Mental health status among Burmese adolescent students living in boarding houses in Thailand: a cross-sectional study

A film-based intervention to reduce child maltreatment among migrant and displaced families from Myanmar: Protocol of a pragmatic cluster randomized controlled trial

BACKGROUND

Child maltreatment is a global public health crisis with negative consequences for physical and mental health. Children in low- and middle-income countries (LMIC)-particularly those affected by poverty, armed conflict, and forced migration-may be at increased risk of maltreatment due to heightened parental distress and disruptions to social support networks. Parenting interventions have been shown to reduce the risk of child maltreatment as well as improve a range of caregiver and child outcomes, yet large-scale implementation remains limited in low-resource displacement settings. This study will examine the impact of an entertainment-education narrative film intervention on reducing physical and emotional abuse and increasing positive parenting among migrant and displaced families from Myanmar living in Thailand.

METHOD

The study is a pragmatic, superiority cluster randomized controlled trial with approximately 40 communities randomized to the intervention or treatment as usual arms in a 1:1 ratio. Participating families in the intervention arm will be invited to attend a community screening of the film intervention and a post-screening discussion, as well as receive a poster depicting key messages from the film. Primary outcomes are changes in physical abuse, emotional abuse, and positive parenting behaviour. Secondary outcomes include caregiver knowledge of positive parenting, caregiver attitudes towards harsh punishment, caregiver psychological distress, and family functioning. Outcomes will be assessed at 3 time points: baseline, 4 weeks post-intervention, and 4-month follow up. A mixed methods process evaluation will be embedded within the trial to assess intervention delivery, acceptability, perceived impacts, and potential mechanisms of change.

DISCUSSION

To our knowledge, this study will be the first randomized controlled trial evaluation of a film-based intervention to reduce child maltreatment among migrant and displaced families in a LMIC. An integrated knowledge translation approach will inform uptake of study findings and application to potential scale up pending evaluation results.

TRIAL REGISTRATION

The study was prospectively registered with the Thai Clinical Trials Registry on 22 February 2023 (TCTR20230222005).

Gender and Place of Settlement as Predictors of Perceived Social Support, PTSD, and Insomnia among Internally Displaced Adolescents in North-East Nigeria

Previous research has shown that gender affects social support and post-traumatic stress disorders (PTSD). The present study explores the main and interaction effects of gender and place of settlement on social support, PTSD symptoms, and insomnia in internally displaced adolescents (IDAs) in North-east of Nigeria. A stratified sampling method was used to select 109 participants from IDAs living in the camp, while 27 additional IDAs were purposively recruited from those living in the host community. Participants completed measures of Harvard Trauma Questionnaire Part-II, Insomnia Severity Index, and Crisis Support. No significant effects of gender on perceived social support, PTSDs, and insomnia were observed. Place of settlement had a significant effect on social support, with IDAs living in the camp having a higher mean score, while place of settlement had no significant effects on PTSD and insomnia. A significant interaction effect of gender and place of settlements on insomnia was found, with males living in the community having a higher mean score than their female counterparts, as well as both males and females in the camp. In conclusion, there is a need to understand male IDAs who reside in non-camp settings better, including the nature of their challenges, the outcomes they desire, and the limitations they experienced.

Mental health of adolescents in Myanmar: A systematic review of prevalence, determinants and interventions

Adolescence is a developmental phase where mental disorders typically manifest and where platforms for response (including schools and health services) change rapidly. However, data to inform public mental health responses are limited, including in countries like Myanmar which has a large adolescent population and where mental health has been identified as a priority of policy. In this paper we sought to systematically review the peer-reviewed and grey literature to determine (i) the prevalence of mental disorder among adolescents in Myanmar, (ii) determinants of mental disorder and (iii) interventions that have been implemented and evaluated. Nine publications met inclusion criteria (7 peer-reviewed and 2 grey literature) that included 7 publications reporting prevalence, 6 reporting correlates and one an intervention. The available data from the 2016 Global School-based Health Survey highlight that depression (27.2%) and suicidal ideation (9.4%) are prevalent in Myanmar, and these rates are substantially higher than regional averages. The limited available data on correlates identified violence and bullying, alcohol and substance use, and home, family and community security and cohesion as being closely related to mental health for adolescents. Only one study focussed on interventions and this found mindfulness meditation training to be an effective approach for young people whose parents were affected by HIV. These findings underscore the need to address adolescent mental health in Myanmar, but also to invest in better data collection efforts.

Annual Research Review: A multilevel bioecological analysis of factors influencing the mental health and psychosocial well-being of refugee children

BACKGROUND

This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well-being of refugees to take stock of developments in the evidence base and conceptualisation of issues for refugee children over the last 25 years.

METHODS

The study deployed a systematic search strategy. This initially identified 784 papers, which was reduced to 65 studies following application of inclusion and exclusion criteria. We used a later iteration of Bronfenbrenner's bioecological model of human development - the PPCT model - to consolidate evidence.

RESULTS

We identify a range of risk and protective factors operating at individual, familial, community and institutional and policy levels that influence outcomes for refugee children. The dynamics shaping the interaction of these influences are linked to the life course principles of socio-historical time and developmental age, proximal processes and child agency.

CONCLUSIONS

Actions at individual, familial, community, school, institutional and policy levels all have potential traction on mental health and psychosocial well-being of refugee children. However, evidence suggests that greatest impact will be secured by multilevel interventions addressing synergies between ecological systems, approaches engaging proximal processes (including parenting programmes) and interventions facilitating the agency of the developing refugee child.

Assessing depressive symptoms among people living with HIV in Yangon city, Myanmar: Does being a member of self-help group matter?

Background

While self-help groups have been formed among people living with HIV, few studies have been conducted to assess the role of self-help groups in mitigating depressive symptoms. This study investigated the association between self-help group membership and depressive symptoms among people living with HIV in Yangon, Myanmar.

Methods

In this cross-sectional study, data were collected from people living with HIV at three antiretroviral therapy clinics in 2017. Multiple logistic regression analyses were carried out to examine the associations between having self-help group membership and depressive symptoms. Three ART clinics were purposively selected based on the recommendation from the National AIDS Program in Myanmar. At these clinics, people living with HIV were recruited by a convenience sampling method.

Results

Among people living with HIV recruited in this study (n = 464), 201 (43.3%) were members of a self-help group. The membership was not associated with having depressive symptoms (adjusted odds ratio [AOR] 1.59, 95% confidence interval [CI] 0.98–2.59). Factors associated with having depressive symptoms were female (AOR 3.70, 95% CI 1.54–8.88) and lack of social support (AOR 0.97, 95% CI 0.96–0.98) among self-help group members, and female (AOR 3.47, 95% CI 1.70–7.09), lack of social support (AOR 0.98, 95% CI 0.97–0.99), and internalized stigma (AOR 1.28, 95% 1.08–1.53) among non-members.

Conclusions

This study did not find evidence on the association between membership in self-help groups and depressive symptoms among people living with HIV. Social support was a protective factor against depressive symptoms both self-help group members and non-members, although the level of social support was lower among members than non-members. The activities of self-help groups and care provided by the ART clinics should be strengthened to address mental health problems among people living with HIV in the study site.

[Knowledge, access and use of the health system by migrant adolescents in Chile: results of an exploratory study]

OBJECTIVE

To identify the knowledge, access, and use of the health system by migrant adolescents, and the barriers to access and use of the health system in that population in Chile.

METHODS

Observational, cross-sectional exploratory study applied in a participatory workshop with migrant adolescents (N=30) in three municipalities of the city of Santiago, Chile. Multimethods study. A baseline survey on the migration process and experiences in the health system was applied, with descriptive data analysis. From the qualitative point of view, discussion groups (n=5) and participatory workshops (n=2) were carried out with migrant adolescents.

RESULTS

Sixty percent of the adolescents said they did not know if they were registered in the health system, and half of them had not used it. Time of residence was identified as a relevant factor for the effective use of some health benefits. Administrative barriers to access the health system were recognized, such as immigration status, perception of obligatory adult companionship, and experiences of discrimination in care. Specific needs were identified in sexual and reproductive health, such as access to condoms, and mental health care from specialists. As facilitators of access and use, experiences of proper treatment and the presence of the health sector in schools were highlighted.

CONCLUSIONS

Lack of information about the health system and various barriers to access and use by migrant adolescents were identified. Based on the results, general recommendations are proposed for the country and the region to improve the health of migrant adolescents.

Direct assessment of mental health and metabolic syndrome amongst Indonesian adolescents: a study design for a mixed-methods study sampled from school and community settings

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with the burden largely borne by people living in low- and middle-income countries. Adolescents are central to NCD control through the potential to modify risks and alter the trajectory of these diseases across the life-course. However, an absence of epidemiological data has contributed to the relative exclusion of adolescents from policies and responses. This paper documents the design of a study to measure the burden of metabolic syndrome (a key risk for NCDs) and poor mental health (a key outcome) amongst Indonesian adolescents. Using a mixed-method design, we sampled 16–18-year-old adolescents from schools and community-based settings across Jakarta and South Sulawesi. Initial formative qualitative enquiry used focus group discussions to understand how young people conceptualise mental health and body weight (separately); what they perceive as determinants of these NCDs; and what responses to these NCDs should involve. These findings informed the design of a quantitative survey that adolescents self-completed electronically. Mental health was measured using the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Kessler-10 (both validated against formal psychiatric interview in a subsample), with the metabolic syndrome measured using biomarkers and anthropometry. The survey also included scales relating to victimisation, connectedness, self-efficacy, body image and quality of life. Adolescents were sampled from schools using a multistage cluster design, and from the community using respondent-driven sampling (RDS). This study will substantially advance the field of NCD measurement amongst adolescents, especially in settings like Indonesia. It demonstrates that high quality, objective measurement is acceptable and feasible, including the collection of biomarkers in a school-based setting. It demonstrates how comparable data can be collected across both in-school and out of school adolescents, allowing a more comprehensive measure of NCD burden, risk and correlates.

Descriptive Characterization of Psycho-Trauma, Psychological Distress, and Post-traumatic Stress Disorder among Children and Adolescent Internally Displaced Persons in Kaduna, Nigeria

BACKGROUND

A postelection violent conflict in Kaduna resulted in 800 deaths and 65,000 displaced people leading to setting up of camp for internally displaced persons (IDPs). We set out to determine the prevalence and pattern of psycho-traumatic stressful life events, psychological distress, and post-traumatic stress disorder (PTSD) among child/adolescents IDPs.

METHODS

A descriptive cross-sectional study of 73 child/adolescent IDPs were selected by total sampling. Stressful life event checklist measured conflict-related trauma and reaction of adolescents to traumatic stress (RATS) measured post-trauma reaction of children/adolescents. Hopkins Symptoms Checklist 37 for Adolescents measured psychological distress associated with trauma. Diagnostic Interview Schedule for Children was used for diagnosis of PTSD.

RESULTS

Of 73 respondents, 3 (4.1%) had probable PTSD, 2 (2.7%) had definitive PTSD, and mean score of the child/adolescent IDPs on HSCL-37A and RATS was 44.7 (SD = 6.3) and 31.9 (SD = 5.7), respectively. Most frequently occurring psychological distress among female participants was suddenly scared for no reason 7 (19.5%) and becoming angry easily and feeling fearful 5 (13.9%). The average score for female participants were higher than that for males on depressive and anxiety subscale of HSCL-37A.

CONCLUSION

We concluded that children/adolescent IDPs were exposed to psycho-trauma following postelection violent conflict and developed psychological distress. However, the low prevalence of psychological distress and PTSD suggested that living with parents and psychosocial intervention provided could have led to much lower morbidity.

Social support and self-care activities among the elderly patients with diabetes in Kelantan

INTRODUCTION

Diabetes is common among the elderly and can significantly affect their lives including the issues related with social support and diabetic self-care activities.

OBJECTIVES

The objective of this study was to examine the social support and self-care activities among the elderly patients with diabetes.

METHODS

A survey involving 200 patients was conducted from March 2013 to May 2013 in three hospitals in Kelantan. Data were obtained through self-administered questionnaires and clinical characteristics were acquired from the patients' records.

RESULTS

The scores for social support (mean = 19.26; SD = 2.63) and self-care activities (mean = 14.83; SD = 4.92) were moderate. Higher social support was associated with high levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS) level, the duration of diabetes and a decrease in body mass index (BMI) (p<0.05). It was observed that the patients with low educational, Hb1Ac and FBS level, with other chronic diseases and who have had diabetes for some time had low self-care activities (p<0.05). There was a significant negative relationship between an increase in social support and decrease in self-care activity (p<0.05).

CONCLUSION

Healthcare providers, family and friends have to strengthen their relationship with the elderly patients with diabetes to provide more social support and promote the compliance with diabetic self-care activities to improve clinical outcomes.

Prevalence and risk factors for depressive reaction among resident survivors after the tsunami following the Great East Japan Earthquake, March 11, 2011

Objectives

The Great East Japan Earthquake caused a gigantic tsunami which devastated coastal areas of northern Japan on 11 March 2011. Despite the large number of ‘resident survivors’ who continued to reside in their damaged houses on the second or upper floors, research on the mental health of these individuals has been limited. This study explored the prevalence of depressive reaction and risk factors for depressive reaction among these resident survivors.

Methods

A cross-sectional household health support needs screening was conducted for resident survivors in Higashi-Matsushima city, Miyagi prefecture, two to four months after the tsunami. The health interview that was conducted including mental status, assessed by the Patient Health Questionnaire-2 (PHQ-2).

Results

Of 5,454 respondents, 8.1% had depressive reaction. After adjustment by the number of weeks from the tsunami and the mortality rate at each respondent's place of residence, depressive reaction was significantly associated with house flooding below or above the ground floor (odds ratios of 1.92, 2.36, respectively), the unavailability of gas supply (odds ratio, 1.67), being female (odds ratio, 1.47), middle aged or elderly (odds ratios of 2.41, 2.42, respectively), regular intake of psychotropic medicine(s) since before the tsunami (odds ratio, 2.53) and the presence of one to five or more than six cohabiters (odds ratios of 0.61, 0.52, respectively).

Conclusions

The results suggest a considerable psychological burden (depressive reaction) following the tsunami among resident survivors. Special supports for families with psychiatric problems need to be considered among resident survivors. Restoration of lifeline utilities and the strengthening of social ties of persons living alone may help prevent depressive reaction among resident survivors after a tsunami.