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Luitel NP, Rimal D, Eleftheriou G, Rose-Clarke K, Nayaju S, Gautam K, Pant SB, Devkota N, Rana S, Chaudhary JM, Gurung BS, Åhs JW, Carvajal-Velez L, Kohrt BA. Translation, cultural adaptation and validation of Patient Health Questionnaire and generalized anxiety disorder among adolescents in Nepal. Child Adolesc Psychiatry Ment Health 2024; 18:74. [PMID: 38898474 PMCID: PMC11188246 DOI: 10.1186/s13034-024-00763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Depression and anxiety are significant contributors to the global burden of disease among young people. Accurate data on the prevalence of these conditions are crucial for the equitable distribution of resources for planning and implementing effective programs. This study aimed to culturally adapt and validate data collection tools for measuring depression and anxiety at the population level. METHODS The study was conducted in Kathmandu, Nepal, a diverse city with multiple ethnicities, languages, and cultures. Ten focus group discussions with 56 participants and 25 cognitive interviews were conducted to inform adaptations of the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Generalized Anxiety Disorder (GAD-7). To validate the tools, a cross-sectional survey of 413 adolescents (aged 12-19) was conducted in three municipalities of Kathmandu district. Trained clinical psychologists administered the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-DSM 5 version) to survey participants. RESULTS A number of cultural adaptations were required, such as changing statements into questions, using a visual scale (glass scale) to maintain uniformity in responses, and including a time frame at the beginning of each item. For younger adolescents aged 12 to 14 years, a PHQ-A cut-off of > = 13 had a sensitivity of 0.93, specificity of 0.80, positive predictive value (PPV) of 0.33, and negative predictive value (NPV) of 0.99. For older adolescents aged 15-19, a cut-off of > = 11 had a sensitivity of 0.89, specificity of 0.70, PPV of 0.32, and NPV of 0.97. For GAD-7, a cut-off of > = 8 had a sensitivity of 0.70 and specificity of 0.67 for younger adolescents and 0.71 for older adolescents, with a PPV of 0.39 and NPV of 0.89. The individual symptom means of both PHQ-A and GAD-7 items showed moderate ability to discriminate between adolescents with and without depression and anxiety. CONCLUSION The PHQ-A and GAD-7 demonstrate fair psychometric properties for screening depression but performed poorly for anxiety, with high rates of false positives. Even when using clinically validated cut-offs, population prevalence rates would be inflated by 2-4 fold with these tools, requiring adjustment when interpreting epidemiological findings.
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Affiliation(s)
- Nagendra P Luitel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA.
| | - Damodar Rimal
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Georgia Eleftheriou
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Suvash Nayaju
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Kamal Gautam
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
| | - Sagun Ballav Pant
- Department of Psychiatry & Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Narmada Devkota
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Shruti Rana
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Jug Maya Chaudhary
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | | | - Jill Witney Åhs
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Liliana Carvajal-Velez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, USA
| | - Brandon A Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
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Lahtinen O, Kangaslampi S, Aalto S, Soosalu J, Peltonen K. Cognitive, social, and mental health functions of refugee children - screening and supportive actions at school: a study protocol. BMC Psychol 2024; 12:251. [PMID: 38715097 PMCID: PMC11077695 DOI: 10.1186/s40359-024-01752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite a world-leading educational system, an achievement gap in educational outcomes exists between children of refugee background and native-born peers in Finland. To offer targeted support for children at schools, we need to be able to reliably assess and understand the interplay of the aspects of children's cognitive, social, and mental health functions that may explain the underachievement of refugee children. This study tests a novel research-based, universally applicable screening battery for evaluating cognitive, social, and mental health functioning of children at schools and planning supportive actions. It aims to answer research questions about a) the cognitive, social, and mental health functioning of refugee children compared with non-refugee immigrant and native-born children, b) the interplay of these different functions among refugee and other children, c) whether implementing a screening battery can inform schools in planning supportive actions for (refugee) children, and d) whether such supportive actions result in improvements in cognitive, social, and mental health functioning. METHODS Four hundred fifty children aged 10-12 will be recruited from primary schools, including 150 children of refugee background, 150 of non-refugee immigrant background, and 150 native-born Finnish children. A screening battery including tasks and questionnaires on different aspects of cognitive, social, and mental health functioning will be used to assess the children in their classrooms at the start and end of a school year. Supporting information will also be collected from parents and teachers. The information gathered will be collated into class-level feedback reports for teachers and, with parental permission, individualized reports for multiprofessional student welfare bodies, for informing supportive actions. Correlational and latent profile analyses, ANOVAs, and linear regression will be used to answer the research questions. DISCUSSION This study will help clarify how the interplay of cognitive, social, and mental health factors may explain underachievement at school among refugee children. It will provide evidence about the extent to which a standardized screening battery could be helpful in informing and planning supportive actions for children at schools, and whether such supportive actions can lead to positive cognitive, social, or mental health outcomes. TRIAL REGISTRATION The study will be preregistered on the Open Science Framework.
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Affiliation(s)
- Oskari Lahtinen
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| | - Samuli Kangaslampi
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland.
- Faculty of Social Sciences / Psychology, Tampere University, Tampere, Finland.
| | - Sanni Aalto
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| | - Joosu Soosalu
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
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Fennig M. Cross-culturally adapting the GHQ-12 for use with refugee populations: Opportunities, dilemmas, and challenges. Transcult Psychiatry 2024; 61:168-181. [PMID: 38233737 PMCID: PMC10943620 DOI: 10.1177/13634615231223884] [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] [Indexed: 01/19/2024]
Abstract
This article discusses the opportunities, dilemmas, and challenges involved in the cross-cultural adaptation (CCA) of psychological scales for use with refugee populations. It draws on insights derived from an attempt to adapt the 12-item General Health Questionnaire (GHQ-12) to the particular culture and context of Eritrean refugees residing in Israel. Multiple techniques including expert translations, a focus-group discussion, a survey, and piloting, were employed to attain a cross-cultural and conceptually equivalent measure. During the CCA process, the research team encountered issues pertaining to conceptual non-equivalence, the structure of the measure's responses and scoring system, and acceptability. These issues required the team to move beyond semantic translation by adapting certain items. This study demonstrates the compromises which need to be made in the adaptation process and indicates the potential bias which each of these compromises introduces. Despite its limitations, CCA does appear to significantly improve detection of mental health symptoms in refugee populations. Overall, the results of the present study provide support for the notion that the sensitive and appropriate assessment of individuals from refugee backgrounds requires adopting a rigorous, systematic, and contextual approach to instrument adaptation, with an emphasis on the integration of idioms of distress as well as the adaptation of Likert-type scales.
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Affiliation(s)
- Maya Fennig
- The Bob Shapell School of Social Work, The Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel
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Dijkstra JIR, van Elteren M, Banstola NL, Shakya L, Sigdel H, van Brakel WH. Cross-cultural validation of two scales to assess mental wellbeing in persons affected by leprosy in Province 1 and 7, Nepal. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002654. [PMID: 38271472 PMCID: PMC10810443 DOI: 10.1371/journal.pgph.0002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Abstract
To assess mental wellbeing among persons affected by leprosy, this study aimed to validate the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and the Patient Health Questionnaire (PHQ-9, depression tool) in Province 1 and 7, Nepal. Using purposive and convenience sampling, cross-cultural equivalences were assessed through semi-structured interviews with persons affected by leprosy (>18 years). Data were transcribed, translated, analysed and discussed with experts before revising the tools. Psychometric properties of the scales were assessed using an interviewer-administered questionnaire with cases affected by leprosy and controls not affected by leprosy (>18 years). Statistical analysis included internal consistency, construct validity, floor and ceiling effects, and interpretability. The qualitative study included 20 respondents of whom eleven were female. The statements in the original tools were rephrased to questions as participants had difficulties understanding the statements. Six additional changes were made to ensure items were understood well. The quantitative study included 90 cases (46% female) and 50 controls (54% female). The WEMWBS and PHQ-9 had adequate psychometric properties. Cronbach's alphas were 0.85 and 0.76, respectively, indicating good internal consistency, 75% of hypotheses for construct validity were confirmed, no floor and ceiling effects were found, and data to help users interpret results are presented. Our study provides evidence that the adapted versions of the WEMWBS and PHQ-9 have good cultural validity to measure mental wellbeing and depression among persons affected by leprosy in Province 1 and 7, Nepal.
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Affiliation(s)
- Janna I. R. Dijkstra
- Department of Ethics, Law and Humanities, VUmc School of Medical Sciences, Amsterdam University Medical Centres (AUMC), Amsterdam, The Netherlands
| | - Marianne van Elteren
- Department of Ethics, Law and Humanities, VUmc School of Medical Sciences, Amsterdam University Medical Centres (AUMC), Amsterdam, The Netherlands
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Lund C, Jordans MJD, Garman E, Araya R, Avendano M, Bauer A, Bahure V, Dua T, Eleftheriou G, Evans-Lacko S, García Rodríguez JF, Gautam K, Gevonden M, Hessel P, Kohrt BA, Krabbendam L, Luitel NP, Roy S, Seifert Bonifaz M, Singh R, Sinichi M, Sorsdahl K, Thornicroft G, Tol WA, Trujillo D, van der Merwe N, Wahid SS, Yarrow P. Strengthening self-regulation and reducing poverty to prevent adolescent depression and anxiety: Rationale, approach and methods of the ALIVE interdisciplinary research collaboration in Colombia, Nepal and South Africa. Epidemiol Psychiatr Sci 2023; 32:e69. [PMID: 38088153 PMCID: PMC10803189 DOI: 10.1017/s2045796023000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS Depression and anxiety are the leading contributors to the global burden of disease among young people, accounting for over a third (34.8%) of years lived with disability. Yet there is limited evidence for interventions that prevent adolescent depression and anxiety in low- and middle-income countries (LMICs), where 90% of adolescents live. This article introduces the 'Improving Adolescent mentaL health by reducing the Impact of poVErty (ALIVE)' study, its conceptual framework, objectives, methods and expected outcomes. The aim of the ALIVE study is to develop and pilot-test an intervention that combines poverty reduction with strengthening self-regulation to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal and South Africa. METHODS This aim will be achieved by addressing four objectives: (1) develop a conceptual framework that identifies the causal mechanisms linking poverty, self-regulation and depression and anxiety; (2) develop a multi-component selective prevention intervention targeting self-regulation and poverty among adolescents at high risk of developing depression or anxiety; (3) adapt and validate instruments to measure incidence of depression and anxiety, mediators and implementation parameters of the prevention intervention; and (4) undertake a four-arm pilot cluster randomised controlled trial to assess the feasibility, acceptability and cost of the selective prevention intervention in the three study sites. RESULTS The contributions of this study include the active engagement and participation of adolescents in the research process; a focus on the causal mechanisms of the intervention; building an evidence base for prevention interventions in LMICs; and the use of an interdisciplinary approach. CONCLUSIONS By developing and evaluating an intervention that addresses multidimensional poverty and self-regulation, ALIVE can make contributions to evidence on the integration of mental health into broader development policy and practice.
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Affiliation(s)
- Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, King’s College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark J. D. Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, King’s College London, London, UK
- WarChild, Amsterdam, Netherlands
| | - Emily Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ricardo Araya
- Centre for Global Mental Health and Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Mauricio Avendano
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Vikram Bahure
- Department of International Development, King’s College London, London, UK
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Georgia Eleftheriou
- Center for Global Mental Health Equity, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal
| | - Martin Gevonden
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Philipp Hessel
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Lydia Krabbendam
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal
| | - Sanchari Roy
- Department of International Development, King’s College London, London, UK
| | - Manuel Seifert Bonifaz
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rakesh Singh
- Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal
| | - Mohammadamin Sinichi
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Wietse A. Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Athena Research Institute, Vrije University Amsterdam, Amsterdam, the Netherlands
| | | | | | - Syed Shabab Wahid
- Department of Global Health, Georgetown University, Washington, DC, USA
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Kim Y, Rimal D, K C A, Shrestha S, Luitel NP, Prigerson HG, Tol WA, Surkan PJ. Understanding Nepali widows' experiences for the adaptation of an instrument to assess Prolonged Grief Disorder. Transcult Psychiatry 2023; 60:891-904. [PMID: 33351725 DOI: 10.1177/1363461520949005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The experience of grief varies across different cultures and contexts. Women in Nepal who lose their husbands confront discrimination, social isolation, and abuse that influence their experience of grief. Through eight focus group discussions with Nepali widows, we elicited socially sanctioned grief reactions and local idioms used to describe common cognitive, behavioral, and emotional symptoms of grief. Accordingly, modifications to an existing instrument for Prolonged Grief Disorder, the PG-13, are suggested to capture grief symptoms as experienced by Nepali widows. Items in the PG-13 were translated to colloquial Nepali and adapted to maintain comprehensibility, acceptability, relevance, and completeness. Based on the grief-related issues reported in the focus group discussions, the addition of five new items and a new criterion to capture symptoms related to social discrimination are proposed. Widows perceived elevated symptoms one year after the loss to be problematic. It is thus recommended that the duration criterion in the original PG-13 be adjusted from at least six months to at least one year after the loss. These proposed modifications to the instrument should be validated through future psychometric testing.
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Affiliation(s)
- Yoona Kim
- Bloomberg School of Public Health, Johns Hopkins University
| | | | - Angela K C
- Bloomberg School of Public Health, Johns Hopkins University
| | | | | | | | - Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen
- Peter C. Alderman Program for Global Mental Health at HealthRight International
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Garriott A, Phan X, Le Roch K, Bintu FM, Darciba SP, Koleti P, Murray SM. Mental health and psychosocial support in response to onset of the COVID-19 pandemic: Emotional and Stress Management Intervention in Liberia, Sierra Leone, and Ivory Coast. J Glob Health 2023; 13:06010. [PMID: 37448339 DOI: 10.7189/jogh.13.06010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Background In response to the psychological distress experienced by people affected by the onset of the COVID-19 pandemic, Action Against Hunger (Action contre la Faim, ACF) developed and implemented the Emotional and Stress Management Intervention (ESMI) in Liberia, Sierra Leone, and Ivory Coast. ESMI is a person-to-person two-session, non-specialized, mental health and psychosocial support intervention for adults and adolescents in the general population based in problem solving therapy and principles of emotional regulation. Methods Using de-identified programmatic data for each country, we conducted paired t-tests to assess whether adults and adolescents who received ESMI experienced changes in reported psychological distress and perceived social support following the intervention. We also performed pairwise correlations to test whether there were associations between changes in distress and social support over the course of participation in ESMI. Descriptive analyses were performed for presenting problems and coping strategies reported during the sessions. Results Mean scores for psychological distress at baseline and follow-up were significantly different in all countries: Sierra Leone (mean (m) = -6.11; 95% confidence interval (CI) = -6.25 to -5.96); Ivory Coast (m = -3.21; 95% CI = -3.33 to -3.10); and Liberia (m = -2.86; 95% CI = -3.15 to -2.56). Changes in perceived social support were also statistically significant for Sierra Leone (m = 6.87; 95% CI = 6.72-7.02); Ivory Coast (m = 3.12; 95% CI = 2.97-3.27); and Liberia (m = 1.13; 95% CI = 1.00-1.27). Correlations (r) between changes in distress and changes in social support varied by country, and ranged from negative in Liberia, (r = -0.88, P = 0.001), to positive in Ivory Coast (r = 55, P = 0.001), and null in Sierra Leone (r = -0.07, P = 0.11). Conclusions Our findings show changes in psychological distress and perceived social support for participants who completed two sessions of ESMI, suggesting a potential benefit of ESMI as a person-to-person mental health and psychosocial support for individuals in distress affected by a pandemic. A future randomized controlled trial with a focus on key implementation factors (i.e., pre-testing visual analogue scales, treatment fidelity, and comparison of in-person vs remote) is recommended as next steps in research.
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Affiliation(s)
- Anna Garriott
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xuan Phan
- Action contre la Faim, Paris, France
| | | | | | | | | | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Carvajal-Velez L, Ottman K, Ahs JW, Li GN, Simmons J, Chorpita B, Requejo JH, Kohrt BA. Translation and Adaptation of the Revised Children's Anxiety and Depression Scale: A Qualitative Study in Belize. J Adolesc Health 2023; 72:S34-S39. [PMID: 35934586 DOI: 10.1016/j.jadohealth.2022.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adapting data collection instruments using transcultural translation and adaptation processes is essential to ensure that respondents comprehend the items and the original meaning is retained across languages and contexts. This approach is central to UNICEF's efforts to expand the use of standard data collection tools across settings and close the global data gap on adolescent mental health. METHODS We conducted transcultural translation and adaptation processes in Belize using the Revised Children's Anxiety and Depression Scale (RCADS). Items from the original scale were translated into Belizean English and Kriol, reviewed by local mental health experts, and discussed in focus groups. Cognitive interviews were conducted with adolescents and parents. The information collected was analyzed with cultural equivalence domains: comprehensibility, acceptability, relevance, completeness, and technical equivalence. Bilingual discussions of findings informed the final item wordings, and the adapted tool was back-translated. RESULTS Adaptation of terms and specific expressions were done to improve comprehensibility and to ensure the appropriate clinical meaning. For example, the expression 'feeling scared' was perceived to imply immaturity or threaten masculinity and was adapted to 'feeling afraid.' Expressions like "shaky" were modified to "trimble" in Kriol. Statements were reworded as questions to enhance acceptability and comprehensibility. DISCUSSION A culturally adapted version of the RCADS was developed for use among adolescents in Belize in Belizean English and Kriol. The transcultural translation and adaptation procedure can be applied for other settings or tools to design contextual adaptations of mental health instruments prior to their validation or use in new settings.
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Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Katherine Ottman
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | | | - Juliet Simmons
- Department of Mental Health, Ministry of Health and Wellness, Belize City, Belize
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jennifer Harris Requejo
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
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Pedersen GA, Lam C, Hoffmann M, Zajkowska Z, Walsh A, Kieling C, Mondelli V, Fisher HL, Gautam K, Kohrt BA. Psychological and contextual risk factors for first-onset depression among adolescents and young people around the globe: A systematic review and meta-analysis. Early Interv Psychiatry 2023; 17:5-20. [PMID: 35388612 PMCID: PMC10084304 DOI: 10.1111/eip.13300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM Identifying predictors for future onset of depression is crucial to effectively developing preventive interventions. We conducted a systematic review and meta-analysis to identify risk factors for first-onset depression among adolescents and young people. METHODS We searched MEDLINE (Ovid), PsycINFO, Cochrane Database, Web of Science, Lilacs, African Journals Online and Global Health (July 2009 to December 2020) for longitudinal studies assessing risk factors for first-onset depression among adolescents and young people aged 10-25 years. Meta-analyses generated summary odds ratio (OR) estimates. REGISTRATION PROSPERO CRD42018103973. RESULTS Nineteen studies representing 21 unique populations were included in the meta-analysis. Among studies reporting race/ethnicity, 79% of participants were of White/European descent. Seventeen studies were from high-income countries, with only two from an upper-middle-income country (China). Odds for first-onset depression were significantly greater for girls compared to boys (n = 13; OR = 1.78 [1.78, 2.28], p < 0.001) and for youth with other mental health problems at baseline (n = 4; OR = 3.20 [1.95, 5.23], p < 0.001). There were non-significant associations for negative family environment (n = 8; OR = 1.60 [0.82, 3.10], p = 0.16) and parental depression (n = 3; OR = 2.30 [0.73, 7.24], p = 0.16). CONCLUSIONS Most longitudinal studies do not report risk factors specifically for first-onset depression. Moreover, predictive data are limited to predominantly White populations in high-income countries. Future research must be more ethnically and geographically representative. Recommendations are provided for consistent and comprehensive reporting of study designs and analyses of risk factors for first-onset depression.
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Affiliation(s)
- Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Crystal Lam
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Megan Hoffmann
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Annabel Walsh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christian Kieling
- Child & Adolescent Psychiatry Division, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
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10
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Carvajal-Velez L, Ahs JW, Lundin A, van den Broek M, Simmons J, Wade P, Chorpita B, Requejo JH, Kohrt BA. Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize. J Adolesc Health 2023; 72:S40-S51. [PMID: 36400635 DOI: 10.1016/j.jadohealth.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia. METHODS Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales. RESULTS For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96). CONCLUSION The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.
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Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Myrthe van den Broek
- War Child Holland and Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Juliet Simmons
- Department of Mental Health, Ministry of Health and Wellness, Belize City, Belize
| | | | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
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11
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Marlow M, Skeen S, Grieve CM, Carvajal-Velez L, Åhs JW, Kohrt BA, Requejo J, Stewart J, Henry J, Goldstone D, Kara T, Tomlinson M. Detecting Depression and Anxiety Among Adolescents in South Africa: Validity of the isiXhosa Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. J Adolesc Health 2023; 72:S52-S60. [PMID: 36274021 DOI: 10.1016/j.jadohealth.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Screening tools such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) could potentially be used in resource-limited settings to identify adolescents who need mental health support. We examined the criterion validity of the isiXhosa versions of the PHQ-9 and GAD-7 in detecting depression and anxiety among adolescents (10-19 years) in South Africa. METHODS Adolescents were recruited from the general population and from nongovernmental organizations working with adolescents in need of mental health support. The PHQ-9 and GAD-7 were culturally adapted and translated into isiXhosa and administered to 302 adolescents (56.9% female). The Kiddie Schedule for Affective Disorders and Schizophrenia was administered by trained clinicians as the gold standard diagnostic measure for depression and anxiety. RESULTS For the PHQ-9, the area under the curve was 0.88 for the full sample of adolescents (10-19 years old). A score of ≥10 had 91% sensitivity and 76% specificity for detecting adolescents with depression. For the GAD-7, the area under the curve was 0.78, and cutoff scores with an optimal sensitivity-specificity balance were low (≥6). A score of ≥6 had 67% sensitivity and 75% specificity for detecting adolescents with anxiety. DISCUSSION The culturally adapted isiXhosa version of the PHQ-9 can be used as a valid measure for depression in adolescents. Further research on the GAD-7 for use with adolescents is recommended.
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Affiliation(s)
- Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Caitlin M Grieve
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jill W Åhs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
| | - Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | - Jackie Stewart
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Junita Henry
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniel Goldstone
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tashmira Kara
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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12
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Carvajal-Velez L, Ahs JW, Requejo JH, Kieling C, Lundin A, Kumar M, Luitel NP, Marlow M, Skeen S, Tomlinson M, Kohrt BA. Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures. J Adolesc Health 2023; 72:S27-S33. [PMID: 36528384 DOI: 10.1016/j.jadohealth.2021.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Mental disorders are among the leading causes of disability among adolescents aged 10-19 years. However, data on prevalence of mental health conditions are extremely sparse across low- and middle-income countries, even though most adolescents live in these settings. This data gap is further exacerbated because few brief instruments for adolescent mental health are validated in these settings, making population-level measurement of adolescent mental health especially cumbersome to carry out. In response, the UNICEF has undertaken the Measurement of Mental Health Among Adolescents at the Population Level (MMAP) initiative, validating open-access brief measures and encouraging data collection in this area. METHODS This protocol presents the MMAP mixed-methods approach for cultural adaptation and clinical validation of adolescent mental health data collection tools across settings. Qualitative activities include an initial translation and adaptation, review by mental health experts, focus-group discussions with adolescents, cognitive interviews, synthesis of findings, and back-translation. An enriched sample of adolescents with mental health problems is then interviewed with the adapted tool, followed by gold-standard semistructured diagnostic interviews. RESULTS The study protocol is being implemented in Belize, Kenya, Nepal, and South Africa and includes measures for anxiety, depression, functional limitations, suicidality, care-seeking, and connectedness. Analyses, including psychometrics, will be conducted individually by country and combined across settings to assess the MMAP methodological process. DISCUSSION This protocol contributes to closing the data gap on adolescent mental health conditions by providing a rigorous process of cross-cultural adaptation and validation of data collection approaches.
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Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York
| | - Christian Kieling
- Division of Child & Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Belfast, United Kingdom
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Belfast, United Kingdom
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Belfast, United Kingdom; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
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13
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Tele AK, Carvajal-Velez L, Nyongesa V, Ahs JW, Mwaniga S, Kathono J, Yator O, Njuguna S, Kanyanya I, Amin N, Kohrt B, Wambua GN, Kumar M. Validation of the English and Swahili Adaptation of the Patient Health Questionnaire-9 for Use Among Adolescents in Kenya. J Adolesc Health 2023; 72:S61-S70. [PMID: 36376148 DOI: 10.1016/j.jadohealth.2022.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Our study aimed to validate culturally adapted English and Swahili versions of the Patient Health Questionnaire-9 (PHQ-9) for use with adolescents in Kenya. Criterion validity was determined with clinician-administered diagnostic interviews using the Kiddie Schedule of Affective Disorders and Schizophrenia. METHODS A total of 250 adolescents comprising 148 (59.2%) females and 102 (40.8%) males aged 10-19 years (mean = 14.76; standard deviation = 2.78) were recruited. The PHQ-9 was administered to all respondents concurrently in English and Swahili. Adolescents were later interviewed by clinicians using Kiddie Schedule of Affective Disorders and Schizophrenia to determine the presence or absence of current symptoms of major depressive disorder. Sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios for various cut-off scores for PHQ-9 were analyzed using receiver operating characteristic curves. RESULTS The internal consistency (Cronbach's α) for PHQ-9 was 0.862 for the English version and 0.834 for Swahili version. The area under the curve was 0.89 (95% confidence interval, 0.84-0.92) and 0.87 (95% confidence interval, 0.82-0.90) for English and Swahili version, respectively, on receiver operating characteristic analysis. A cut-off of ≥ 9 on the English-language version had a sensitivity of 95.0%, specificity of 73.0%, PPV of 0.23, and NPV of 0.99; a cut-off of ≥ 9 on the Swahili version yielded a sensitivity of 89.0%, specificity of 70.0%, PPV of 0.20, and NPV of 0.90. DISCUSSION Psychometric properties were comparable across both English-adapted and Swahili-adapted version of the PHQ-9, are reliable, and valid instrument to detect major depressive disorder among adolescents which can be used in resource-limited settings for early identification of adolescents in need of mental health support.
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Affiliation(s)
- Albert Kimtai Tele
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands.
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Jill W Ahs
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Swedish Red Cross University, Stockholm, Sweden
| | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Simon Njuguna
- Department of Mental Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Ian Kanyanya
- Department of Mental Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nabila Amin
- Mathare National Referral and Teaching Hospital, Nairobi, Kenya
| | - Brandon Kohrt
- Department of Psychiatry, George Washington University, Washington, DC
| | - Grace Nduku Wambua
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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14
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Nyongesa V, Kathono J, Mwaniga S, Yator O, Madeghe B, Kanana S, Amugune B, Anyango N, Nyamai D, Wambua GN, Chorpita B, Kohrt BA, Ahs JW, Idele P, Carvajal L, Kumar M. Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study. PLoS One 2022; 17:e0277619. [PMID: 36520943 PMCID: PMC9754261 DOI: 10.1371/journal.pone.0277619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children's Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. MATERIALS AND METHODS Using a qualitative approach, we explored adolescent participants' views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. RESULTS We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. DISCUSSION Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10-19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. CONCLUSION Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools.
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Affiliation(s)
| | - Joseph Kathono
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Nairobi Metropolitan Services, Nairobi, Kenya
| | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya
- Vrije University, Amsterdam, Netherlands
| | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Beatrice Madeghe
- Department of Food and Nutrition Sciences, University of Nairobi, Nairobi, Kenya
| | | | | | - Naomi Anyango
- Department of Mental Health, Ministry of Health, Kenya
| | | | - Grace Nduku Wambua
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruce Chorpita
- University of California, Los Angeles, United States of America
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Science, The George Washington University, Washington, District of Columbia, United States of America
| | - Jill W. Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Department of Health Care Sciences, Swedish Red Cross University College, Huddinge, Sweden
| | - Priscilla Idele
- UN Secretariat, New York, New York, United States of America
| | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, United States of America
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenyau
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Kaiser BN, Ticao C, Anoje C, Boglosa J, Gafaar T, Minto J, Kohrt BA. Challenges in simultaneous validation of mental health screening tools in multiple languages: Adolescent assessments in Hausa and Pidgin in Nigeria. SSM - MENTAL HEALTH 2022; 2:100168. [PMID: 36712479 PMCID: PMC9878994 DOI: 10.1016/j.ssmmh.2022.100168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background With growing global recognition of the need to address mental health, a key challenge is determining who needs mental health services. Most self-report screening tools were developed in English-speaking high-income settings, and this cultural milieu influences the types and content of items, the manner in which items are asked, and the options for responding to items. Approaches have been developed for transcultural translation and validation. However, these approaches are typically applied in one language at a time, which is of limited utility in linguistically diverse settings. Methods To address challenges in cross-cultural validation, we undertook a unique process of simultaneously validating tools in two languages in Nigeria. Through this dual-language validation, we explored how cultural and contextual differences may influence what is considered valid for a mental health tool. We validated the Depression Self Rating Scale, Child PTSD Symptom Scale (CPSS), and Disruptive Behavior Disorders Rating Scale with a community sample of 330 adolescents aged 12-17. Validity was assessed in Hausa and Pidgin, two languages commonly spoken in Nigeria. Clinical psychologists used the Kiddie-Schedule for Affective Disorders and Schizophrenia to establish caseness. Results Most items had good discriminant validity, except on the CPSS, on which only 8 of 17 items discriminated by caseness. Findings indicate the influence of culture (e.g., linguistic differences in translatability of items) and context (e.g., items that reflect experiences of hunger or foodborne illness; different PTSD caseness by language might reflect differential trauma exposure between populations). We also identified items that operated differently between languages. Conclusion We identified shortcomings in cross-cultural validation procedures with regard to determining whether language, context, or or other differences influence performance of items. For future validation efforts, we recommend systematically collecting information on context and stressful/traumatic exposures as a way to contextualize interpretation of the validity findings. Acronyms Depression Self Rating Scale (DSRS), Child PTSD Symptom Scale (CPSS), Disruptive Behavior Disorders Rating Scale (DBDRS), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Area Under the Curve (AUC), Diagnostic Odds Ratio (DOR), Low- and Middle-Income Countries (LMICs), Posttraumatic Stress Disorder (PTSD).
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Affiliation(s)
- Bonnie N. Kaiser
- University of California San Diego, United States,Duke Global Health Institute, United States,Corresponding author. 9500 Gilman Road #0532, La Jolla, CA, 92093, United States. (B.N. Kaiser)
| | | | | | | | | | | | - Brandon A. Kohrt
- Duke Global Health Institute, United States,George Washington University, United States
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Ramaiya MK, McLean CL, Pokharel M, Thapa K, Schmidt MA, Berg M, Simoni JM, Rao D, Kohrt BA. Feasibility and Acceptability of a School-Based Emotion Regulation Prevention Intervention (READY-Nepal) for Secondary School Students in Post-Earthquake Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114497. [PMID: 36361372 PMCID: PMC9655041 DOI: 10.3390/ijerph192114497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND Child and adolescent mental health problems are major contributors to the global burden of disease in low- and middle-income country (LMIC) settings. To advance the evidence base for adolescent mental health interventions in LMICs, we evaluated the feasibility and acceptability of a school-based emotion regulation prevention intervention (READY-Nepal) for adolescents who had a recent exposure to a humanitarian disaster. METHODS A mixed-method, non-randomized controlled trial was conducted with Nepali secondary school students in one heavily affected post-earthquake district. Students (N = 102; aged 13 to 17 years) were enrolled in the intervention (n = 42) and waitlist control (n = 60) conditions. Feasibility and acceptability were examined via attendance, and by qualitative interviews with a subset of students (n = 15), teachers (n = 2), and caregivers (n = 3). Preliminary efficacy was examined on primary outcome (emotion regulation) and secondary outcomes (anxiety symptoms, posttraumatic stress symptoms, functional impairment, resilience, coping skills), which were measured at baseline and post-intervention (four weeks). RESULTS Delivering the intervention was feasible and acceptable, as demonstrated by low dropout (8%) and high program attendance (6.7 of 8 sessions). Qualitative data suggested high uptake of anger regulation skills, but lower uptake of mindfulness skills. Despite this, there were no significant differences by condition on primary or secondary outcomes at four-week follow-up. Students provided suggestions for improvement of the program. CONCLUSION Further research on longitudinal outcome measurement, use of alternatives to retrospective self-report data, and rigorous development of culturally grounded models of emotion regulation is necessary to explore the utility of school-based emotion regulation interventions in Nepal and other LMICs.
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Affiliation(s)
- Megan K. Ramaiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA
- Correspondence:
| | - Caitlin L. McLean
- VA San Diego Healthcare System, University of California, San Diego, CA 92161, USA
| | - Manjila Pokharel
- Transcultural Psychosocial Organization Nepal, Kathmandu 44600, Nepal
| | - Kiran Thapa
- College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - M. Andi Schmidt
- School of Graduate Psychology, Pacific University Oregon, Forest Grove, OR 97116, USA
| | - Martha Berg
- Department of Psychology, University of Michigan-Ann Arbor, Ann Arbor, MI 48103, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA 98104, USA
| | - Brandon A. Kohrt
- Division of Global Mental Health, George Washington University, Washington, DC 20052, USA
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17
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Claudius M, Shino EN, Job S, Hofmann D, Thalmayer AG. Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14323. [PMID: 36361207 PMCID: PMC9657148 DOI: 10.3390/ijerph192114323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, "it keeps on coming back"; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress.
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Affiliation(s)
- Milena Claudius
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
- Department of Psychology and Professional Counseling, Webster University Geneva, 1293 Bellevue, Switzerland
| | - Elizabeth N. Shino
- Department of Psychology and Social Work, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek 10026, Namibia
| | - Sylvanus Job
- Department of Humanities and Arts, Faculty of Education & Human Sciences, University of Namibia, Windhoek 10026, Namibia
| | - Daniel Hofmann
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Amber Gayle Thalmayer
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland
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18
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Hassan E, BK P, Magar J, Luitel N, Kohrt BA, Jordans M, Rose-Clarke K. Community perspectives on the implementation of a group psychological intervention for adolescents with depression: A qualitative study in rural Nepal. Front Psychiatry 2022; 13:949251. [PMID: 36339866 PMCID: PMC9634215 DOI: 10.3389/fpsyt.2022.949251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Group-based psychological interventions could help to close the treatment gap for depression in low-resource settings, but implementation barriers exist. In Nepal we sought community members' perspectives on how to implement group interpersonal therapy for adolescents. We conducted qualitative interviews with 25 adolescents with depression (aged 13-18) and seven health and non-governmental organization workers, and four focus groups with non-depressed adolescents, four with parents/guardians, and two with teachers (126 participants total). Data were analyzed using the Framework Method. Participants recommended same-sex groups. School was the preferred location because it is accessible for adolescents and acceptable to parents. Adolescents wanted facilitators from their own community with good communication skills. They did not want parents or teachers to participate in groups but emphasized the need to inform parents and obtain their permission. Community members supported group psychological intervention. School-based psychological interventions facilitated by local people could be an acceptable option in rural Nepal.
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Affiliation(s)
- Eliz Hassan
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Prakash BK
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Mark Jordans
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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Figge CJ, Martinez-Torteya C, Taing S, Chhim S, Hinton DE. Key expressions of trauma-related distress in Cambodian children: A step toward culturally sensitive trauma assessment and intervention. Transcult Psychiatry 2022; 59:492-505. [PMID: 32178597 DOI: 10.1177/1363461520906008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
More than half of all children in Cambodia experience direct abuse and over 70% experience other traumatic events, which significantly increase their risks for a range of physical and mental health problems. Additionally, Cambodian children face longstanding sociopolitical, intergenerational, and cultural factors that compound the impact of other trauma. As a result, rates of posttraumatic stress symptoms among Cambodian youth are high. However, care providers often rely on Western-based nosology that does not account for culturally specific expressions of trauma. A greater understanding of culturally-salient expressions of distress can help inform diagnostic assessment accuracy and treatment effectiveness and monitoring. The current study utilized a qualitative design to interview 30 Cambodian caregivers of children with trauma experiences and 30 Cambodian children (ages 10-13 years) with trauma experiences to identify key local expressions of trauma. Findings reveal certain PTSD symptoms and culturally-specific frequent and severe trauma-related problems for Cambodian children and domains of functioning impacted by trauma. Certain symptoms seem particularly important to evaluate in this group, such as anger, physical complaints (e.g., headache and palpitations), and cognitive-focused complaints (in particular, "thinking too much"). All caregivers and children reported physical health as impacted by trauma-related problems, highlighting a particularly salient domain of functioning for this population. Expressions of distress explored in the current study are discussed in the context of assessment and intervention development to inform diagnostic and clinical efforts for those working with trauma-exposed Cambodian children.
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Affiliation(s)
- Caleb J Figge
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | | | - Sopheap Taing
- Transcultural Psychosocial Organization (TPO) Cambodia, Phnom Penh, Cambodia
| | - Sotheara Chhim
- Transcultural Psychosocial Organization (TPO) Cambodia, Phnom Penh, Cambodia
| | - Devon E Hinton
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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20
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Kaiser BN, Weaver LJ. Culture-bound syndromes, idioms of distress, and cultural concepts of distress: New directions for an old concept in psychological anthropology. Transcult Psychiatry 2022; 59:395-398. [PMID: 35980292 DOI: 10.1177/13634615221110665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Thulin EJ, McLean KE, Sevalie S, Akinsulure-Smith AM, Betancourt TS. Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress. Transcult Psychiatry 2022; 59:461-478. [PMID: 32316867 DOI: 10.1177/1363461520916695] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health.
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Affiliation(s)
- Elyse J Thulin
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, USA
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22
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Trang K, Jovanovic T, Hinton DE, Sullivan P, Worthman CM, Lam LX, Chi NK, Thanh NC, Ha TV, Go V, Hoffman I, Giang LM. Elevated trauma exposure and mental health burden among men who have sex with men in Vietnam. Transcult Psychiatry 2022; 59:362-379. [PMID: 35072562 DOI: 10.1177/13634615211058348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n = 12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam.
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In Their Own Words: Using Open-Ended Assessment to Identify Culturally Relevant Concerns among Kenyan Adolescents. Cult Med Psychiatry 2022; 46:297-321. [PMID: 33528725 DOI: 10.1007/s11013-020-09706-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 12/31/2022]
Abstract
Standardized assessment tools developed in western contexts may systematically miss certain problems that are considered important in non-western cultures. In this mixed-methods study, we used an open-ended assessment tool (the Top Problem Assessment; TPA) to identify culturally relevant concerns among low-income Kenyan youth. We then (a) applied thematic analysis to identify the most frequently reported problems and (b) examined the extent to which these problems were reflected in standardized mental health measures. Using the TPA, we identified common social, academic, and economic problems facing Kenyan youths. Specifically, 61% of the sample reported a social problem, 38% an academic problem, and 35% an economic problem. By contrast, the standardized assessments revealed that worrying and difficulty concentrating were the most commonly reported symptoms. However, the emotional and behavioral problems assessed via the standardized measures were only reported as top problems by 17% of the sample. Overall, our findings are consistent with the idea that standardized measures can miss certain culturally-salient concerns that can be acquired through open-ended assessments. We discuss how brief open-ended assessment tools could complement standardized measures, inform the development of culturally relevant standardized measures, and offer rich data about the experiences of people in understudied cultural contexts.
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Liu J, Chan C, Leung PWL. Youth psychopathology: Universal or culture-specific? Testing the syndrome models of youth self-report in Chinese population. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:126-141. [PMID: 34595782 PMCID: PMC10082997 DOI: 10.1111/jcap.12353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM The debate on whether psychiatric symptoms are universal and to what extent they are affected by culture is generally divided between the universalist and relativist approaches. METHODS This study compared Achenbach/Rescorla's model and Weisz's model of youth self-report in 2521 Chinese adolescents (mean age = 12 years). Indigenous exploratory factor analyses were conducted to explore the factor structure of youth self-report (YSR), and the derived models were tested with confirmatory factor analysis. FINDINGS These analyses indicated good support of the Chinese YSR models for males and females. Further analyses revealed three syndromes, namely anxious/depressed, somatic complaints, and aggressive behaviors, which represented broad internalizing and externalizing factors. These syndromes consistently demonstrated high correlations across the different models, indicating their universal nature. Conversely, some unique factors emerged in the Chinese YSR model, such as weight concern and rule-breaking behavior, which may reflect underlying culture-bound factors. CONCLUSIONS Our findings support a combined perspective to the universalist and relativist approaches, which argues that some syndromes including Anxious/Depressed, Somatic Complaints, Aggressive Behavior and Attention Problems are more likely to be universal in male adolescents, while a new emerging syndrome like Weight Concern may reflect the socioeconomic, culture, and lifestyle changes that are currently emerging in China.
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Affiliation(s)
- Jianghong Liu
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Clare Chan
- Chinese University of Hong Kong, Hong Kong, China
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25
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 286] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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26
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Defining culturally compelling mental health interventions: A qualitative study of perspectives on adolescent depression in Lagos, Nigeria. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Silwal S, Chudal R, Dybdahl R, Sillanmäki L, Lien L, Sourander A. Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study. Child Psychiatry Hum Dev 2022; 53:430-439. [PMID: 33606131 PMCID: PMC9107405 DOI: 10.1007/s10578-021-01136-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/01/2022]
Abstract
Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.
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Affiliation(s)
- Sanju Silwal
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland. .,Department of Clinical Science, Faculty of Medicine, Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd. floor), 20014, Turku, Finland.
| | - Roshan Chudal
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Ragnhild Dybdahl
- Department of Social Work, Child Welfare and Social Policy, OsloMet University, Oslo, Norway ,Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Lauri Sillanmäki
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Lars Lien
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway ,Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Andre Sourander
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,Department of Child Psychiatry, Turku University Hospital, Turku, Finland ,INVEST Research Flagship, University of Turku, Turku, Finland
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School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost. Glob Ment Health (Camb) 2022; 9:416-428. [PMID: 36618751 PMCID: PMC9806967 DOI: 10.1017/gmh.2022.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost. METHODS We recruited 32 boys and 30 girls (aged 13-19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0-2 weeks after IPT), and follow-up (8-10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective. RESULTS Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70-95); functional impairment decreased by 288% (249-351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity. CONCLUSIONS School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
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Hermosilla S, Forthal S, Van Husen M, Metzler J, Ghimire D, Ager A. The Child PTSD Symptom Scale: Psychometric Properties among Earthquake Survivors. Child Psychiatry Hum Dev 2021; 52:1184-1193. [PMID: 33247347 PMCID: PMC8155094 DOI: 10.1007/s10578-020-01097-z] [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] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.
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Affiliation(s)
- Sabrina Hermosilla
- Institute for Social Research, University of Michigan, 426 Thompson Street, 1006E, Ann Arbor, MI, 48104, USA.
| | - Sarah Forthal
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Madeline Van Husen
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Janna Metzler
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
| | - Dirgha Ghimire
- Institute for Social Research, University of Michigan, 426 Thompson Street, 1006E, Ann Arbor, MI, 48104, USA
| | - Alastair Ager
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
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30
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de Graaff AM, Cuijpers P, Leeflang M, Sferra I, Uppendahl JR, de Vries R, Sijbrandij M. A systematic review and meta-analysis of diagnostic test accuracy studies of self-report screening instruments for common mental disorders in Arabic-speaking adults. Glob Ment Health (Camb) 2021; 8:e43. [PMID: 34966543 PMCID: PMC8679833 DOI: 10.1017/gmh.2021.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/03/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Self-report screening instruments are frequently used as scalable methods to detect common mental disorders (CMDs), but their validity across cultural and linguistic groups is unclear. We summarized the diagnostic accuracy of brief questionnaires on symptoms of depression, anxiety and posttraumatic stress disorder (PTSD) among Arabic-speaking adults. METHODS Five databases were searched from inception to 22 January 2021 (PROSPERO: CRD42018070645). Studies were included when diagnostic accuracy of brief (maximally 25 items) psychological questionnaires was assessed in Arabic-speaking populations and the reference standard was a clinical interview. Data on sensitivity/specificity, area under the curve, and data to generate 2 × 2 tables at various thresholds were extracted. Meta-analysis was performed using the diagmeta package in R. Quality of studies was assessed with QUADAS-2. RESULTS Thirty-two studies (N participants = 4042) reporting on 17 questionnaires with 5-25 items targeting depression/anxiety (n = 14), general distress (n = 2), and PTSD (n = 1) were included. Seventeen studies (53%) scored high risk on at least two QUADAS-2 domains. The meta-analysis identified an optimal threshold of 11 (sensitivity 76.9%, specificity 85.1%) for the Edinburgh Postnatal Depression Scale (EPDS) (n studies = 7, n participants = 711), 7 (sensitivity 81.9%, specificity 87.6%) for the Hospital Anxiety and Depression Scale (HADS) anxiety subscale and 6 (sensitivity 73.0%, specificity 88.6%) for the depression subscale (n studies = 4, n participants = 492), and 8 (sensitivity 86.0%, specificity 83.9%) for the Self-Reporting Questionnaire (SRQ-20) (n studies = 4, n participants = 459). CONCLUSION We present optimal thresholds to screen for perinatal depression with the EPDS, anxiety/depression with the HADS, and CMDs with the SRQ-20. More research on Arabic-language questionnaires, especially those targeting PTSD, is needed.
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Affiliation(s)
- Anne M. de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mariska Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene Sferra
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Jana R. Uppendahl
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Charak R, De Jong JTVM, Berckmoes LH, Ndayisaba H, Reis R. Intergenerational maltreatment in parent-child dyads from Burundi, Africa: Associations among parental depression and connectedness, posttraumatic stress symptoms, and aggression in children. J Trauma Stress 2021; 34:943-954. [PMID: 34644415 DOI: 10.1002/jts.22735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022]
Abstract
Studies investigating the associations between histories of childhood maltreatment (CM) in parent-child dyads have primarily involved samples from high-income countries; however, CM rates are higher in low- and middle-income countries. The present study aimed to examine the (a) association between maltreatment in parents and maltreatment of their children through risk (i.e., parent depression) and protective (i.e., parent-child connectedness) factors and (b) associations between CM in children with aggression through posttraumatic stress symptoms (PTSS) and peer/sibling victimization. Participants were 227 parent-child dyads from Burundi, Africa, a low-income country. Parents were 18 years of age or older, and children were 12-18 years (M = 14.76, SD = 1.88, 57.7% female). Among parents, 20.7%-69.5% of participants reported a history of physical and emotional abuse and neglect; among children, the rates of sexual, physical, and emotional abuse ranged from 14.5% to 89.4%. A history of CM in parents was associated with CM in children, B = 0.19, p < .01, and CM in parents was indirectly associated with CM in children through parent-child connectedness, β = .04, 95% CI [.01, .10], and parental depression, β = .08, 95% CI [.03, .15]. In children, maltreatment was positively associated with peer/sibling victimization, and CM was associated with aggression, β = .07, 95% CI [.04, 0.11], through PTSS but not via peer/sibling victimization. Continued efforts to improve CM-related preventive strategies and the accessibility of prevention services are needed to reduce CM in low-income countries such as Burundi.
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Affiliation(s)
- Ruby Charak
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - J T V M De Jong
- Amsterdam University Medical Center, Amsterdam, The Netherlands.,School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Herman Ndayisaba
- Transcultural Psychosocial Organisation, Burundi, Amsterdam, The Netherlands
| | - Ria Reis
- Leiden University Medical Center, Leiden University, Leiden, The Netherlands.,Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.,The Children's Institute, University of Cape Town, Cape Town, South Africa
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Depression or resilience? A participatory study to identify an appropriate assessment tool with Kanien'kéha (Mohawk) and Inuit in Quebec. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1891-1902. [PMID: 33683413 DOI: 10.1007/s00127-021-02057-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec. METHODS We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information. RESULTS The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner. CONCLUSION This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.
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Kohrt BA, Kaiser BN. Measuring mental health in humanitarian crises: a practitioner's guide to validity. Confl Health 2021; 15:72. [PMID: 34565416 PMCID: PMC8474916 DOI: 10.1186/s13031-021-00408-y] [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: 06/10/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background There are ongoing methodological advances in measuring mental health in humanitarian crises. This Special Section describes numerous innovations. Here we take a practitioner's view in understanding the key issues related to assessment of mental health in humanitarian contexts and how the innovations contribute to the field. Main body In this guide for practitioners, we address the following issues: (1) clarifying the intended purpose of conducting mental health assessment in humanitarian crises: why is this information collected and for what intended purposes?; (2) determining what type of tool should be selected and the types of psychometric properties that are important for tools serving this particular purpose; (3) when a validated tool is not available, considering how qualitative and quantitative methods should be used to generate information on validity; and finally, (4) how to report on validity and its implications for interpreting information for humanitarian practitioners, governments, care providers, and other stakeholders supporting people affected by humanitarian emergencies. Conclusion Ultimately, mental health assessment tools are not independent of the group with which they were designed, nor are the psychometric properties of the tools or their utility universal across purposes. Therefore, organizations and stakeholders will optimize their positive impact when choosing tools wisely, appropriately adapting and validating tools, and providing guidance on how to interpret those findings to best serve populations in need.
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Fine SL, Malik A, Guimond MF, Nemiro A, Temu G, Likindikoki S, Annan J, Tol WA. Improving mental health in low-resource settings: A feasibility randomized controlled trial of a transdiagnostic psychological intervention among Burundian refugee adolescents and their caregivers. Behav Res Ther 2021; 145:103944. [PMID: 34392115 DOI: 10.1016/j.brat.2021.103944] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 05/21/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
There is a paucity of evidence regarding interventions that can improve the mental health of adversity-affected young adolescents living in low-resource settings. We evaluated the feasibility, acceptability, relevance, and safety of the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention among Burundian refugee adolescents and their caregivers in Tanzania. This study consisted of a feasibility cluster randomized controlled trial (cRCT) and a process evaluation. The feasibility cRCT included 82 young adolescents and their 64 caregivers, with two clusters randomized to EASE and two to an enhanced control condition. EASE was delivered by adult refugees without prior training in mental health. The process evaluation consisted of 36 semi-structured qualitative interviews with key stakeholders, including adolescents, caregivers, and facilitators. EASE participants and facilitators gave positive feedback about its format, accessibility, and content. Trained non-specialist refugee facilitators were able to deliver EASE with high fidelity. The research protocol functioned well in terms of balanced randomization, limited loss to follow-up, and psychometrically promising measures, but discordance was observed between the short screener and psychological distress symptom checklist. This formative study suggests the potential of EASE in targeting psychological distress among displaced young adolescents and lays the groundwork for a future definitive trial.
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Affiliation(s)
- Shoshanna L Fine
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Aiysha Malik
- World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | | | - Ashley Nemiro
- International Rescue Committee, 122 East 42nd St., New York, NY, 10168, USA
| | - Getruda Temu
- International Rescue Committee, 122 East 42nd St., New York, NY, 10168, USA
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Jeannie Annan
- International Rescue Committee, 122 East 42nd St., New York, NY, 10168, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark; HealthRight International, 14 East 14th St., New York, NY, 10012, USA
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Omari F, Chrysanthopoulou SA, Embleton LE, Atwoli L, Ayuku DO, Sang E, Braitstein P. The impact of care environment on the mental health of orphaned, separated and street-connected children and adolescents in western Kenya: a prospective cohort analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003644. [PMID: 33789867 PMCID: PMC8016077 DOI: 10.1136/bmjgh-2020-003644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction The effect of care environment on orphaned and separated children and adolescents’ (OSCA) mental health is not well characterised in sub-Saharan Africa. We compared the risk of incident post-traumatic stress disorder (PTSD), depression, anxiety and suicidality among OSCA living in Charitable Children’s Institutions (CCIs), family-based care (FBC) and street-connected children and youth (SCY). Methods This prospective cohort followed up OSCA from 300 randomly selected households (FBC), 19 CCIs and 100 SCY in western Kenya from 2009 to 2019. Annual data were collected through standardised assessments. We fit survival regression models to investigate the association between care environment and mental health diagnoses. Results The analysis included 1931 participants: 1069 in FBC, 783 in CCIs and 79 SCY. At baseline, 1004 participants (52%) were male with a mean age (SD) of 13 years (2.37); 54% were double orphans. In adjusted analysis (adjusted HR, AHR), OSCA in CCIs were significantly less likely to be diagnosed with PTSD (AHR 0.69, 95% CI 0.49 to 0.97), depression (AHR 0.48 95% CI 0.24 to 0.97), anxiety (AHR 0.56, 95% CI 0.45 to 0.68) and suicidality (AHR 0.73, 95% CI 0.56 to 0.95) compared with those in FBC. SCY were significantly more likely to be diagnosed with PTSD (AHR 4.52, 95% CI 4.10 to 4.97), depression (AHR 4.72, 95% CI 3.12 to 7.15), anxiety (AHR 4.71, 95% CI 1.56 to 14.26) and suicidality (AHR 3.10, 95% CI 2.14 to 4.48) compared with those in FBC. Conclusion OSCA living in CCIs in this setting were significantly less likely to have incident mental illness, while SCY were significantly more, compared with OSCA in FBC.
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Affiliation(s)
- Felicita Omari
- Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Lonnie E Embleton
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lukoye Atwoli
- Mental Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - David O Ayuku
- Behavioral Sciences, Moi University College of Health Sciences, Eldoret, Kenya
| | - Edwin Sang
- Data Management and Biostatistics, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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Puffer ES, Giusto A, Rieder AD, Friis-Healy E, Ayuku D, Green EP. Development of the Family Togetherness Scale: A Mixed-Methods Validation Study in Kenya. Front Psychol 2021; 12:662991. [PMID: 34168594 PMCID: PMC8217654 DOI: 10.3389/fpsyg.2021.662991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Family functioning is an important target of clinical intervention and research given its close ties with mental health outcomes of both children and adults. However, we lack family functioning measures validated for use in many low- and middle-income country (LMIC) settings. In this mixed-methods prospective diagnostic accuracy study, we first used formative qualitative data to develop an extensive battery of screening items to measure family functioning in Kenya. We then recruited 30 Kenyan families (N = 44 adults; 30 youth aged 8-17 years) to complete the questionnaires and participate in clinical interviews conducted by local interviewers. Quantitative and qualitative analyses were then conducted to select a subset of screening items that balanced conceptual understanding of family distress with diagnostic efficiency and accuracy to yield a brief but valid scale. The final index test consisting of 30 items correctly identified distressed families in 89% of cases according to adult-report and 76% of cases according to child-report. The optimal cutoffs are associated with estimates of sensitivity/specificity of 0.88/0.90 and 0.75/0.77 for adult-report and child-report measures, respectively. The final measure-the Family Togetherness Scale (FTS)-assesses global family functioning, including items related to family organization, emotional closeness, and communication/problem-solving. In addition to general items, the scale also includes items explicitly assessing family responses to stressors common in LMIC settings. Results establish a strong rationale for larger-scale validation studies.
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Affiliation(s)
- Eve S. Puffer
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Ali Giusto
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Amber D. Rieder
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Elsa Friis-Healy
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Eric P. Green
- Duke Global Health Institute, Duke University, Durham, NC, United States
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Patel AR, Hall BJ. Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:197-203. [PMID: 34690583 PMCID: PMC8475922 DOI: 10.1176/appi.focus.20200049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 06/13/2023]
Abstract
Although trauma exposure is a global phenomenon, trauma reactions vary considerably across cultures. Western psychiatric diagnoses, such as posttraumatic stress disorder (PTSD), may be limited in capturing the breadth of trauma reactions in cross-cultural contexts. Instead, cross-cultural instruments should examine locally relevant reactions, such as idioms of distress and explanatory models of illness, and account for ongoing stress and adversity. This article explains the need for complementing traditional trauma assessment approaches, how to create culturally sensitive instruments, the style and stance of practicing cultural humility when administering instruments, how to account for ongoing trauma and adversity, and ways to incorporate findings into treatment. These steps can improve culturally sensitive and comprehensive trauma assessment to capture universal and culturally relevant trauma reactions.
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Affiliation(s)
- Anushka R Patel
- Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California, San Francisco (Patel); School of Global Public Health, New York University-Shanghai (Hall)
| | - Brian J Hall
- Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California, San Francisco (Patel); School of Global Public Health, New York University-Shanghai (Hall)
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Maharjan SM, Poudyal A, van Heerden A, Byanjankar P, Thapa A, Islam C, Kohrt BA, Hagaman A. Passive sensing on mobile devices to improve mental health services with adolescent and young mothers in low-resource settings: the role of families in feasibility and acceptability. BMC Med Inform Decis Mak 2021; 21:117. [PMID: 33827552 PMCID: PMC8025381 DOI: 10.1186/s12911-021-01473-2] [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] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive sensor data from mobile devices can shed light on daily activities, social behavior, and maternal-child interactions to improve maternal and child health services including mental healthcare. We assessed feasibility and acceptability of the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) platform. The StandStrong passive data collection platform was piloted with adolescent and young mothers, including mothers experiencing postpartum depression, in Nepal. METHODS Mothers (15-25 years old) with infants (< 12 months old) were recruited in person from vaccination clinics in rural Nepal. They were provided with an Android smartphone and a Bluetooth beacon to collect data in four domains: the mother's location using the Global Positioning System (GPS), physical activity using the phone's accelerometer, auditory environment using episodic audio recording on the phone, and mother-infant proximity measured with the Bluetooth beacon attached to the infant's clothing. Feasibility and acceptability were evaluated based on the amount of passive sensing data collected compared to the total amount that could be collected in a 2-week period. Endline qualitative interviews were conducted to understand mothers' experiences and perceptions of passive data collection. RESULTS Of the 782 women approached, 320 met eligibility criteria and 38 mothers (11 depressed, 27 non-depressed) were enrolled. 38 mothers (11 depressed, 27 non-depressed) were enrolled. Across all participants, 5,579 of the hour-long data collection windows had at least one audio recording [mean (M) = 57.4% of the total possible hour-long recording windows per participant; median (Mdn) = 62.6%], 5,001 activity readings (M = 50.6%; Mdn = 63.2%), 4,168 proximity readings (M = 41.1%; Mdn = 47.6%), and 3,482 GPS readings (M = 35.4%; Mdn = 39.2%). Feasibility challenges were phone battery charging, data usage exceeding prepaid limits, and burden of carrying mobile phones. Acceptability challenges were privacy concerns and lack of family involvement. Overall, families' understanding of passive sensing and families' awareness of potential benefits to mothers and infants were the major modifiable factors increasing acceptability and reducing gaps in data collection. CONCLUSION Per sensor type, approximately half of the hour-long collection windows had at least one reading. Feasibility challenges for passive sensing on mobile devices can be addressed by providing alternative phone charging options, reverse billing for the app, and replacing mobile phones with smartwatches. Enhancing acceptability will require greater family involvement and improved communication regarding benefits of passive sensing for psychological interventions and other health services. Registration International Registered Report Identifier (IRRID): DERR1-10.2196/14734.
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Affiliation(s)
- Sujen Man Maharjan
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA
| | - Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Ada Thapa
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA
| | - Celia Islam
- George Washington School of Medicine and Health Sciences, Washington, DC, 20037, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA.
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
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Kar N, Sharma A. Matching the Symptom Profile of Adolescent Disaster Survivors with Changing Diagnostic Criteria of Posttraumatic Stress Disorder: Focus on ICD-11. Indian J Psychol Med 2021; 43:100-105. [PMID: 34376883 PMCID: PMC8313442 DOI: 10.1177/0253717620926848] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Considering recent changes in the diagnostic guidelines for posttraumatic stress disorder (PTSD), it has become imperative to review their influence, especially on the symptoms related to children and adolescent victims of disasters. We intended to assess the profile of posttraumatic stress symptoms (PTSS) of adolescents following an earthquake, especially the gender differences, in relation to the changing diagnostic guidelines, particularly ICD-11. METHODS In a cross-sectional study, PTSS and functional impairments were evaluated in school-going adolescents in Nepal, one year after the 2015 earthquake, using the Child Posttraumatic Stress Scale (CPSS). RESULTS A considerable proportion of adolescent survivors of the earthquake had PTSS. Most common ones were intrusive thoughts (46.7%), avoiding thoughts, conversations and feelings about the disaster (44.2%), decreased interest in activities (40.0%), distress with reminders (35.6%), and concentration problems (35.6%). Females had a higher prevalence for all the PTSS compared with males, except for avoiding thought, conversations, feelings, and being overly careful/vigilant. Proportion of adolescents who met symptomatic criteria for PTSD diagnosis in different systems ranged from 14.7% in DSM-5 to 15.6% in ICD-11 three-factor model, and 22.2% in DSM-IV and 31.7% in ICD-10. Inclusion of the criterion of significant functional impairment changed the proportions to 10.0%, 10.3%, 12.8%, and 16.4%, respectively. In all of the diagnostic systems, higher proportions of females had possible PTSD. CONCLUSION Adolescent females had a higher prevalence for most of the PTSS and at the diagnostic level. It appears that for adolescents, diagnosis of PTSD in ICD-11 has become more robust with a focus on core symptoms and having a functional impairment criterion.
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Affiliation(s)
- Nilamadhab Kar
- Black Country Healthcare NHS Foundation Trust, Wolverhampton, UK
| | - Asmita Sharma
- Dept. of Paediatric Nursing, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Onchonga D, Hammoud S, Kuriakose S, Muhammad EAK. Exploring fear of childbirth in Kenya through evaluation of the readability of Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A). SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100605. [PMID: 33626433 DOI: 10.1016/j.srhc.2021.100605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several tools measuring fear of childbirth (FOC) have been developed in the last three decades, however concerns about their readability have been raised. AIM To explore the fear of childbirth in a sample of women of reproductive age by evaluating the readability of Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ-A). METHODS The Flesch Reading Ease Formula, the Flesch-Kincaid Grade Level, the FOG Scale, the SMOG Index, the Coleman-Liau Index, the Automated Readability Index, and the Linsear Write Formula were used to evaluate the readability of the W-DEQ-A. Also, focus group discussions were held to validate the findings of the readability scales mentioned above. FINDINGS The SMOG Index (score = 7.6), Coleman-Liau Index (score = 7.6), and the Linsear Write Formula (score = 9.4) were easily readable by women of reproductive age who had at least secondary school education (grade 12). Concerns were raised over some terms used such as desolate and deserted, which were rarely used in day to day English language conversations. CONCLUSIONS In this study, participants observed that W-DEQ- A was readable if administered to expectant women with a basic secondary school certificate; but there is a need to simplify some words. It was emphasized that societal dynamics play an important role in the fear of childbirth and therefore the questionnaire should address all aspects contributing to fear of childbirth and not merely the feelings and thoughts women may have at the prospect of labor and delivery.
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Affiliation(s)
- David Onchonga
- Doctoral School of Health Sciences, University of Pécs, Hungary.
| | - Sahar Hammoud
- Doctoral School of Health Sciences, University of Pécs, Hungary.
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Surkan PJ, Garrison-Desany HM, Rimal D, Luitel NP, Kim Y, Prigerson HG, Shrestha S, Tol W, Murray SM. Adaptation and psychometric validation of the Prolonged Grief Disorder scale among widows in central Nepal. J Affect Disord 2021; 281:397-405. [PMID: 33352410 DOI: 10.1016/j.jad.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Symptoms of grief vary by culture and societal reactions to death may be gender specific. We aimed to validate a Nepali language version of the Prolonged Grief-13 item scale (PG-13) among widows. METHODS We tested two adapted versions of a Prolonged Grief Disorder (PGD) instrument with 204 Nepali-speaking widows: one was a Nepali translation of the original PG-13 items, while the other contained five additional items derived from qualitative research. We evaluated internal consistency, factor structure, and construct and criterion validity. RESULTS Participants were on average 44 years old (SD=9.3), completed 6.7 years of school (SD=3.3) and had survived their husbands by 10 years (SD=8.1). Thirteen percent met global criteria for PGD. The removal of one original PG-13 item (felt emotionally numb) from both versions due to poor discriminant validity resulted in 12- and 17-item versions. Exploratory factor analysis supported a one-factor structure for the PG-12 and PG-17. Both versions of the scale exhibited high internal consistency (0.89 and 0.93 respectively). Confirmatory factor analysis suggested that symptoms of PGD were distinct from post-traumatic stress disorder (PTSD), anxiety and depressive symptoms. The PG-12 had lower sensitivity (74.1%) but higher specificity (83.6%) compared to the PG-17 (81.5% and 73.5% respectively). LIMITATIONS Psychosocial counselors' clinical interview global ratings were used as the standard for comparison in criterion validity analyses. Generalizability to other socio-cultural (e.g. non-widowed, low-caste) populations and men in Nepal cannot be assumed. CONCLUSIONS Results indicate satisfactory psychometric properties and validity of both versions of the PG instruments, supporting their use with Nepali speaking widows.
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Affiliation(s)
- Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Damodar Rimal
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal, GPO Box 8974/CPC Box 612
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal, GPO Box 8974/CPC Box 612
| | - Yoona Kim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, NY, USA
| | - Sumeera Shrestha
- Women for Human Rights, single women's group, P.O. Box 8973 NPC 427, Baluwatar, Kathmandu, Nepal
| | - Wietse Tol
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Section of Global Health, Department of Public Health, University of Copenhagen
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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A cross-cultural interpersonal model of adolescent depression: A qualitative study in rural Nepal. Soc Sci Med 2021; 270:113623. [PMID: 33461033 PMCID: PMC7895817 DOI: 10.1016/j.socscimed.2020.113623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
Most cross-cultural qualitative research on depression has been descriptive, documenting symptoms and explanatory models. There is a lack of qualitative research testing theoretical models of depression. The interpersonal model conceptualises grief, interpersonal disputes, role transitions and social isolation as the context in which depression develops and is the basis of interpersonal therapy (IPT), which is increasingly used in cross-cultural settings to treat depression. We aimed to qualitatively evaluate to what extent the interpersonal model can explain adolescent depression in Nepal. Data were collected between December 2018 and April 2019 and comprised transcripts from 126 participants: 25 semi-structured interviews with depressed adolescents aged 13–18; four focus group discussions with adolescents (N = 38), four with parents/caregivers (N = 39), and two with teachers (N = 17); and seven semi-structured interviews with health and non-governmental organisation workers. We coded data using an analytical framework comprising deductive codes representing key concepts from the interpersonal model of depression and IPT, including principles, techniques and strategies. Participants mainly related depression to interpersonal problem areas of grief, dispute, role transition and social isolation. Interpersonal disputes were common, and for many adolescents this involved parental physical and emotional abuse. Although role transitions were common few adolescents grieved loss of the prior role. Distress related to social isolation was evident despite close physical proximity and extensive social interaction with family and community members. Adolescents described coping strategies that were similar to strategies central to IPT, e.g. identifying helpful and unhelpful relationships and generating options and ways of managing problems. In conclusion, interpersonal problems are relevant to this population and conceptualisations align with core principles of the interpersonal model of depression. The findings highlight the importance of addressing abuse and maltreatment in depression aetiology. They also inform future cultural adaptations of IPT in Nepal and beyond, including the opportunity to integrate local coping strategies. Testing psychological models cross-culturally is important for adapting therapies. Interpersonal problems trigger depression among adolescents in Nepal. Experiences of depression align with core principles of interpersonal therapy (IPT). Few adolescents use IPT strategies to address interpersonal problems. Models of depression must incorporate poverty, migration and abuse as risk factors.
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Brathwaite R, Rocha TBM, Kieling C, Gautam K, Koirala S, Mondelli V, Kohrt B, Fisher HL. Predicting the risk of depression among adolescents in Nepal using a model developed in Brazil: the IDEA Project. Eur Child Adolesc Psychiatry 2021; 30:213-223. [PMID: 32162056 PMCID: PMC7486232 DOI: 10.1007/s00787-020-01505-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/29/2020] [Indexed: 12/11/2022]
Abstract
The burden of adolescent depression is high in low- and middle-income countries (LMICs), yet research into prevention is lacking. Development and validation of models to predict individualized risk of depression among adolescents in LMICs is rare but crucial to ensure appropriate targeting of preventive interventions. We assessed the ability of a model developed in Brazil, a middle-income country, to predict depression in an existing culturally different adolescent cohort from Nepal, a low-income country with a large youth population with high rates of depression. Data were utilized from the longitudinal study of 258 former child soldiers matched with 258 war-affected civilian adolescents in Nepal. Prediction modelling techniques were employed to predict individualized risk of depression at age 18 or older in the Nepali cohort using a penalized logistic regression model. Following a priori exclusions for prior depression and age, 55 child soldiers and 71 war-affected civilians were included in the final analysis. The model was well calibrated, had good overall performance, and achieved good discrimination between depressed and non-depressed individuals with an area under the curve (AUC) of 0.73 (bootstrap-corrected 95% confidence interval 0.62-0.83). The Brazilian model comprising seven matching sociodemographic predictors, was able to stratify individualized risk of depression in a Nepali adolescent cohort. Further testing of the model's performance in larger socio-culturally diverse samples in other geographical regions should be attempted to test the model's wider generalizability.
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Affiliation(s)
- Rachel Brathwaite
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Thiago Botter-Maio Rocha
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil ,Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Christian Kieling
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil ,Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Suraj Koirala
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Brandon Kohrt
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal ,Division of Global Mental Health, George Washington University, Washington, DC USA
| | - Helen L. Fisher
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
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Moore A, van Loenhout JAF, de Almeida MM, Smith P, Guha-Sapir D. Measuring mental health burden in humanitarian settings: a critical review of assessment tools. Glob Health Action 2020; 13:1783957. [PMID: 32657249 PMCID: PMC7480646 DOI: 10.1080/16549716.2020.1783957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters’ impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement. Objective The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts. Method Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table. Results Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts. Conclusion It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.
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Affiliation(s)
- Ashley Moore
- Department of Social and Behavioral Sciences, Yale University School of Public Health , New Haven, CT, USA
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain , Brussels, Belgium
| | - Maria Moitinho de Almeida
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain , Brussels, Belgium
| | - Pierre Smith
- Institute of Health and Society IRSS, Université Catholique de Louvain , Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain , Brussels, Belgium
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Tupetz A, Friedman K, Zhao D, Liao H, Isenburg MV, Keating EM, Vissoci JRN, Staton CA. Prevention of childhood unintentional injuries in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0243464. [PMID: 33373371 PMCID: PMC7771986 DOI: 10.1371/journal.pone.0243464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022] Open
Abstract
Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Duan Zhao
- Duke Kunshan University, Kunshan, Suzhou, Jiangsu, China
| | - Huipeng Liao
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Megan Von Isenburg
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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Dahal S, Dhimal M, Pant SB, Sharma P, Marahatta K, Luitel N, Shakya S, Labh S, Ojha SP, Jha AK, Sheehan DV. Pilot Mental Health Survey, Nepal: Lessons Learned for Survey Design and Instrumentation. INNOVATIONS IN CLINICAL NEUROSCIENCE 2020; 17:17-23. [PMID: 33898097 PMCID: PMC7819577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: Learning from pilot studies is crucial for the successful implementation of large-scale surveys. In this manuscript, we present the lessons learned for instrumentation and survey methods from a pilot national mental health survey conducted in Nepal. Design: We conducted a cross-sectional study among 1,647 participants aged 13 years and older in three districts of Nepal. We used the Nepali translated standard adult and adolescent versions of the Mini International Neuropsychiatric Interview (MINI) 7.0.2 for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to do face-to-face structured diagnostic interviews. In addition, we included questionnaires on help-seeking behavior and barriers in accessing care. Results: We used a six-step procedure to translate and fit the tools in the context of Nepal. We conducted pretesting to evaluate the Nepali translated tools and adaptations, such as the addition of bridging sentences at the start of different modules. We identified different challenges during the tools administration and the ways to minimize reporting bias during data collection. Conclusion: The pilot survey identified the areas for improvement in survey tools, techniques, and methodology. The lessons learned from the pilot survey and the resulting corrective recommendations helped in more successful implementation of the Nepal national mental health survey.
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Affiliation(s)
- Sushma Dahal
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Meghnath Dhimal
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Sagun Ballav Pant
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Pawan Sharma
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Kedar Marahatta
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Nagendra Luitel
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Suraj Shakya
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Sweta Labh
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Saroj Prasad Ojha
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - Anjani Kumar Jha
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
| | - David V Sheehan
- Drs. Dhimal and Jha and Ms. Dahal and Ms. Labh are with the Nepal Health Research Council in Kathmandu, Nepal, and are members of the Technical Working Group, National Mental Health Survey, in Nepal
- Drs. Pant, Shakya, and Ojha are members of the Technical Working Group, National Mental Health Survey, in Nepal and are with the Department of Psychiatry and Mental Health, Institute of Medicine at Tribhuvan University in Kathmandu, Nepal
- Dr. Sharma is a member of the Technical Working Group, National Mental Health Survey, in Nepal and with the Patan Academy of Health Sciences in Lalitpur, Nepal
- Dr. Marahatta is a member of the Technical Working Group, National Mental Health Survey, in Nepal. Mr. Luitel is a member of the Technical Working Group, National Mental Health Survey, in Nepal and is with the Transcultural Psychosocial Organization Nepal in Kathmandu, Nepal
- Dr. Sheehan is with the University of South Florida College of Medicine in Tampa, Florida
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Kohrt BA, Carruth L. Syndemic effects in complex humanitarian emergencies: A framework for understanding political violence and improving multi-morbidity health outcomes. Soc Sci Med 2020; 295:113378. [PMID: 33051023 PMCID: PMC7501533 DOI: 10.1016/j.socscimed.2020.113378] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
Abstract
A hallmark of complex humanitarian emergencies is the collective exposure, often over extended periods of time, to political violence in the forms of war, terrorism, political intimidation, repression, unlawful detention, and forced displacement. Populations in complex humanitarian emergencies have higher risks of multiple co-morbidities: mental disorders, infectious diseases, malnutrition, and chronic non-communicable diseases. However, there is wide variation in the health impacts both across and within humanitarian emergencies. Syndemic theory is an approach to conceptualizing disease and social determinants to understand differential patterns of multi-morbidity, elucidate underlying mechanisms, and better design interventions. Syndemic theory, if applied to complex humanitarian emergencies, has the potential to uncover origins of localized patterns of multi-morbidity resulting from political violence and historical inequities. In this paper, we present two case studies based on mixed-methods research to illustrate how syndemic models can be applied in complex humanitarian emergencies. First, in a Nepal case study, we explore different patterns of posttraumatic stress disorder (PTSD) and depression co-morbidity among female former child soldiers returning home after war. Despite comparable exposure to war-related traumas, girl soldiers in high-caste Hindu communities had 63% co-morbidity of PTSD and depression, whereas girl soldiers in communities with mixed castes and religions, had 8% PTSD prevalence, but no cases of PTSD and depression co-morbidity. In the second case study, we explore the high rates of type 2 diabetes during a spike in political violence and population displacement. Despite low rates of obesity and other common risk factors, Somalis in Ethiopia experienced rising cases of and poor outcomes from type-2 diabetes. Political violence shapes healthcare resources, diets, and potentially, this epidemiological anomaly. Based on these case studies we propose a humanitarian syndemic research agenda for observational and intervention studies, with the central focus being that public health efforts need to target violence prevention at family, community, national, and global levels. Violence is a key feature of syndemic interactions in many contexts. In complex humanitarian emergencies, political violence exacerbates multi-morbidity. A syndemic approach could integrate fragmented and siloed health responses in complex humanitarian emergencies. A syndemic approach demands mitigating the roots of political violence and resulting multi-morbidities.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, Department of Global Health, Milken School of Public Health, George Washington University, USA.
| | - Lauren Carruth
- School of International Service, American University, Washington, DC, 20016, USA.
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Betancourt TS, Keegan K, Farrar J, Brennan RT. The intergenerational impact of war on mental health and psychosocial wellbeing: lessons from the longitudinal study of war-affected youth in Sierra Leone. Confl Health 2020; 14:62. [PMID: 32884581 PMCID: PMC7461150 DOI: 10.1186/s13031-020-00308-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, one in four children lives in a country affected by armed conflict or disaster often accompanied by exposure to a range of adversities including violent trauma and loss. Children involved with armed groups (often referred to as "child soldiers") typically exhibit high levels of mental health needs linked to their experiences. The Longitudinal Study of War-Affected Youth (LSWAY) in Sierra Leone is a seventeen-year prospective longitudinal study of the long-term effects of children's experiences in the country's eleven-year (1991-2002) civil war on their adult mental health and functioning in addition to exploring the potential mechanisms by which intergenerational transmission of emotional and behavioral disruptions due to war trauma may operate. LSWAY illuminates how war-related and post-conflict experiences shape long-term adult functioning, family dynamics, and developmental outcomes in offspring. Discussion The LSWAY study utilizes mixed methodologies that incorporate qualitative and quantitative data to unpack risk and protective factors involved in social reintegration, psychosocial adjustment, parenting, and interpersonal relationships. To date, study findings demonstrate striking levels of persistent mental health problems among former child soldiers as adults with consequences for their families, but also risk and protective patterns that involve family- and community-level factors. This case study examines the course of LSWAY from inception through implementation and dissemination, including building on the study results to design and evaluate several intervention models. Conclusion The case study offers a unique perspective on challenges and field realities of health research in a fragile, post-conflict setting common in the context of humanitarian emergencies. LSWAY findings along with lessons learned from the field can inform future research as well as intervention research and implementation science to address the mental health and development of war-affected young people. With four waves of data collection and a planned fifth wave, LSWAY also provides rare insights into the intergenerational effects of humanitarian crises on children, youth, and families across generations.
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Affiliation(s)
- Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA
| | - Katrina Keegan
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA
| | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA.,Women's Studies Research Center, Brandeis University, Waltham, MA USA
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Zefferman MR, Mathew S. An evolutionary theory of moral injury with insight from Turkana warriors. EVOL HUM BEHAV 2020. [DOI: 10.1016/j.evolhumbehav.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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50
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Ishimwe AB, Kaufman J, Uwamahoro D, Wall JT, Herth K, Chang E, Ngirabega JDD, Leonard W. Cross-cultural adaptation and psychometric properties of the Herth Hope Index in Kinyarwanda: adapting a positive psychosocial tool for healthcare recipients and providers in the Rwandan setting. Health Qual Life Outcomes 2020; 18:286. [PMID: 32831084 PMCID: PMC7444040 DOI: 10.1186/s12955-020-01537-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background The lack of culturally appropriate instruments to measure hope across cultural settings is a barrier to assessing and addressing the relationship between hope and health outcomes. The study aim was to adapt and evaluate the psychometric properties of the Herth Hope Index (HHI) in Kinyarwanda in a population of healthcare recipients and healthcare workers in Rwanda. Methods A transcultural translation and adaptation of the HHI was conducted using qualitative methods (n = 43) to achieve semantic, content, and technical equivalence. The adapted instrument was administered to a purposive sample (n = 206) of Rwandan healthcare patients and providers. Temporal reliability, internal reliability using Cronbach’s alpha, and construct validity using confirmatory factor analysis (CFA) were assessed. Results The Herth Hope Index-Kinyarwanda (HHI-K) was found to have strong internal consistency (α = 0.85) and test-retest reliability (r = 0.85). The original HHI three-factor structure fit the data well in CFA (normed chi-square = 1.53; root mean square error of approximation = 0.05; standardized root mean square residual = 0.05; comparative fit index = 0.96; Tucker-Lewis Index = 0.95). Conclusion This article presents the first rigorous cultural adaptation of the HHI in a low-income country. The HHI-K has acceptable psychometric properties, resulting in a new useful tool for research, program development, and evaluation in Rwandan healthcare settings. The HHI-K instrument can be used to assess the effectiveness of programs that aim to promote hope and health outcomes across health system- and individual-levels. The process also provides a feasible model for adaptation of a positive psychosocial tool for both patients and providers in low-resource settings.
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Affiliation(s)
| | - Julia Kaufman
- TIP Global Health, PO Box 1285, KN 4 St, Kigali, Rwanda
| | | | - Jonathan Taylor Wall
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Kaye Herth
- Minnesota State University, Mankato, 228 Wiecking Center, Mankato, MN, 56001, USA
| | - Emery Chang
- UCLA Health, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Jean de Dieu Ngirabega
- East African Health Research Commission, Quartier Kigobe, Avenue des Etats Unis, no. 71, B.P, 350, Bujumbura, Burundi
| | - Wendy Leonard
- TIP Global Health, PO Box 1285, KN 4 St, Kigali, Rwanda
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