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Ametaj AA, Denckla CA, Stevenson A, Stroud RE, Hall J, Ongeri L, Milkias B, Hoffman J, Naisanga M, Akena D, Kyebuzibwa J, Kwobah EK, Atwoli L, Gichuru S, Teferra S, Alemayehu M, Zingela Z, Stein DJ, Pretorius A, Newton CR, Mwema RM, Kariuki SM, Koenen KC, Gelaye B. Cross-cultural equivalence of the Kessler Psychological Distress Scale (K10) across four African countries in a multi-national study of adults. SSM - MENTAL HEALTH 2024; 5:100300. [PMID: 38706931 PMCID: PMC11064105 DOI: 10.1016/j.ssmmh.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all. Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confirmatory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries. Monte Carlo simulations showed a correlation of 0.998, a good replication of population values, indicating minimal noninvariance, or variation. Items "so nervous," "lack of energy/effortful tasks," and "tired" were consistently equivalent for intercepts and factor loadings, respectively. However, items "depressed" and "so depressed" consistently differed across study countries (R2 = 0) for intercepts and factor loadings for both items. The K10 scale likely functions equivalently across the four countries for most items, except "depressed" and "so depressed." Differences in K10 items were more common in Kenya and Ethiopia, suggesting cultural context may influence the interpretation of some items and the potential need for cultural adaptations in these countries.
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Affiliation(s)
- Amantia A. Ametaj
- Institute of Health Equity and Social Justice, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rocky E. Stroud
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jasmine Hall
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Barkot Milkias
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jacob Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Molly Naisanga
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | - Edith K. Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Stella Gichuru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Internal Medicine, Medical College East Africa, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkam Alemayehu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zukiswa Zingela
- Executive Dean’s Office, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Adele Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charles R.J.C. Newton
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rehema M. Mwema
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
| | - Symon M. Kariuki
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bizu Gelaye
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H Chan School of Public Health, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Limenih G, MacDougall A, Wedlake M, Nouvet E. Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:95-107. [PMID: 38105446 PMCID: PMC10955781 DOI: 10.1177/27551938231220230] [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: 03/09/2023] [Revised: 09/09/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.
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Affiliation(s)
- Gojjam Limenih
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Arlene MacDougall
- Department of Pyschiatry, Western University Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Marnie Wedlake
- School of Health Studies, Western University, London, ON, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, London, ON, Canada
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Kacmarek CN, Johnson NE, Osborn TL, Wasanga C, Weisz JR, Yates BT. Costs and cost-effectiveness of Shamiri, a brief, layperson-delivered intervention for Kenyan adolescents: a randomized controlled trial. BMC Health Serv Res 2023; 23:827. [PMID: 37542304 PMCID: PMC10403919 DOI: 10.1186/s12913-023-09856-z] [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: 03/05/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group- and school-based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation. METHODS We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat. RESULTS Base case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between $48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up. CONCLUSIONS Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12-16 weekly sessions necessary for gold-standard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced the cost per student; however, broader conclusions about the cost-effectiveness of Shamiri have yet to be determined due to limited economic evaluations of mental health programs in LMICs. TRIAL REGISTRATION This study was registered prior to participant enrollment in the Pan-African Clinical Trials Registry (PACTR201906525818462), registered 20 Jun 2019, https://pactr.samrc.ac.za/Search.aspx .
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Affiliation(s)
- Corinne N. Kacmarek
- Department of Psychology, American University, 4400 Massachusetts Ave NW, Washington, DC 20016 USA
| | - Natalie E. Johnson
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Totengässlein 3, 4051 Basel, Switzerland
| | - Tom L. Osborn
- Shamiri Institute, 13th Floor, Pioneer Point (CMS Africa), Chania Avenue, Nairobi, Kenya
| | - Christine Wasanga
- Department of Psychology, Kenyatta University, Box 43844, Nairobi, 00100 Kenya
| | - John R. Weisz
- Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA 02138 USA
| | - Brian T. Yates
- Department of Psychology, American University, 4400 Massachusetts Ave NW, Asbury Building Room 321, Washington, DC, 20016-8062 USA
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Giusto A, Romer A, Lovero K, dos Santos PF, Greene C, Gouveia L, Suleman A, Feliciano P, Oquendo MA, Mootz J, Wainberg ML. Examination of the Factor Structure of Psychopathology in a Mozambican Sample. Clin Psychol Sci 2023; 11:409-424. [PMID: 37181407 PMCID: PMC10181828 DOI: 10.1177/21677026221122773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Factor-analytic studies are needed in global samples to advance understanding of psychopathology. We aimed to examine the structure of psychopathology and a general psychopathology ('p') factor using data from a cross-sectional study of 971 adults (63% women) from Maputo City, Mozambique. We used confirmatory factor analyses of symptoms from 15 psychiatric disorders to test common models of the structure of psychopathology. Models including internalizing, substance use, and thought disorder factors as well as a general p-factor fit the data well. Measurement invariance testing revealed that factor loadings on p differed by gender. Higher levels of p, internalizing, and thought disorder factors were associated with greater suicide risk, psychiatric comorbidity, chronic medical illnesses, and poorer functioning. A general psychopathology ('p') factor and internalizing, substance use, and thought disorder factors are identifiable in this Mozambican sample. Understanding psychopathology dimensions is a step toward building more scalable mental health service approaches globally.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Adrienne Romer
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Belmont, MA, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Palmira Fortunado dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Antonio Suleman
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Paulino Feliciano
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Jennifer Mootz
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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Affiliation(s)
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
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6
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Depression and anxiety symptoms amongst kenyan adolescents: Psychometric Properties, Prevalence Rates and Associations with Psychosocial Wellbeing and Sociodemographic factors. Res Child Adolesc Psychopathol 2022; 50:1471-1485. [PMID: 35675002 DOI: 10.1007/s10802-022-00940-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 01/09/2023]
Abstract
This study assessed the psychometric properties of standard Western-derived instruments, the prevalence of depression and anxiety symptoms, and their associations with sociodemographic and wellbeing variables in a large sample of Kenyan adolescents. Self-report measures of depression (PHQ-8) and anxiety (GAD-7) symptoms, social support, gratitude, happiness, optimism, and perceived control were administered to 2,192 Kenyan youths (57.57% female) aged 12-19. Both the PHQ-8 (α = 0.78) and GAD-7 (α = 0.82) showed adequate internal consistency. EFA with a sub-sample (N = 1096) yielded a 1-factor structure for both PHQ-8 and GAD-7, a subsequent CFA conducted on the basis of a 1-factor model on another sub-sample (N = 1096) yielded good and moderate goodness of fit, respectively, for the PHQ-8 (χ2 = 76.73; p < 0.001; RMSEA = 0.05; CFI = 0.96; TLI = 0.95) and the GAD-7 (χ2 = 88.19; p < 0.001; RMSEA = 0.07; CFI = 0.97; TLI = 0.95). Some 28.06% and 30.38% of participants met the clinical cut-off for depressive and anxiety symptoms, respectively. Social support, gratitude, happiness, and perceived control were negatively associated with both depression and anxiety symptoms. Older adolescents reported higher symptoms while adolescents with more siblings reported lower symptoms. The western-derived PHQ and GAD met conventional psychometric standards with adolescents in Kenya; depression and anxiety symptoms showed relatively high prevalence and significant associations with important psychosocial and sociodemographic factors.
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Wallin MI, Galanti MR, Nevonen L, Lewis-Fernández R, Bäärnhielm S. Impact on routine psychiatric diagnostic practice from implementing the DSM-5 cultural formulation interview: a pragmatic RCT in Sweden. BMC Psychiatry 2022; 22:149. [PMID: 35216555 PMCID: PMC8876131 DOI: 10.1186/s12888-022-03791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive tool, the DSM-5 core Cultural Formulation Interview (CFI), to routine diagnostic procedures impacts the psychiatric diagnostic process. METHOD We compared the outcome of a diagnostic procedure that included the CFI with routine diagnostic procedures used at Swedish psychiatric clinics. New patients (n = 256) admitted to a psychiatric outpatient clinic were randomized to a control (n = 122) or CFI-enhanced diagnostic procedure (n = 134) group. An intention-to-treat analysis was conducted and the prevalence ratio and corresponding 95% confidence intervals (CI) were calculated across arms for depressive and anxiety disorder diagnoses, multiple diagnoses, and delayed diagnosis. RESULTS The prevalence ratio (PR) of a depressive disorder diagnosis across arms was 1.21 (95% CI = 0.83-1.75), 33.6% of intervention-arm participants vs. 27.9% of controls. The prevalence ratio was higher among patients whose native language was not Swedish (PR =1.61, 95% CI = 0.91-2.86). The prevalence ratio of receiving multiple diagnoses was higher for the CFI group among non-native speaking patients, and lower to a statistically significant degree among native Swedish speakers (PR = .39, 95% CI = 0.18-0.82). CONCLUSIONS The results suggest that the implementation of the DSM-5 CFI in routine psychiatric diagnostic practice may facilitate identification of symptoms of certain psychiatric disorders, like depression, among non-native speaking patients in a migration context. The CFI did not result in a reduction of patients with a non-definite diagnosis. TRIAL REGISTRATION ISRCTN51527289 , 30/07/2019. The trial was retrospectively registered.
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Affiliation(s)
- Malin Idar Wallin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Region Stockholm, Sweden.
| | - Maria Rosaria Galanti
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, & Centre for Epidemiology and Community Medicine (CES), Stockholm, Region Stockholm Sweden
| | - Lauri Nevonen
- grid.15895.300000 0001 0738 8966Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, & Aleris Psychiatry AB, Stockholm, Sweden
| | - Roberto Lewis-Fernández
- grid.413734.60000 0000 8499 1112Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Sofie Bäärnhielm
- grid.467087.a0000 0004 0442 1056Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Region Stockholm Sweden
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Kumar M, Osborn TL, Mugo C, Akbarialiabad H, Warfa O, Mbuthia WM, Wambugu C, Ngunu C, Gohar F, Mwaniga S, Njuguna S, Saxena S. A Four-Component Framework Toward Patient-Centered, Integrated Mental Healthcare in Kenya. Front Public Health 2021; 9:756861. [PMID: 34926382 PMCID: PMC8671159 DOI: 10.3389/fpubh.2021.756861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022] Open
Abstract
Background: How can we fast-track the global agenda of integrated mental healthcare in low- and middle-income countries (LMICs) such as Kenya? This is a question that has become increasingly important for individuals with lived experiences, policymakers, mental health advocates and health care providers at the local and international levels. Discussion: This narrative synthesis and perspective piece encompasses an overview of mental health care competencies, best practices and capacity building needed to fast track patient responsive services. In that vein we also review key policy developments like UHC to make a case for fast-tracking our four-step framework. Results: While there is an increasingly global impetus for integrated mental healthcare, there is a lack of clarity around what patient-responsive mental healthcare services should look like and how to measure and improve provider readiness appropriately. Here, our collaborative team of local and international experts proposes a simple four-step approach to integrating responsive mental healthcare in Kenya. Our recommended framework prioritizes a clear understanding and demonstration of multidimensional skills by the provider. The four steps are (1) provider sensitization, (2) continuous supervision, (3) continuous professional training, and (4) leadership empowerment. Conclusion: Our proposed framework can provide pointers to embracing patient-centered and provider empowerment focused quality of care improvements. Though elements of our proposed framework are well-known, it has not been sufficiently intertwined and therefore not been integrated. We think in the current times our integrated framework offers an opportunity to “building back better” mental health for all.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.,Department of Psychology, University College London, London, United Kingdom
| | - Thomas L Osborn
- Shamiri Institute, Nairobi, Kenya.,Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Cyrus Mugo
- Kenyatta National Hospital, Nairobi, Kenya
| | - Hossein Akbarialiabad
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Osman Warfa
- Health Service Coordination, Ministry of Health, Nairobi, Kenya
| | | | | | - Carol Ngunu
- Preventive and Promotive Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Fatima Gohar
- United Nations Children's Fund (UNICEF), ESARO, Nairobi, Kenya
| | - Shillah Mwaniga
- Adolescents and Key Populations, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Simon Njuguna
- Mental Health and Substance Use Department, Ministry of Health, Nairobi, Kenya
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard TC Chan School of Public Health, Harvard University, Cambridge, MA, United States
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Venturo-Conerly KE, Osborn TL, Wasil AR, Le H, Corrigan E, Wasanga C, Weisz JR. Testing the effects of the Shamiri Intervention and its components on anxiety, depression, wellbeing, and academic functioning in Kenyan adolescents: study protocol for a five-arm randomized controlled trial. Trials 2021; 22:829. [PMID: 34809679 PMCID: PMC8607059 DOI: 10.1186/s13063-021-05736-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/20/2021] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Treatments for youth mental disorders are a public health priority, especially in sub-Saharan Africa (SSA), where treatment options remain limited due to high cost, elevated stigma, and lack of trained mental health professionals. Brief, accessible, and non-stigmatizing community-based interventions delivered by lay providers may help address treatment needs in SSA. One such intervention, the Shamiri Intervention, consisting of three elements (growth mindset, gratitude, and value affirmation) has been tested in randomized controlled trials with school-going Kenyan adolescents. This three-element Shamiri Intervention has been shown to significantly reduce depression and anxiety symptoms and improve social support and academic performance relative to a control group. In this trial, we aim to investigate the effects of each element of the Shamiri Intervention. METHODS In this five-arm randomized controlled trial, we will test each of the intervention components (growth mindset, gratitude, and value affirmation) against the full Shamiri Intervention and against a study skills control intervention. Students (Nplanned = 1288) at participating secondary schools who are interested in participating in this universal intervention will be randomized in equal numbers into the five groups. The students will meet in groups of 8-15 students led by local high school graduate lay providers. These lay providers will receive a brief training, plus expert supervision once a week throughout the intervention delivery. Multi-level models will be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes in each intervention group to the control group. Multi-level models will also be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes of participants in the single-element interventions compared to the full Shamiri Intervention. Finally, effect sizes (calculated as mean gain scores) will be used to compare all groups on all measures. DISCUSSION This trial will shed light on the mechanisms and outcomes targeted by each individual intervention, helping prioritize which mental health interventions are most important to disseminate. TRIAL REGISTRATION PACTR Trial ID: PACTR202104716135752 . Approved on 4/19/2021.
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Affiliation(s)
- Katherine E Venturo-Conerly
- Shamiri Institute, Nairobi, Kenya.
- Department of Psychology, Harvard University, Cambridge, MA, USA.
- Shamiri Institute, Allston, MA, USA.
| | - Tom L Osborn
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Akash R Wasil
- Shamiri Institute, Allston, MA, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Huong Le
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Emily Corrigan
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Christine Wasanga
- Shamiri Institute, Nairobi, Kenya
- Department of Psychology, Kenyatta University, Nairobi, Kenya
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Shamiri Institute, Allston, MA, USA
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10
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Burrows K, Pelupessy DC, Khoshnood K, Bell ML. Environmental Displacement and Mental Well-Being in Banjarnegara, Indonesia. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:117002. [PMID: 34747632 PMCID: PMC8575071 DOI: 10.1289/ehp9391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Residential moves (displacement) owing to climate- and weather-related disasters may significantly impact mental health. Despite the growing risk from climate change, health impacts of environmental-mobility remain understudied. OBJECTIVES We assessed the effects of displacement on the association between landslides and changes in perceived mental well-being in Banjarnegara, Indonesia. We also investigated whether sociodemographics (age, sex, level of education, household-level income, or employment in agriculture) and landslide characteristics (number and severity of landslides) were associated with differing odds of relocation after experiencing landslides. METHODS In this cross-sectional study, we surveyed 420 individuals who experienced landslides between 2014 and 2018 to assess perceived changes in mental well-being, comparing after landslide exposure to before landslide exposure. We used a novel six-item measure that was created in collaboration with the local community to compare perceived changes between those who were displaced by landslides and those who were not displaced, using logistic and multinomial regressions adjusted for sociodemographic characteristics. We then assessed whether the odds of displacement differed based on sociodemographic characteristics and landslide exposure characteristics, using logistic regressions. RESULTS Those who were displaced were more likely than those who were not displaced to report perceived increases in economic stability [odds ratio (OR)=3.06; 95% confidence interval (CI): 1.45, 6.46], optimism (OR=4.01; 95% CI: 1.87, 8.61), safety (OR=2.71; 95% CI: 1.44, 5.10), religiosity (OR=1.92; 95% CI: 1.03, 3.65), and closeness with community (OR=1.90; 95% CI: 1.10, 3.33) after landslides compared with before their first landslide during the study period. More frequent landslide exposures were associated with reduced odds of relocation, but more severe landslides were associated with increased odds of relocation. DISCUSSION These findings suggest that landslides affect the mental well-being not only of those who are displaced but also of those who are left behind. Further, this work supports the need for community-based participatory research to fully capture the health impacts of environmental mobility. https://doi.org/10.1289/EHP9391.
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Affiliation(s)
- Kate Burrows
- School of the Environment, Yale University, New Haven, Connecticut, USA
| | | | - Kaveh Khoshnood
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Michelle L. Bell
- School of the Environment, Yale University, New Haven, Connecticut, USA
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Ojagbemi A, Gureje O. Sociocultural contexts of mental illness experience among Africans. Transcult Psychiatry 2021; 58:455-459. [PMID: 34427458 DOI: 10.1177/13634615211029055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
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Campbell S, Osborn TL. Adolescent psychopathology and psychological wellbeing: a network analysis approach. BMC Psychiatry 2021; 21:333. [PMID: 34217254 PMCID: PMC8254923 DOI: 10.1186/s12888-021-03331-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/18/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The extent to which psychological wellbeing may play a preventive and therapeutic role in the development and maintenance of adolescent emotional disorders depends, in part, on the nature of the overlap between these two constructs. We estimated network analysis to examine the relationship between adolescent psychopathology (measured by depression and anxiety symptoms) and psychological wellbeing (measured by happiness, optimism, social support, perceived control, and gratitude). METHODS This was a cross-sectional study with a large community sample of Kenyan adolescents (N = 2192, aged 13-18). Network analyses were conducted to examine the topology, stability, centrality, and bridge nodes of a network of psychopathology and psychological wellbeing measures. RESULTS Two distinct community clusters emerged, one for psychopathology nodes and another for wellbeing nodes, suggesting that these are two distinct but connected concepts. Central and bridge nodes of the wellbeing and psychopathology network were identified. The most central nodes in the network were family provides emotional help and support and self-blame; the strongest negative edges between psychopathology and psychological wellbeing were depressed mood-I love life and irritability-I am a joyful person; the main bridge nodes were family helps me and I can talk to family about problems. CONCLUSIONS Our findings expand understanding of the relationship between psychopathology and wellbeing in an understudied population and are suggestive of how psychological wellbeing can inform psychopathological treatment and preventive efforts in low-income regions such as those in Sub Saharan Africa.
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