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Zhang Q, Liu P, Zhang Y, Yan M. The Psychological Experiences of Adolescents Who Engage in Non-Suicidal Self-Injury: A Meta-Aggregative Synthesis of Qualitative Studies. Issues Ment Health Nurs 2024; 45:857-867. [PMID: 39106276 DOI: 10.1080/01612840.2024.2374011] [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: 08/09/2024]
Abstract
Non-suicidal self-injury (NSSI) is an international public health problem. Qualitative synthesis of the psychological experiences associated with NSSI in adolescents remains limited. This study aimed to systematically review the factors, emotional experiences, coping strategies, and help-seeking experiences of adolescents who engage in NSSI. A comprehensive search of 10 databases was conducted. Two researchers independently conducted study screening, data extraction, and quality assessment. Eighteen articles were included and analyzed using a meta-aggregation approach. Four themes were identified: (1) factors contributing to NSSI, (2) emotions associated with engaging in NSSI, (3) coping strategies, and (4) potential barriers to seeking help. Our findings provide a comprehensive picture of the psychological experiences of adolescents who engage in NSSI. They primarily adopt negative coping strategies to deal with serious problems, and there are potential barriers to seeking help. Further research is needed to explore the true needs of adolescents, as well as how schools, families, and hospitals can play a collaborative role in improving adolescents' psychological issues.
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Affiliation(s)
- Qian Zhang
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Panyu Liu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Yuhan Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Meiqin Yan
- Department of Science and Education, Children's Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, China
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Brault MA, Peskin MF, Jones AN, Saikia A, Bhutia RO, Cheruvu SS, Jagtap VM, Singh R, Nair P, Vedanthan R, Vermund SH, Maitra S. A Mixed Methods Exploration of Young Women's Agency and Mental Health during COVID-19 in Low-Income Communities in Mumbai, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1007. [PMID: 39200618 PMCID: PMC11354834 DOI: 10.3390/ijerph21081007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 09/02/2024]
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) in India face additional health inequities compared to their male peers, as gender norms constrain agency for prevention and self-care. The onset of the COVID-19 pandemic and associated lockdowns deepened health inequities and often worsened mental health, but the impacts on agency are unclear. This exploratory sequential mixed methods paper examined mental health and COVID-19 elements that exacerbated or mitigated adverse consequences for AGYW in low-income communities in Mumbai. METHODS We conducted semi-structured interviews with AGYW (aged 15-25 years; N = 60) and adults (parents, healthcare providers, community-based organization representative; N = 30). We administered a structured survey to AGYW (N = 150) to assess health concerns, depression and anxiety symptoms (using the PHQ-8 and GAD-7 scales), and experiences during COVID-19. We analyzed qualitative data using the constant comparative approach in Atlas.ti, and quantitative data using R and SPSS. RESULTS Qualitative data revealed that AGYW faced stressors and had limited agency during lockdowns due to limited access to education, financial insecurity, and community violence. Quantitative data indicated that limited agency in the context of COVID-19 was significantly associated with depression and anxiety. Financial resources to address COVID-19 created new employment and leadership opportunities for AGYW to become COVID educators and preschool teachers; participation in these opportunities was associated with less anxiety. DISCUSSION Pandemic stress was difficult for low-income AGYW in Mumbai. Mitigating programs for COVID-19 control helped address acute needs and enable capabilities. Exploring similar themes among a broader population of youth can help design strategies and opportunities for young people in low-income communities during health emergencies.
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Affiliation(s)
- Marie A. Brault
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX 78229, USA
| | - Melissa F. Peskin
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA;
| | - Anastasia N. Jones
- Department of Epidemiology, Human Genetics and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX 78229, USA;
| | - Amrita Saikia
- Jamsetji Tata School of Disaster Studies, Tata Institute of Social Sciences, Mumbai 400088, India;
| | - Rinchen O. Bhutia
- Centre for Public Health, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai 400088, India;
| | - Sai Sammitha Cheruvu
- Department of Epidemiology, Human Genetics and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA;
| | | | - Rajendra Singh
- International Center for Research on Women (ICRW) Asia Office, New Delhi 110018, India;
| | - Poornima Nair
- Health and Disability, Apnalaya, Mumbai 400071, India;
| | - Rajesh Vedanthan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Shubhada Maitra
- Centre for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai 400088, India;
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Hagaman AK, Bates LM, Atif N, Chung E, LeMasters K, Rahman A, Saqib K, Sikander S, Maselko J. Suicide Ideation within and outside the Perinatal Period: An Exploration of Interpersonal Factors from a Maternal Cohort in Rural Pakistan to Improve Intervention Targeting. Arch Suicide Res 2024; 28:231-249. [PMID: 36533657 PMCID: PMC10277318 DOI: 10.1080/13811118.2022.2154727] [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: 12/23/2022]
Abstract
OBJECTIVE Suicide accounts for substantial mortality in low-resourced settings and contributes to nearly 20% of maternal deaths. In Asia, interpersonal conflict is a salient factor that contributes to suicidal thoughts and actions, yet limited research has been done to explore the type and timing of such conflicts and a woman's accompanying social support. Identifying such risk factors can inform improved efforts to identify who to target for psychosocial interventions. METHODS Using the Bachpan Cohort study of mothers in Pakistan (n = 1154), we examined the prevalence and interpersonal influences on SI within the past two weeks of pregnancy and then at 3, 6, and 24 months after birth. Using hierarchical mixed effects models, we explored the separate and combined associations of interpersonal factors [e.g., social support, interpersonal conflict, isolation, and past year intimate partner violence (IPV)] on SI at each timepoint. RESULTS SI prevalence was highest in pregnancy (12.2%) and dropped to 5% throughout two years postpartum. The interpersonal conflict was independently associated with increased odds of SI in pregnancy and 24 months postpartum. IPV was associated with increased SI in pregnancy and 24 months postpartum. Isolation was not associated with SI at any timepoint. Perceived social support remained a robust independent factor associated with reduced SI at all timepoints. CONCLUSION In addition to screening and deploying interventions for perinatal women with depression, targeting interventions for those who also experience interpersonal conflict, including intimate partner violence, may significantly reduce suicidal thoughts and related sequelae. Social support is a viable and potentially powerful target to reduce the burden of suicide among women.HIGHLIGHTSSuicidal ideation prevalence was higher in pregnancy compared to postpartum.Perceived social support was independently associated with reduced suicidal ideation.Interventions addressing suicide must attend to women's family and social context.
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Aggarwal S, Armstrong G. How, when and where to intervene in self-harm in youth in low- and middle-income countries: Thinking beyond healthcare systems. Int J Soc Psychiatry 2023; 69:1837-1839. [PMID: 37162034 PMCID: PMC7615317 DOI: 10.1177/00207640231174368] [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: 05/11/2023]
Abstract
BACKGROUND Low- and middle-income countries (LMICs) account for 78% of global suicides. Self-harm is the clearest antecedent of suicide. The health and social systems have struggled to provide adequate evidence based help to young people with self-harm. In addition, the negative attitudes towards those who self-harm in these settings interfere with help-seeking behaviour. AIMS AND METHOD In our submission of a comment, we discuss the reasons for thinking beyond healthcare systems in LMICs to address self-harm in youth and the possible ways to achieve it. RESULTS AND CONCLUSION We truly believe that harnessing the potential of social systems such as schools is important for addressing self-harm in LMICs. We present our arguments in favour of feasible measures that can be implemented to achieve this.
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Affiliation(s)
- Shilpa Aggarwal
- Public Health Foundation of India, New Delhi, India
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Mellbourne, VIC, Australia
- Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Rameez S, Nasir A. Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review. J Family Med Prim Care 2023; 12:1485-1504. [PMID: 37767443 PMCID: PMC10521856 DOI: 10.4103/jfmpc.jfmpc_391_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 09/29/2023] Open
Abstract
General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.
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Affiliation(s)
- Sahar Rameez
- Student Health and Wellbeing Organization (SHAW), Pakistan
| | - Almas Nasir
- Pakistan Association of Lifestyle Medicine, Pakistan
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Aggarwal S, Borschmann R, Patton GC. Tackling stigma in self-harm and suicide in the young. LANCET PUBLIC HEALTH 2021; 6:e6-e7. [PMID: 33417848 PMCID: PMC7611270 DOI: 10.1016/s2468-2667(20)30259-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Shilpa Aggarwal
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; Department of Psychiatry and Clinical Psychology, NH SRCC Children's Hospital, Mumbai, India; Faculty of Health, School of Medicine, Deakin University, Geelong, VIC 3220, Australia.
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Aggarwal S, Patton G, Berk M, Patel V. Design of a brief psychological intervention for youth who self-harm: a formative study in India. EVIDENCE-BASED MENTAL HEALTH 2020; 24:e2. [PMID: 33208508 DOI: 10.1136/ebmental-2020-300188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs). OBJECTIVE The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms. METHODS A systematic, sequential approach was used to integrate available scientific evidence, expert service providers' knowledge and experience, and service users' lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops. FINDINGS We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients. CONCLUSION AND CLINICAL IMPLICATIONS ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers.
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Affiliation(s)
- Shilpa Aggarwal
- Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia .,Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen (Centre for Youth Mental Health), Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Vikram Patel
- Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, Massachusetts, USA
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