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Gigaba SG, Luvuno Z, Bhana A, Janse van Rensburg A, Mthethwa L, Rao D, Hongo N, Petersen I. Collaborative implementation of an evidence-based package of integrated primary mental healthcare using quality improvement within a learning health systems approach: Lessons from the Mental health INTegration programme in South Africa. Learn Health Syst 2024; 8:e10389. [PMID: 38633025 PMCID: PMC11019379 DOI: 10.1002/lrh2.10389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/26/2023] [Accepted: 08/13/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction The treatment gap for mental health disorders persists in low- and middle-income countries despite overwhelming evidence of the efficacy of task-sharing mental health interventions. Key barriers in the uptake of these innovations include the absence of policy to support implementation and diverting of staff from usual routines in health systems that are already overstretched. South Africa enjoys a conducive policy environment; however, strategies for operationalizing the policy ideals are lacking. This paper describes the Mental health INTegration Programme (MhINT), which adopted a health system strengthening approach to embed an evidence-based task-sharing care package for depression to integrate mental health care into chronic care at primary health care (PHC). Methods The MhINT care package consisting of psycho-education talks, nurse-led mental health assessment, and a structured psychosocial counselling intervention provided by lay counsellors was implemented in Amajuba district in KwaZulu-Natal over a 2-year period. A learning health systems approach was adopted, using continuous quality improvement (CQI) strategies to facilitate embedding of the intervention.MhINT was implemented along five phases: the project phase wherein teams to drive implementation were formed; the diagnostic phase where routinely collected data were used to identify system barriers to integrated mental health care; the intervention phase consisting of capacity building and using Plan-Do-Study-Act cycles to address implementation barriers and the impact and sustaining improvement phases entailed assessing the impact of the program and initiation of system-level interventions to sustain and institutionalize successful change ideas. Results Integrated planning and monitoring were enabled by including key mental health service indicators in weekly meetings designed to track the performance of noncommunicable diseases and human immunovirus clinical programmes. Lack of standardization in mental health screening prompted the validation of a mental health screening tool and testing feasibility of its use in centralized screening stations. A culture of collaborative problem-solving was promoted through CQI data-driven learning sessions. The province-level screening rate increased by 10%, whilst the district screening rate increased by 7% and new patients initiated to mental health treatment increased by 16%. Conclusions The CQI approach holds promise in facilitating the attainment of integrated mental health care in resource-scarce contexts. A collaborative relationship between researchers and health system stakeholders is an important strategy for facilitating the uptake of evidence-based innovations. However, the lack of interventions to address healthcare workers' own mental health poses a threat to integrated mental health care at PHC.
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Affiliation(s)
- Sithabisile Gugulethu Gigaba
- University of KwaZulu‐Natal Centre for Rural HealthSchool of Nursing and Public HealthDurbanSouth Africa
- Psychology DepartmentKwaZulu‐Natal Department of HealthDurbanSouth Africa
| | - Zamasomi Luvuno
- University of KwaZulu‐Natal Centre for Rural HealthSchool of Nursing and Public HealthDurbanSouth Africa
| | - Arvin Bhana
- South African Medical Research CouncilUniversity of KwaZulu‐Natal Centre for Rural HealthDurbanSouth Africa
| | - Andre Janse van Rensburg
- University of KwaZulu‐Natal Centre for Rural HealthSchool of Nursing and Public HealthDurbanSouth Africa
| | - Londiwe Mthethwa
- University of KwaZulu‐Natal Centre for Rural HealthSchool of Nursing and Public HealthDurbanSouth Africa
| | - Deepa Rao
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Nikiwe Hongo
- Mental Health DirectorateKwaZulu‐Natal Department of HealthDurbanSouth Africa
| | - Inge Petersen
- University of KwaZulu‐Natal Centre for Rural HealthSchool of Nursing and Public HealthDurbanSouth Africa
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Elyoseph Z, Levkovich I. Comparing the Perspectives of Generative AI, Mental Health Experts, and the General Public on Schizophrenia Recovery: Case Vignette Study. JMIR Ment Health 2024; 11:e53043. [PMID: 38533615 PMCID: PMC11004608 DOI: 10.2196/53043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/28/2024] Open
Abstract
Background The current paradigm in mental health care focuses on clinical recovery and symptom remission. This model's efficacy is influenced by therapist trust in patient recovery potential and the depth of the therapeutic relationship. Schizophrenia is a chronic illness with severe symptoms where the possibility of recovery is a matter of debate. As artificial intelligence (AI) becomes integrated into the health care field, it is important to examine its ability to assess recovery potential in major psychiatric disorders such as schizophrenia. Objective This study aimed to evaluate the ability of large language models (LLMs) in comparison to mental health professionals to assess the prognosis of schizophrenia with and without professional treatment and the long-term positive and negative outcomes. Methods Vignettes were inputted into LLMs interfaces and assessed 10 times by 4 AI platforms: ChatGPT-3.5, ChatGPT-4, Google Bard, and Claude. A total of 80 evaluations were collected and benchmarked against existing norms to analyze what mental health professionals (general practitioners, psychiatrists, clinical psychologists, and mental health nurses) and the general public think about schizophrenia prognosis with and without professional treatment and the positive and negative long-term outcomes of schizophrenia interventions. Results For the prognosis of schizophrenia with professional treatment, ChatGPT-3.5 was notably pessimistic, whereas ChatGPT-4, Claude, and Bard aligned with professional views but differed from the general public. All LLMs believed untreated schizophrenia would remain static or worsen without professional treatment. For long-term outcomes, ChatGPT-4 and Claude predicted more negative outcomes than Bard and ChatGPT-3.5. For positive outcomes, ChatGPT-3.5 and Claude were more pessimistic than Bard and ChatGPT-4. Conclusions The finding that 3 out of the 4 LLMs aligned closely with the predictions of mental health professionals when considering the "with treatment" condition is a demonstration of the potential of this technology in providing professional clinical prognosis. The pessimistic assessment of ChatGPT-3.5 is a disturbing finding since it may reduce the motivation of patients to start or persist with treatment for schizophrenia. Overall, although LLMs hold promise in augmenting health care, their application necessitates rigorous validation and a harmonious blend with human expertise.
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Affiliation(s)
- Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College, Kiryat Tiv'on, Israel
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Elyoseph Z, Levkovich I, Shinan-Altman S. Assessing prognosis in depression: comparing perspectives of AI models, mental health professionals and the general public. Fam Med Community Health 2024; 12:e002583. [PMID: 38199604 PMCID: PMC10806564 DOI: 10.1136/fmch-2023-002583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) has rapidly permeated various sectors, including healthcare, highlighting its potential to facilitate mental health assessments. This study explores the underexplored domain of AI's role in evaluating prognosis and long-term outcomes in depressive disorders, offering insights into how AI large language models (LLMs) compare with human perspectives. METHODS Using case vignettes, we conducted a comparative analysis involving different LLMs (ChatGPT-3.5, ChatGPT-4, Claude and Bard), mental health professionals (general practitioners, psychiatrists, clinical psychologists and mental health nurses), and the general public that reported previously. We evaluate the LLMs ability to generate prognosis, anticipated outcomes with and without professional intervention, and envisioned long-term positive and negative consequences for individuals with depression. RESULTS In most of the examined cases, the four LLMs consistently identified depression as the primary diagnosis and recommended a combined treatment of psychotherapy and antidepressant medication. ChatGPT-3.5 exhibited a significantly pessimistic prognosis distinct from other LLMs, professionals and the public. ChatGPT-4, Claude and Bard aligned closely with mental health professionals and the general public perspectives, all of whom anticipated no improvement or worsening without professional help. Regarding long-term outcomes, ChatGPT 3.5, Claude and Bard consistently projected significantly fewer negative long-term consequences of treatment than ChatGPT-4. CONCLUSIONS This study underscores the potential of AI to complement the expertise of mental health professionals and promote a collaborative paradigm in mental healthcare. The observation that three of the four LLMs closely mirrored the anticipations of mental health experts in scenarios involving treatment underscores the technology's prospective value in offering professional clinical forecasts. The pessimistic outlook presented by ChatGPT 3.5 is concerning, as it could potentially diminish patients' drive to initiate or continue depression therapy. In summary, although LLMs show potential in enhancing healthcare services, their utilisation requires thorough verification and a seamless integration with human judgement and skills.
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Affiliation(s)
- Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Yezreel Valley, Israel
- Department of Brain Sciences, Imperial College London, London, UK
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College, Tivon, Israel
| | - Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Tel Aviv, Israel
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Cone PH, Lassche‐Scheffer J, Bø B, Kuven BM, McSherry W, Owusu B, Ross L, Schep‐Akkerman A, Ueland V, Giske T. Strengths and challenges with spiritual care: Student feedback from the EPICC Spiritual Care Self-Assessment Tool. Nurs Open 2023; 10:6923-6934. [PMID: 37475149 PMCID: PMC10495739 DOI: 10.1002/nop2.1946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/10/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
AIM To explore qualitative data from students' self-reported competencies in spiritual care gathered during testing of a student self-assessment tool based on the EPICC Spiritual Care Education Standard. DESIGN Reflexive thematic analysis of qualitative data from a multinational study on validating a new self-assessment tool. METHODS The EPICC Spiritual Care Education Standard for competency in spiritual care was developed to enhance nurses' and midwives' ability to provide spiritual care by creating a baccalaureate education standard for spiritual care competencies. Spiritual care researchers then developed a self-assessment tool to raise student awareness of spirituality and track personal and professional growth in spiritual care competency. The EPICC Spiritual Care Competency Self-Assessment Tool, tested at eight universities in five countries, provided many opportunities for student comments, resulting in rich qualitative data presented here. RESULTS Themes related to strengths, weaknesses and areas for improvement. Identified strengths were similar across countries: caring attitudes, general knowledge of caring and compassion and good communication skills. Weaknesses/challenges touched on spirituality as overlooked in some cultures but part of life for others, complex questions were hard to understand, and self-assessment tools are common for some and rare for others. Areas for improvement included need for knowledge of religious and other deeply held beliefs and for greater spiritual assessment skills. Similarities across countries related to basic training in communication and compassionate care for nurses globally. Differences lay in the challenges and/or barriers for spiritual care and may relate to cultures within countries and/or university test sites. RELEVANCE TO CLINICAL PRACTICE The Tool raises awareness of spirituality among students and working nurses, providing an accessible way to self-check personal and professional growth in spiritual care competencies, which increases student and nurse capacity to become more knowledgeable and skilled in facilitating spiritual care, thus be role models for students at the intersection of spirituality and health.
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Affiliation(s)
- Pamela H. Cone
- School of NursingAzusa Pacific UniversityGreater Los AngelesCaliforniaUSA
- VID Specialized UniversityBergenNorway
| | - Joanne Lassche‐Scheffer
- Nursing Academy of Health CareViaa Christian University of Applied SciencesZwolleThe Netherlands
| | - Bodil Bø
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Britt Moene Kuven
- Western Norway University of Applied SciencesBergenNorway
- Faculty of Health Studies, VID Specialized UniversityBergenNorway
| | - Wilfred McSherry
- VID Specialized UniversityBergenNorway
- Department of Nursing, School of Health, Science and Wellbeing, Staffordshire University Stoke‐on‐TrentUniversity Hospitals of North Midlands NHS TrustStoke‐on‐Trent/StaffordUK
- Faculty of Health StudiesVID Specialized UniversityOsloNorway
| | - Benson Owusu
- School of Public Health, College of Health SciencesUniversity of GhanaAccraGhana
| | - Linda Ross
- School of Care Sciences, Faculty of Life Sciences & EducationUniversity of South WalesNewportUK
| | | | - Venke Ueland
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Tove Giske
- Faculty of Health Studies, VID Specialized UniversityBergenNorway
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Asiimwe R, Dwanyen L, Subramaniam S, Kasujja R, Blow AJ. Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa. FAMILY PROCESS 2023; 62:160-181. [PMID: 35570371 DOI: 10.1111/famp.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
There has been an increase in the implementation of evidence-based parenting programs from high-income countries to several African countries. In this review, we systematically evaluated intervention studies of culturally adapted parenting programs in nine African countries with the objective of examining the quality of training for interventionists and cultural adaptation procedures. A total of 18 studies, obtained from an electronic search of 6 databases, met the inclusion criteria and were evaluated following PRISMA guidelines. The Ecological Validity Model was adopted to organize data on cultural adaptation procedures. Sixteen of the 18 studies reported information regarding the clinical training of interventionists and the cultural adaptations undertaken. Live and interactive workshops were the most common format used to train interventionists in the focal intervention. Overall, cultural adaptations in most studies included translation of intervention protocols into the local language. However, studies varied in the way cultural adaptation procedures were reported with some studies failing to report on cultural adaptation procedures. Concurring with previous literature, attending to issues of culture, power, privilege, access, sustainability, and other relevant concepts to increase the cultural relevance is highly encouraged in parent intervention studies in Africa. This review provides a baseline upon which future training and adaptation procedures can be built.
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Affiliation(s)
- Ronald Asiimwe
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Lekie Dwanyen
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Saila Subramaniam
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Rosco Kasujja
- Department of Mental Health, School of Psychology, Makerere University, Kampala, Uganda
| | - Adrian J Blow
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Bunn M, Zolman N, Smith CP, Khanna D, Hanneke R, Betancourt TS, Weine S. Family-based mental health interventions for refugees across the migration continuum: A systematic review. SSM - MENTAL HEALTH 2022. [PMID: 37529116 PMCID: PMC10392776 DOI: 10.1016/j.ssmmh.2022.100153] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study reviewed the literature on family-based mental health interventions for refugees across migration contexts and settings to identify types of interventions and intervention components, implementation approaches and to assess effectiveness. The review used a systematic approach, and ten intervention studies were retained for analysis. The findings identified three primary types of family-based mental health interventions used with diverse refugee communities in settings in the Global North and South-parenting groups, multiple family groups and home visiting interventions. Findings indicated that non-specialized or peer providers were frequently utilized to deliver the interventions though additional details on the workforce and workforce development strategies are needed to better understand how to sustain and support such providers. The findings suggest that family-based mental health interventions are potentially effective for improving a range of child and caregiver mental health outcomes and improving family processes and functioning among refugee families. However, the empirical evidence is quite limited to date, with a need for additional rigorous studies, especially with refugee families in humanitarian settings, to further build the evidence base.
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Giusto A, Friis-Healy EA, Kaiser BN, Ayuku D, Rono W, Puffer ES. Mechanisms of change for a family intervention in Kenya: An Integrated Clinical and Implementation Mapping approach. Behav Res Ther 2022; 159:104219. [PMID: 36283239 PMCID: PMC10155602 DOI: 10.1016/j.brat.2022.104219] [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: 09/30/2021] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.
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Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA; Duke Global Health Institute, Durham, NC, USA.
| | - Elsa A Friis-Healy
- Duke Global Health Institute, Durham, NC, USA; Department of Psychiatry Duke University School of Medicine, Durham, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Durham, NC, USA; University of California San Diego, Anthropology Department and Global Health Program, La Jolla, CA, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya.
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya.
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA; Department of Neuroscience and Psychology, Duke University, Durham, NC, USA.
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Wang C, Yan S, Jiang H, Guo Y, Gan Y, Lv C, Lu Z. Socio-demographic characteristics, lifestyles, social support quality and mental health in college students: a cross-sectional study. BMC Public Health 2022; 22:1583. [PMID: 35987998 PMCID: PMC9392273 DOI: 10.1186/s12889-022-14002-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mental health problems are important public health issues among college students and are associated with various social factors. However, these influencing factors were scarcely summarized in Chinese college students comprehensively. This study aims to assess the associations between socio-demographic characteristics, lifestyles, social support quality (SSQ) and mental health among Chinese college students .
Methods
A cross-sectional study was conducted in Wuhan, China, from October 2017 to February 2018. College students from 18 colleges or universities were randomly recruited using multi-stage cluster sampling method. The Multidimensional Scale of Perceived Social Support scale and 12-items General Health Questionnaire were used to estimate students’ SSQ and mental health statuses, respectively. Logistic regression analysis was used to evaluate the associations between socio-demographic characteristics, lifestyles, SSQ and mental health problems.
Results
A total of 10,676 college students were included. Among them, 21.4% were identified as having possible mental health problems. Students being a female, aged 18–22 years old, whose mother held college degrees and above, and drinking alcohol were more likely to have mental health problems (P < 0.05). Contrarily, having general or higher household economic levels, work-rest regularly, and sleeping ≥ 7 h were preventive factors (P < 0.05). Especially, a decreasing trend in the risk of having mental health problems with the improvement of SSQ was identified.
Conclusion
Besides socio-demographic and lifestyle factors, social support is a critical factor for mental health among college students. Improving SSQ, especially which from the family, could be an effective method to prevent mental health problems among college students.
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Lebow JL. Attending to the larger system in systemic therapy and family research. FAMILY PROCESS 2021; 60:1079-1082. [PMID: 34961952 DOI: 10.1111/famp.12729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jay L Lebow
- Family Process and Family Institute at Northwestern and Northwestern University, Evanston, Illinois, USA
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Springer PR, Falceto O, Bischoff RJ, Barros E, Scheeren P, Taylor NC, Cargnin D. A pilot study of a family systems oriented telemental health model in rural Brazil. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:533-548. [PMID: 33742717 DOI: 10.1111/jmft.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
There are large disparities in access to mental health care, especially in low- and middle-income countries. Telemental health is a viable solution to reducing these disparities, but quality research demonstrating its effectiveness is needed. The purpose of this pilot study was to examine the feasibility of a telemental health approach in a rural region of Brazil. Primary care providers referred patients diagnosed with depression and anxiety to a 12-session family systems-oriented telemental health program developed by the researchers. Participants (n = 10) received therapy by family systems trained therapists. While sessions were delivered via telemental health, each received one face-to-face session as part of the treatment regimen. Results from the one-tailed t-tests indicate reductions in psychosocial symptoms and improvements in family functioning with medium and large effect sizes. Findings reveal that a family systems-oriented telemental health approach is a promising intervention for improving mental health outcomes in a middle-income country.
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Affiliation(s)
- Paul R Springer
- Department of Child, Youth, and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Olga Falceto
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Richard J Bischoff
- Institute of Agriculture and Natural Resources, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Enrique Barros
- Clinica da Familia Teewald Santa Maria do Herval and the Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | | | - Nathan C Taylor
- School of Applied Human Sciences, University of Northern Iowa, Cedar Falls, IA, USA
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Puffer ES, Healy EF, Green EP, Giusto AM, Kaiser BN, Patel P, Ayuku D. Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:3493-3508. [PMID: 33664559 PMCID: PMC7924913 DOI: 10.1007/s10826-020-01816-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-based interventions offer a promising avenue for addressing chronic negative family interactions that contribute to lasting consequences, including family violence and the onset and maintenance of mental health disorders. The purpose of this study was to conduct a mixed-methods, single group pre-post pilot trial of a family therapy intervention (N = 10) delivered by lay counselors in Kenya. Results show that both caregivers and children reported reductions in family dysfunction and improved mental health after the intervention. Point estimates represent change of more than two standard deviations from baseline for the majority of primary outcomes. Treated families also reported a decrease in harsh discipline, intimate partner violence, and alcohol-related problems. These results were corroborated by findings from an observational measure of family functioning and in-depth qualitative interviews. This study presents preliminary evidence of pre-post improvements following a family therapy intervention consisting of streamlined, evidence-informed family therapy strategies to target family dysfunction and mental health.
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Affiliation(s)
- Eve S. Puffer
- Department of Psychology and Neuroscience, Duke University, Box 90086417 Chapel Drive, Durham, NC 27708-0086, USA
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - Elsa Friis Healy
- Department of Psychology and Neuroscience, Duke University, Box 90086417 Chapel Drive, Durham, NC 27708-0086, USA
| | - Eric P. Green
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - Ali M. Giusto
- Department of Psychology and Neuroscience, Duke University, Box 90086417 Chapel Drive, Durham, NC 27708-0086, USA
| | - Bonnie N. Kaiser
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - Puja Patel
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - David Ayuku
- Department of Behavioral Science, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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Noubani A, Diaconu K, Ghandour L, El Koussa M, Loffreda G, Saleh S. A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon. Global Health 2020; 16:28. [PMID: 32228648 PMCID: PMC7106684 DOI: 10.1186/s12992-020-00556-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/10/2020] [Indexed: 02/05/2024] Open
Abstract
Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. Methods A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees’ community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. Results Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. Conclusion Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.
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Affiliation(s)
- Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maria El Koussa
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Giulia Loffreda
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
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Utržan DS, Wieling EA. A Phenomenological Study on the Experience of Syrian Asylum-Seekers and Refugees in the United States. FAMILY PROCESS 2020; 59:209-228. [PMID: 30414325 DOI: 10.1111/famp.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Violence in Syria has displaced an unprecedented number of people from their homes. While couple/family therapy (C/MFT) scholars have explored migration experiences, particularly among refugees, there is still limited research using a bioecological framework. This exploratory study examined the experiences of Syrian asylum-seekers and refugees living in the United States using a qualitative phenomenological approach. Twelve Syrians (n = 8 men, n = 4 women) between 20 and 52 years of age (M = 35.8, SD = 10.7) were interviewed about their experiences across three stages of resettlement: (1) pre-resettlement, (2) resettlement/migration, and (3) post-resettlement. Findings suggest that the effects of conflict-induced displacement and resettlement permeate across multiple ecologies. These range from the individual and his or her interpersonal relationships to their larger community and society. C/MFTs should account for contextual factors while becoming familiar with the sociopolitical impact of displacement and resettlement in their clinical work with this population.
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Affiliation(s)
- Damir S Utržan
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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Lebow JL. Editorial: Family Therapy and the Mental Health Professions Across the Globe. FAMILY PROCESS 2019; 58:269-272. [PMID: 31161613 DOI: 10.1111/famp.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jay L Lebow
- Family Institute at Northwestern, Evanston, IL
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Singh PP, Goel I, Mondal A, Khan FA, Singh AK, Dubey P, Chaudhary S, Reddy PVAK, Rodrigues V, Bassi V, Ahuja K, Shetty A, Sahu AK, Jodha K, Singh N, Das S, Sharma R, Bagaria R, Poojary S, Gohil SM, Bonu A, Vazirani S, Esfandiari L, Shukla S, Shukla S, Khurana S. Acceptability of Mental Health Facilities and De-addiction Centers in India. J Exp Neurosci 2019; 13:1179069519839990. [PMID: 31001063 PMCID: PMC6454643 DOI: 10.1177/1179069519839990] [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] [Received: 11/13/2018] [Accepted: 03/01/2019] [Indexed: 11/07/2022] Open
Abstract
Not much is known about disease prevalence, treatment outcomes, trained manpower,
programs, and patients’ awareness of diseases from South Asia, compared with the
Western world. While other aspects are improving, the quantitative evaluation of
awareness of diseases is lagging. Compared with other diseases, the situation
for mental health disorders and addiction is worse. While no single study can
fully quantify all aspects of awareness, a good starting point is to understand
if increasing the number of mental health facilities is beneficial by
understanding people’s perception toward the likelihood of contracting various
diseases, their preferred approach to treatment, and their perception of whether
there are enough current facilities. We surveyed over 8000 families across
several states of India and asked if they would treat a particular problem at
home, visit a local healer, seek religious council, or go to a modern hospital
for treatment. Our questions also included non-medical options to assess how
likely people are to avoid trained medical help. We also asked people about
their perceived likelihood of a family member ever suffering from (1) diarrhea,
(2) high fever, (3) alcoholism, and (4) schizophrenia and other mental health
problems. We reversed the order of diseases in our questions for a fraction of
the population to evaluate the effect of order of questioning. Finally, we
asked, if people feel they have enough local healers, religious places, general
hospitals, de-addiction centers, and mental health facilities. Despite the taboo
around mental health, many people claimed that their family members were
unlikely to contract mental health or addiction problems, people recognized the
severe paucity of mental health facilities and de-addiction centers. This raises
hope for improving the mental health situation in India. We also found a
significant relation between education levels and choices people make,
underscoring the positive role education has in improving mental health.
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Affiliation(s)
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- Department of Zoology, Government Meera Girls College, Udaipur, India
| | - Shubha Shukla
- Department of Pharmacology, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Sukant Khurana
- Department of Pharmacology, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
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Lebow JL. Editorial: Social Justice in Family Therapy. FAMILY PROCESS 2019; 58:3-8. [PMID: 30851135 DOI: 10.1111/famp.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jay L Lebow
- Family Institute at Northwestern, Evanston, IL
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