higher in women who had attempted breastfeeding compared to women who never attempted breastfeeding. DISCUSSION Rates of EBF in this sample are lower than in other recent studies, suggesting this sample experiences multiple barriers to EBF. Healthcare providers should seek to correct misconceptions regarding HIV transmission and breastfeeding practices. Social and logistical support for EBF may be important considerations for future interventions.
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Affiliation(s)
- Jocelyn E Remmert
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, USA
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Georgia Goodman
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University - Portland State University, Portland, OR, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jennifer A Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.,Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
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Agents of change: Comparing HIV-related risk behavior of people attending ART clinics in Dar es Salaam with members of their social networks. PLoS One 2020; 15:e0238240. [PMID: 32886666 PMCID: PMC7473570 DOI: 10.1371/journal.pone.0238240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/12/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of the study is to compare sociodemographic characteristics, psychosocial factors, HIV knowledge and risk behaviors of people living with HIV (PLH) and their social network members (NMs) to inform HIV prevention programs that engage PLH as prevention educators in their communities. We compared baseline characteristics of PLH enrolled in an intervention to become HIV prevention Change Agents (CAs) (n = 458) and 602 NMs they recruited. CAs and NMs responded to questionnaires through a computer-driven interface with Audio Computer-Assisted Self Interview (ACASI) software. Although NMs scored higher on socio-economic status, self-esteem and general self-efficacy, they had lower HIV knowledge (AOR 1.5; 95% CI: 1.1–2.1), greater inconsistent condom use (AOR 3.2; 95% CI: 2.4–4.9), and recent experience as perpetrators of physical (AOR 2.5; 95% CI: 1.2–5.1) or sexual (AOR 4.1; 95% CI: 1.4–12.7) intimate partner violence; and as victims of physical (AOR 1.5; 95% CI: 1.0–2.3) or sexual (AOR 2.2; 95% CI: 1.3–3.8) forms of violence than CAs. Higher HIV knowledge and lower sexual risk behaviors among CAs suggest PLH’s potential as communicators of HIV prevention information to NMs. CAs’ training should also focus on improving self-esteem, general self-efficacy and social support to increase their potential effectiveness as HIV prevention educators and enhance their own overall health and well-being.
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Psaros C, Smit JA, Mosery N, Bennett K, Coleman JN, Bangsberg DR, Safren SA. PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to Care. Ann Behav Med 2020; 54:626-636. [PMID: 32128556 PMCID: PMC7459185 DOI: 10.1093/abm/kaaa005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support. PURPOSE To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development. METHODS We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence. RESULTS Elevated depressive symptoms were directly associated with significantly lower adherence (est = -8.60, 95% confidence interval [-15.02, -2.18], p < .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p < .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p < .01). Structural barriers, defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence. CONCLUSIONS Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support.
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Affiliation(s)
- Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Kara Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY
| | - Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University–Portland State University, Portland, OR
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL
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32
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Matthews LT, Orrell C, Bwana MB, Tsai AC, Psaros C, Asiimwe S, Amanyire G, Musinguzi N, Bell K, Bangsberg DR, Haberer JE. Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12-month cohort study in urban South Africa and rural Uganda. J Int AIDS Soc 2020; 23:e25586. [PMID: 32820622 PMCID: PMC7441010 DOI: 10.1002/jia2.25586] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. METHODS We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression models included demographics and socio-behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV-RNA at 12 months by ever- versus never-pregnant status. RESULTS In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non-pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm3 ). HIV-RNA was suppressed among 91% (N = 135) ever-pregnant and 86% (N = 85) never-pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non-pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non-pregnancy-related follow-up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV-RNA was suppressed among 57% (N = 47) ever-pregnant and 86% (N = 93) never-pregnant women. CONCLUSIONS Women in rural Uganda maintained high adherence with 91% of ever-pregnant and 86% of never-pregnant women suppressing HIV-RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow-up with median adherence of 40% and 57% of women with HIV-RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.
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Affiliation(s)
- Lynn T Matthews
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Department of MedicineMassachusetts General HospitalBostonMAUSA
| | | | | | - Alexander C Tsai
- Mbarara University of Science and TechnologyMbararaUganda
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
- Harvard Center for Population and Development StudiesBostonMAUSA
| | - Christina Psaros
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA
| | - Stephen Asiimwe
- Mbarara University of Science and TechnologyMbararaUganda
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
- Kabwohe Clinical Research Center (KCRC)KabwoheUganda
| | - Gideon Amanyire
- Makerere‐Mbarara Universities Joint AIDS Program (MJAP)MbararaUganda
| | - Nicholas Musinguzi
- Mbarara University of Science and TechnologyMbararaUganda
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
| | - Kathleen Bell
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
| | - David R Bangsberg
- School of Public HealthOregon Health and Science University/Portland State UniversityPortlandORUSA
| | - Jessica E Haberer
- Department of MedicineMassachusetts General HospitalBostonMAUSA
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
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Mughal AY, Devadas J, Ardman E, Levis B, Go VF, Gaynes BN. A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries. BMC Psychiatry 2020; 20:338. [PMID: 32605551 PMCID: PMC7325104 DOI: 10.1186/s12888-020-02753-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 06/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs). Screening has been proposed to improve identification and management of these disorders, but little is known about the validity of screening tools for these disorders. We conducted a systematic review of validated screening tools for detecting anxiety and PTSD in LMICs. METHODS MEDLINE, EMBASE, Global Health and PsychINFO were searched (inception-April 22, 2020). Eligible studies (1) screened for anxiety disorders and/or PTSD; (2) reported sensitivity and specificity for a given cut-off value; (3) were conducted in LMICs; and (4) compared screening results to diagnostic classifications based on a reference standard. Screening tool, cut-off, disorder, region, country, and clinical population were extracted for each study, and we assessed study quality. Accuracy results were organized based on screening tool, cut-off, and specific disorder. Accuracy estimates for the same cut-off for the same screening tool and disorder were combined via meta-analysis. RESULTS Of 6322 unique citations identified, 58 articles including 77 screening tools were included. There were 46, 19 and 12 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (35). Regionally, South Asia (11) had the most validations, followed by South Africa (10) and West Asia (9). The Kessler-10 (7) and the Generalized Anxiety Disorder-7 item scale (GAD-7) (6) were the most commonly validated tools for anxiety disorders, while the Harvard Trauma Questionnaire (3) and Posttraumatic Diagnostic Scale (3) were the most commonly validated tools for PTSD. Most studies (29) had the lowest quality rating (unblinded). Due to incomplete reporting, we could meta-analyze results from only two studies, which involved the GAD-7 (cut-off ≥10, pooled sensitivity = 76%, pooled specificity = 64%). CONCLUSION Use of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations. However, many have been validated in inadequately designed studies, precluding any general recommendation for specific tools in LMICs. Locally validated screening tools for anxiety and PTSD need further evaluation in well-designed studies to assess whether they can improve the detection and management of these common disorders. TRIAL REGISTRATION PROSPERO registry number CRD42019121794 .
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Affiliation(s)
- Anisa Y. Mughal
- The University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA
| | - Jackson Devadas
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - Eric Ardman
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA
| | - Brooke Levis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2 Canada
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG UK
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Dr, Chapel Hill, NC 27514 USA
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McNaughton Reyes HL, Maman S, Groves AK, Moodley D. Intimate partner violence and postpartum emotional distress among South African women: Moderating effects of resilience and vulnerability factors. Glob Public Health 2020; 15:1157-1167. [PMID: 32290779 DOI: 10.1080/17441692.2020.1751233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this study we aimed to identify factors that condition (i.e. buffer or exacerbate) the impact of exposure to intimate partner violence (IPV) on postpartum emotional distress among South African women. Hypothesised buffering factors included: socioeconomic status, family social support, and religiosity. Hypothesised exacerbating factors included: baseline distress, HIV status, and childhood abuse. Longitudinal analyses examined interactions between putative buffering and exacerbating factors and exposure to physical or sexual IPV, assessed during pregnancy (T1), as predictors of emotional distress, measured at 14 weeks (T2) and 9 months postpartum (T3). Consistent with hypotheses, at both T2 and T3 the impact of IPV exposure on emotional distress was significantly stronger among women who reported greater baseline distress and weaker among women of greater socioeconomic status. At T3, an interaction emerged with HIV status; the impact of IPV exposure on emotional distress was stronger for women who were diagnosed as HIV-positive during pregnancy. Findings support the need for targeted mental health promotion interventions for IPV-exposed women who are newly diagnosed with HIV and/or report high levels of emotional distress during pregnancy. Although more research is needed, findings also suggest that strengthening socioeconomic supports for IPV-exposed women may buffer impacts on postpartum mental health.
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Affiliation(s)
- H Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Allison K Groves
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Bantjes J, Kagee A, Saal W. The Utility of the Hopkins Symptom Checklist as a Trans-Diagnostic Screening Instrument for Common Mental Disorders Among Persons Seeking HIV Testing. AIDS Behav 2020; 24:629-636. [PMID: 31041626 DOI: 10.1007/s10461-019-02524-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is a need for effective psychiatric screening of HIV test seekers, given the high rates of psychopathology in this population. We used receiver operating characteristic curve analysis to establish the utility of the short version of the Hopkins Symptom Checklist (HSCL-25) to correctly identify common mental disorders (CMDs) among persons seeking HIV testing. The HSCL-25 is moderately accurate in identifying CMDs (sensitivity = 69%, specificity = 71%). The HSCL-25 performed better than the Beck Depression Inventory at detecting depressive disorders, and was comparable to the Beck Anxiety Inventory and Posttraumatic Stress Scale-Self-report at detecting cases of generalised anxiety disorder and posttraumatic stress disorder, respectively. However, the instrument generates a high number of false positives and is poor at detecting cases of alcohol use disorder, which limits its utility as a trans-diagnostic screening tool in HIV testing sites.
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Madoro D, Kerebih H, Habtamu Y, G/Tsadik M, Mokona H, Molla A, Wondie T, Yohannes K. Post-Traumatic Stress Disorder and Associated Factors Among Internally Displaced People in South Ethiopia: A Cross-Sectional Study. Neuropsychiatr Dis Treat 2020; 16:2317-2326. [PMID: 33116530 PMCID: PMC7548318 DOI: 10.2147/ndt.s267307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Displaced people experience different traumatic events. This can have serious and long-lasting consequences in terms of physical and mental health outcome. Post-traumatic stress disorder (PTSD) is the most frequent mental disorder following traumatic exposure. In 2018 Ethiopia saw the highest number of internal displacement, despite this, less attention has been given to mental health among internally displaced people in the country. This study aims to determine the estimated prevalence and associated factors of PTSD among internally displaced people in the Gede'o zone, south Ethiopia. PARTICIPANTS AND METHODS A community-based cross-sectional study was conducted between 1 and 30, May 2019 among 636 participants, who were selected using a simple random sampling technique. PTSD was measured by the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The association between outcome and independent variables was identified by bi-variable and multivariate logistic regression. Finally, variables with P-value less than 0.05 were considered statistically significant at 95% CI. RESULTS A total of 625 participants were interviewed with a response rate of 98.3%. The estimated prevalence of PTSD was 58.4% with 95% CI 55 to 61.9. In the multivariate logistic regression, being female (AOR=2.4, 95% CI 1.6 to 3.4), depression (AOR=2.6, 95% CI 1.2 to 3.9), displaced more than once (AOR=3.7, 95% CI 2.4 to 5.8), destruction of personal property (AOR=1.6, 95% CI 1.04 to 2.44), witness the murder of family (AOR=2, 95% CI 1.2, 3.9), and cumulative trauma (AOR=4, 95% CI 1.7 to 9.6) were significantly associated factors. CONCLUSION In the current study, the estimated prevalence of PTSD was high. Ministry of health should plan routine screening and management of PTSD, depression and linking with available mental health service is recommended.
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Affiliation(s)
- Derebe Madoro
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Habtamu Kerebih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gonidar, Ethiopia
| | - Yodit Habtamu
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Meseret G/Tsadik
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Hirbaye Mokona
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Alemayehu Molla
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tirusew Wondie
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Raggio GA, Psaros C, Fatch R, Goodman G, Matthews LT, Magidson JF, Amanyire G, Cross A, Asiimwe S, Hahn JA, Haberer JE. High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda. J Acquir Immune Defic Syndr 2019; 82:443-451. [PMID: 31567551 PMCID: PMC6857734 DOI: 10.1097/qai.0000000000002156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. METHODS Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). RESULTS Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23-29], median gestational age was 20 weeks [interquartile range: 16-26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). CONCLUSIONS Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.
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Affiliation(s)
- Greer A. Raggio
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- National Center for Weight and Wellness, Washington, DC
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lynn T. Matthews
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Anna Cross
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa;
| | - Stephen Asiimwe
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; and
- Kabwohe Clinical Research Center, Kabwohe, Uganda.
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Granderson RM, Harper GW, Wade R, Odero W, Onyango Olwango DP, Fields EL. Gender Role Strain and the Precarious Manhood of Sexual Minority Kenyan Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:420-432. [PMID: 33620336 PMCID: PMC7897423 DOI: 10.1037/sgd0000340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Examining the impact of precarious manhood on the mental health of sexual minority men living in Kenya, we hypothesized that (a) men who have sex with men exclusively (MSME) and men who have sex with men and women (MSMW) would display differential patterns of conformity to norms of masculinity; (b) these differences would result in distinct patterns of association between masculine conformity and symptoms of psychological distress for MSME and MSMW; and (c) conformity to norms of masculinity would be bidirectionally associated with symptoms of depression and anxiety. Using data collected from 391 young men who participated in a community-based, cross-sectional study of HIV-related risk and resilience among young sexual minority men in western Kenya, we ran a multivariate analysis of variance (MANOVA) to assess differences in conformity to masculine norms and four hierarchical linear regression models to examine the associations between conformity to masculine norms and symptoms of anxiety and depression for MSME and MSMW. MANOVA results revealed no significant differences between MSME and MSMW in overall conformity to masculinity, although MSMW were significantly more likely to conform to the masculine norm of power over women. Regression results revealed that conformity to norms of masculinity was bidirectionally associated with psychological distress and that these patterns of association were distinct for MSME and MSMW. The discussion explores possible explanations for revealed differences between MSME and MSMW using existing research. Clinical implications, limitations, and opportunities for future research are also discussed.
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Affiliation(s)
| | | | - Ryan Wade
- University of Illinois at Urbana-Champaign
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Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda. J Acquir Immune Defic Syndr 2019; 78:257-268. [PMID: 29509587 PMCID: PMC6012052 DOI: 10.1097/qai.0000000000001671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence. Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda. Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender. Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, <0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing ≥12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner ≥10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40). Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health initiatives are urgently required.
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Hung YW, Musci R, Tol W, Aketch S, Bachani AM. Longitudinal depressive and anxiety symptoms of adult injury patients in Kenya and their risk factors. Disabil Rehabil 2019; 42:3816-3824. [PMID: 31081392 DOI: 10.1080/09638288.2019.1610804] [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: 10/26/2022]
Abstract
Background: Injuries account for a significant proportion of the health and economic burden for populations in low- and middle-income countries. However, little is known about psychological distress trajectories amongst injury survivors in low- and middle-income countries.Methods: Adult injury patients (n = 644) admitted to Kenyatta National Hospital in Nairobi, Kenya, were enrolled and interviewed in the hospital, and at 1, 2-3, and 4-7 months after hospital discharge through phone to assess depressive and anxiety symptoms and level of disability. Growth mixture modeling was applied to identify latent trajectories of depressive and anxiety symptoms.Results: Elevated depressive and moderate-level anxiety symptoms (13%) and low depressive and anxiety symptoms (87%) trajectories were found between hospitalization and up to seven months after hospital discharge. Being female, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, and lack of monetary assistance during hospitalization were associated with the elevated symptoms trajectory. The higher symptoms trajectory associated with higher disability levels after hospital discharge and significantly lower proportion of resuming daily activities and work.Conclusion: The persistence of elevated depressive symptoms and associated reduced functioning several months after physical injury underscores the importance of identifying populations at risk for preventive and early interventions.Implications for RehabilitationHealth providers following up with injury survivors should screen for depressive and anxiety symptomsSpecial attention to women and people with a potential traumatic exposure historyIncorporation of evidence-based culturally adapted psychosocial interventions in rehabilitation and outpatient clinics.
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Affiliation(s)
- Yuen W Hung
- Department of Health Sciences, Wilfred Laurier University, Waterloo, Canada
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse Tol
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Hung YW, Tol W, Musci R, Aketch S, Bachani AM. Trauma Exposure, Posttraumatic Stress Disorder Symptoms Trajectory, and Disability Level Among Hospitalized Injury Survivors in Kenya. J Trauma Stress 2019; 32:108-118. [PMID: 30720891 PMCID: PMC6386584 DOI: 10.1002/jts.22373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 10/04/2018] [Accepted: 10/28/2018] [Indexed: 11/10/2022]
Abstract
Potentially traumatic events (PTEs) have been consistently associated with posttraumatic stress disorder (PTSD). However, the extent of association and attribution to subsequent disability has varied, with limited studies conducted in urban low-income contexts. This longitudinal study estimated the trajectory of PTSD symptoms up to 7 months after hospitalization and the associated disability level among adult patients who had been hospitalized due to injury. Adult injury patients (N = 476) admitted to Kenyatta National Hospital in Nairobi, Kenya, were interviewed in person in the hospital, and via phone at 1, 2-3, and 4-7 months after hospital discharge. Using latent growth curve modeling, two trajectories of PTSD symptoms emerged: (a) persistently elevated PTSD symptoms (9.2%), and (b) low PTSD symptoms (90.8%). Number of PTEs experienced remained moderately associated with the elevated trajectory after controlling for in-hospital depressive symptoms. Having previously witnessed killings or serious injuries, AOR = 2.32, 95% CI [1.07, 5.05]; being female, AOR = 4.74, 95% CI [4.53, 4.96]; elevated depressive symptoms during hospitalization, AOR = 2.96, 95% CI [1.28, 6.83]; and having no household savings/assets, AOR = 1.28, 95% CI [1.13, 1.44], were associated with the elevated PTSD symptoms trajectory class after controlling for other risk factors. Latent membership in the elevated PTSD trajectory was associated with a significantly higher level of disability several months after hospital discharge, p < .001, after controlling for injury and demographic characteristics. These results underline the associations among in-hospital depressive symptoms, witnessing atrocities, and poverty, and an elevated PTSD symptoms trajectory.
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Affiliation(s)
- Yuen W. Hung
- Department of International Health, Johns Hopkins International Injury Research Unit, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse Tol
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Abdulgafoor M. Bachani
- Department of International Health, Johns Hopkins International Injury Research Unit, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Chorwe-Sungani G, Chipps J. Performance of the 3-item screener, the Edinburgh Postnatal Depression Scale, the Hopkins Symptoms Checklist-15 and the Self-Reporting Questionnaire and Pregnancy Risk Questionnaire, in screening of depression in antenatal clinics in the Blantyre district of Malawi. Malawi Med J 2019; 30:184-190. [PMID: 30627354 PMCID: PMC6307058 DOI: 10.4314/mmj.v30i3.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Screening instruments for antenatal depression vary in performance. This study aimed at assessing the performance of a range of screening instruments in detecting depressive symptoms in antenatal clinics in Blantyre district, Malawi. Methods A cross-sectional study was conducted to screen for depression among women attending 8 selected antenatal clinics in Blantyre district using 3-item screener, Edinburgh Postnatal Depression Scale (EPDS), Hopkins Symptoms Checklist-15 (HSCL-15), Self-Reporting Questionnaire (SRQ) and Pregnancy Risk Questionnaire (PRQ). The instruments were administered to a random sample of 480 pregnant women. Data were analysed using SPSS 22.0 testing for performance differences in proportions of screen positives and how screen positive results might differ by particular variables. Results The prevalence estimates yielded by screening instruments ranged from 12.9% (SRQ) to 42.1% (3-item screener). There were no significant differences in prevalence estimates for EPDS, HSCL-15, PRQ and SRQ. There were performance differences in the proportions of screen positives with significant systematic differences between proportions of screen positives of PRQ and SRQ (p<.001), EPDS and HSCL-15 (p=.001), HSCL and PRQ (p<.001), and EPDS and SRQ (p<.001). Screen positive results on HSCL-15, PRQ, 3-item screener and EPDS were found to differ by variables such as “not being supported by partner” which resulted in respondents having ≥3 times chances to screen positive on these four instruments. The screen positive results on SRQ were found not to differ by age, education, employment status, marital status, setting, gestation and number of pregnancies. Conclusions There were minimal variations in the performance of the EPDS, SRQ and HSCL-15 as standard public health screening instruments. However, systematic differences between proportions of screen positives exist and screen positive results from these instruments differed by demographics. It is important to validate screening instruments against a gold standard to ensure relevant clinical outcomes for pregnant women with depression.
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Affiliation(s)
- Genesis Chorwe-Sungani
- University of Malawi, Kamuzu College of Nursing.,University of the Western Cape, School of Nursing
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Nordin L, Perrin S. Pre-treatment pain predicts outcomes in multimodal treatment for tortured and traumatized refugees: a pilot investigation. Eur J Psychotraumatol 2019; 10:1686807. [PMID: 31762955 PMCID: PMC6853218 DOI: 10.1080/20008198.2019.1686807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Chronic pain is a common comorbid complaint in traumatized refugees seeking treatment for posttraumatic stress disorder (PTSD) and depression. However, the effect of comorbid pain on treatment remains under investigated. Objective: To investigate whether pre-treatment pain (severity/interference) predicts outcomes in a multimodal treatment targeting PTSD, depression, anxiety, somatic complaints, and health-related disability in refugees exposed to torture and organized violence. Additional predictors were gender, age, and number of treatment sessions. Method: Participants were active cases at a specialist outpatient clinic for tortured refugees (n = 276; 170 men, 106 women) who were either on a treatment waitlist (mean length = 7.4 months, SD = 4.5), in treatment (mean length = 12.2 months, SD = 6.5), or who completed treatment and had (or were waiting for) a follow-up assessment. Participants completed symptom measures at referral, pre- and post-treatment, and 9-month follow-up. Multi-level mixed modelling was used to assess whether outcomes at post-treatment and 9-months were predicted by pain, gender, age, or the number of treatment sessions. Results: Treatment yielded significant pre-to-post-treatment reductions in PTSD, depression, anxiety, and number of pain locations, but no reductions in pain severity/interference, or health-related disability, except for societal participation. Gains for PTSD, depression, and societal participation were maintained at the 9-month follow-up. Higher levels of pain interference (but not severity) predicted poorer outcomes (PTSD, depression, and anxiety). Age, gender and number of treatment sessions did not predict outcomes, except for a small negative effect of (older) age on PTSD. Conclusions: A growing body of literature suggests that pain and PTSD symptoms interact in ways to increase the severity and impact of both disorders in refugee and non-refugee populations alike. The present study suggests interference from pain can lessen the effectiveness of standard multi-modal treatments for refugees.
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Affiliation(s)
- Linda Nordin
- Rehabilitation Department, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark.,Department of Psychology, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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Smith Fawzi MC, Ngakongwa F, Liu Y, Rutayuga T, Siril H, Somba M, Kaaya SF. Validating the Patient Health Questionnaire-9 (PHQ-9) for screening of depression in Tanzania. ACTA ACUST UNITED AC 2018; 31:9-14. [PMID: 32863596 DOI: 10.1016/j.npbr.2018.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Major depression has a significant impact on years lived with disability (YLD) globally. In resource-limited countries, depression may accompany daily challenges of economic security that people face, hence there is a critical need to develop depression screening tools at primary levels of health care. The overall goal of the study is to validate the PHQ-9 in Tanzania. Methods A validation study was conducted from August to October 2014 among adults accessing primary health care at public clinics in Dar es Salaam. The Mini-International Neuropsychiatric Interview (MINI) was used as the gold standard for current major depressive episode. Results Among 180 patients recruited, six were not included in the analysis since the PHQ-9 and MINI assessments were conducted more than two weeks apart (n=174). The PHQ-9 demonstrated reasonable reliability in this setting (α=0.83). Evidence for construct validity was observed through expected associations with female gender (r=0.16, p=0.04) and food insecurity (r=0.30, p<0.0001). Receiver Operating Characteristic analysis demonstrated good overall accuracy of the PHQ-9 (AOC=0.87, 95%CI: 0.77, 0.96). The optimal cut-off score in this population was 9, with a sensitivity of 78% and specificity of 87%. Limitations The study sample is from a primary health care setting, hence the findings may have some limited generalizability at the community level. Conclusions The PHQ-9 demonstrated reliability and validity among adults accessing primary health care in Dar es Salaam, indicating that it can serve as a useful tool in identifying patients with depression in primary care clinics in Tanzania and similar settings.
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Affiliation(s)
- Mary C Smith Fawzi
- Harvard Medical School, Department of Global Health and Social Medicine, Boston MA, USA
| | - Fileuka Ngakongwa
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, Dar es Salaam, Tanzania
| | - Yuanyuan Liu
- Harvard Medical School, Department of Global Health and Social Medicine, Boston MA, USA
| | - Theonest Rutayuga
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Magreat Somba
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Sylvia F Kaaya
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, Dar es Salaam, Tanzania
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Giammusso I, Casadei F, Catania N, Foddai E, Monti MC, Savoja G, Tosto C. Immigrants Psychopathology: Emerging Phenomena and Adaptation of Mental Health Care Setting by Native Language. Clin Pract Epidemiol Ment Health 2018; 14:312-322. [PMID: 30972131 PMCID: PMC6407656 DOI: 10.2174/1745017901814010312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/18/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
Mental health of immigrants is an important social and clinical issue. Immigrants may report higher rates of mental disorders and lower levels of use of mental health service with respect to natives. The aim of the present work is to review recent findings of the psychopathology of immigrants and analyze how to adapt the mental care settings through the use of mother tongues. We searched the literature to individuate and review the most recent scientific articles focused on the psychopathology of immigrants realized in Europe. Moreover, we summarized the guidelines about immigrants mental health care and we focused on the barriers caused by language. We individuated 15 papers reporting data about mental disorders among immigrants and the related risk and protective factors. The articles reported information about psychosis, depression, anxiety, post-traumatic stress disorder, somatization and suicide rates. Risk and protective factors are individuated mainly among social factors (e.g. ethnic density effect, hosting countries' policies). Furthermore, immigrants encounter language barriers in the use of mental care services. The realization of cross-cultural training and the development of a working alliance between clinicians and interpreters resulted to be effective solutions even if these interventions are not frequently implemented. The extent of migratory flows and the related difficulties experienced by immigrants require attention and well-informed interventions. The high rates of incidence of mental disorder and the strict number of services who implement interventions taking into accounts fundamental aspect as language show that there is still a lot to do.
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Affiliation(s)
- Isabella Giammusso
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.,Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Filippo Casadei
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Nicolay Catania
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Elena Foddai
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Maria Chiara Monti
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Giorgia Savoja
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Crispino Tosto
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
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Harrington BJ, Pence BW, John M, Melhado CG, Phulusa J, Mthiko B, Gaynes BN, Maselko J, Miller WC, Hosseinipour MC. Prevalence and factors associated with antenatal depressive symptoms among women enrolled in Option B+ antenatal HIV care in Malawi: a cross-sectional analysis. J Ment Health 2018; 28:198-205. [PMID: 30270683 DOI: 10.1080/09638237.2018.1487542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Option B+ has increased the number of pregnant women initiating antiretroviral therapy for HIV, yet retention in HIV care is sub-optimal. Retention may be affected by antenatal depression. However, few data exist on antenatal depression in this population. AIM Describe the prevalence and factors associated with antenatal depression among Malawian women enrolled in Option B+. METHOD At their first antenatal visit, women with HIV provided demographic and psychosocial information, including depression as measured with the locally validated Edinburgh Postnatal Depression Scale (EPDS). Prevalence ratios (PR) for factors associated with probable depression (EPDS ≥6) were estimated with log binomial regression. RESULTS 9.5% (95% CI: 7.5-11.9%) of women screened positive for current depression, and 46% self-reported a history of depression or anxiety. Women were more likely to screen positive for current depression if they reported a history of depression (adjusted PR: 2.42; 95% CI: 1.48-3.95) or had ever experienced intimate partner violence (1.77; 1.11-2.81). Having an unintended current pregnancy (1.78; 0.99-3.21), being unmarried (1.66; 0.97-2.84), or employed (1.56; 1.00-2.44) had potential associations with probable depression. CONCLUSIONS Probable antenatal depression affected a notable proportion of women living with HIV, comparable to other global regions. Screening for antenatal depression in HIV care should be considered.
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Affiliation(s)
- Bryna J Harrington
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Brian W Pence
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mathias John
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Caroline G Melhado
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Jacob Phulusa
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Bryan Mthiko
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Bradley N Gaynes
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joanna Maselko
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - William C Miller
- c College of Public Health , The Ohio State University , Columbus , OH , USA
| | - Mina C Hosseinipour
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
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47
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Hill LM, Kajula LJ, Maman S. Correlates of Anxiety and Depression among Young Men Living in Dar es Salaam, Tanzania. Int J Ment Health Addict 2018; 18:917-931. [PMID: 32863800 PMCID: PMC7450723 DOI: 10.1007/s11469-018-9993-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Depression and anxiety are important sources of morbidity globally, but we have little knowledge of risk groups and risk factors for both classes of disorders in Tanzania and other low-resource settings. We aimed to identify socio-demographic markers and risk and protective factors associated with symptoms of anxiety and depression among 1249 young men belonging to social groups known as "camps" in Dar es Salaam. Anxiety and depression were measured using the HSCL-25. Men living apart from family reported greater symptoms of anxiety and depression than men living with family, and employment was associated with a greater likelihood of clinically significant symptoms of both anxiety and depression. Childhood experience of violence was strongly associated with both anxiety and depression. Social support was associated with lower levels of anxiety and depression, and with a lower likelihood of clinically significant levels of anxiety and depression in this population. Youth not living with family and the working poor may be important populations for future investigation. Interventions targeting survivors of childhood violence and social support-based interventions should be tested to address the burden of anxiety and depression in this setting.
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Affiliation(s)
- Lauren M Hill
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC
| | - Lusajo J Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC
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Munro-Kramer ML, Scott N, Boyd CJ, Veliz PT, Murray SM, Musonda G, Lori JR. Postpartum physical intimate partner violence among women in rural Zambia. Int J Gynaecol Obstet 2018; 143:199-204. [PMID: 30125966 PMCID: PMC6221031 DOI: 10.1002/ijgo.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/25/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022]
Abstract
Objective To examine the demographic characteristics and mental health of women in rural Zambia who experienced physical intimate partner violence (IPV) postpartum. Methods The present secondary analysis was conducted using baseline data from an impact evaluation of a maternity waiting home intervention in rural Zambia. A quantitative household survey was conducted over 6 weeks, from mid‐April to late May, 2016, at 40 rural health facility catchment areas among 2381 postpartum women (13 months after delivery; age ≥15 years). Results A total of 192 (8.1%) women reported experiencing any type of physical IPV in the preceding 2 weeks; 126 had experienced severe physical IPV (had been kicked, dragged, beat, and/or choked by a husband or partner). High levels of depression were recorded for 174 (7.3%) women in the preceding 2 weeks. Being a female head of household was associated with an increased likelihood of experiencing severe physical IPV (aOR 2.64, 95% CI 1.70–4.10). Women with high depression scores were also at an increased risk of experiencing any physical IPV (aOR 17.1, 95% CI 8.44–34.9) and severe physical IPV (aOR 15.4, 95% CI 5.17–45.9). Conclusion Future work should consider the implications of government and educational policies that could impact the screening and treatment of pregnant women affected by all forms of physical IPV and depression in rural Zambia. Postpartum physical intimate partner violence among women in rural Zambia was associated with being a female head of household and high levels of depression.
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Affiliation(s)
- Michelle L Munro-Kramer
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Nancy Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Carol J Boyd
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Philip T Veliz
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Applied Biostatistics Laboratory, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jody R Lori
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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Caruso BA, Cooper HL, Haardörfer R, Yount KM, Routray P, Torondel B, Clasen T. The association between women's sanitation experiences and mental health: A cross-sectional study in Rural, Odisha India. SSM Popul Health 2018; 5:257-266. [PMID: 30094321 PMCID: PMC6077264 DOI: 10.1016/j.ssmph.2018.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
Emerging qualitative research suggests women's sanitation experiences may impact mental health. However, specific associations remain unclear. We aimed to determine if sanitation access and sanitation experiences were associated with mental health among women in rural Odisha, India. Using a cross-sectional design, we evaluated the association between sanitation access and sanitation experiences and selected mental health outcomes. Data were collected from 1347 randomly selected women across four life course stages in 60 rural communities (December 2014-February 2015). Our four primary outcomes included: mental well-being, and symptoms of anxiety, depression, and distress. The primary exposures were (1) access to a functional latrine within the household compound and (2) sanitation insecurity (SI), evaluated using a seven domain measure assessing women's negative sanitation experiences and concerns. We used hierarchical linear modeling to determine associations between the exposures and mental health outcomes, adjusting for covariates (life stage, poverty, current health status, social support). Mean well-being scores were moderate and mean anxiety, depression, and distress scores were above a threshold indicating the potential presence of any of the three conditions. Access to a functional household latrine was associated with higher well-being scores, but not with anxiety, depression or distress. Women's SI domains were associated with all four outcomes: four domains were significantly associated with lower well-being scores, two were significantly associated with higher anxiety scores, three were significantly associated with higher depression scores, and three were significantly associated with higher distress scores, all independent of functional household latrine access. Women in rural Odisha, India may suffer assaults to their well-being and have higher symptoms of anxiety, depression, and distress when urinating and defecating, even if they have an available facility. These findings suggest that sanitation-related interventions should consider how to accommodate women's experiences beyond excreta management to comprehensively impact health.
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Affiliation(s)
- Bethany A. Caruso
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah L.F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Sociology, Emory University, Atlanta, GA, USA
| | - Parimita Routray
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hedemann ER, Frazier SL. Leveraging After-School Programs to Minimize Risks for Internalizing Symptoms Among Urban Youth: Weaving Together Music Education and Social Development. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:756-770. [PMID: 27544670 DOI: 10.1007/s10488-016-0758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined a university-community partnership, focusing on mental health promotion within an after-school music program. We pursued two goals: (a) supporting staff around student engagement and behavior management; (b) integrating social-emotional activities into the curriculum. We assessed youth's mental health needs and examined feasibility of social-emotional activities delivered. One-hundred sixty-two youth participated in activities, while a subset of youth (n = 61) and their parents provided information on mental health need. Rates of anxiety and depression symptoms were high, and youth reported high satisfaction with the activities. Results suggest promise of this model for mental health promotion for urban youth.
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Affiliation(s)
- Erin R Hedemann
- Florida International University, AHC-1 Room 140, 11200 S.W. 8th St., Miami, FL, 33199, USA.
| | - Stacy L Frazier
- Florida International University, AHC-1 Room 140, 11200 S.W. 8th St., Miami, FL, 33199, USA
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