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Ainamani HE, Rukundo G, Gumisiriza N, Tumwine C, Hall J. Traumatised youth harbour feelings of revenge: investigating the association between PTSD symptomatology, vengeance, and willingness to forgive among the Congolese adolescent refugees in Uganda. Eur J Psychotraumatol 2024; 15:2406169. [PMID: 39356003 PMCID: PMC11448343 DOI: 10.1080/20008066.2024.2406169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 10/03/2024] Open
Abstract
Background: Prolonged conflicts in the Democratic Republic of Congo (DRC) have caused widespread psychological trauma among civilians leading to maladaptive coping strategies across generations. Despite this occurrence, empirical studies on the prevalence of trauma and its impact on attitudes towards revenge and forgiveness, particularly among the youth, are scarce. This study aims to clarify the relationship between Post Traumatic Stress Disorder (PTSD) symptom severity and the desires for forgiveness and revenge among Congolese adolescents residing in Uganda.Methods: We analysed data from 269 adolescent refugees from the DRC living in the Nakivale refugee settlement in Southwestern Uganda. The assessment included exposure to war-related traumatic events and the MINI-KID for DSM-V PTSD symptom severity. The Heartland Forgiveness and Vengeance Scales measured willingness to forgive and feelings of vengeance.Results: Exposure to war-related traumatic events was notably high in our sample, with severe deprivation of food (260 [97%]), exposure to armed combat (249 [93%]), witnessing bombing, burning, or destruction of houses (245 [91%]), disappearance of family members (239 [89%]), and seeing dead bodies (236 [88%]). PTSD symptom severity was negatively associated with willingness to forgive (b = -0.48; 95% CI -0.71--0.25; p < .001) and positively associated with vengeance (b = 0.18; 95% CI 0.04-0.32; p = .011).Conclusion: PTSD symptom severity reduces the willingness to forgive and increases the desire for vengeance among adolescent refugees. Mental health clinicians and policymakers should consider addressing maladaptive coping behaviours related to feelings of revenge and unwillingness to forgive in their support strategies for refugees.
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Affiliation(s)
- Herbert E. Ainamani
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | - Godfrey Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nolbert Gumisiriza
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | - Christopher Tumwine
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | - Jonathan Hall
- Department of Peace and Conflict Research, Uppsala University, Uppsala, Sweden
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Mokaya AG, Kikuvi GM, Mutai J, Khasakhala LI, Memiah P. Predictors of depression among adolescents joining selected public secondary schools in Nairobi County, Kenya. PSYCHOLOGY IN THE SCHOOLS 2023. [DOI: 10.1002/pits.22873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Aggrey G. Mokaya
- Training Programs, Graduate School Kenya Medical Research Institute Nairobi Kenya
- Environmental Health Research Unit Centre for Public Health Research, Kenya Medical Research Institute Nairobi Kenya
- Department of Environmental Health and Disease Control Jomo Kenyatta University of Agriculture and Technology Juja Kenya
| | - Gideon M. Kikuvi
- Department of Environmental Health and Disease Control Jomo Kenyatta University of Agriculture and Technology Juja Kenya
| | - Joseph Mutai
- Training Programs, Graduate School Kenya Medical Research Institute Nairobi Kenya
- Environmental Health Research Unit Centre for Public Health Research, Kenya Medical Research Institute Nairobi Kenya
| | | | - Peter Memiah
- Masters in Global Health Program University of Maryland Graduate School Baltimore Maryland USA
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Haag K, Du Toit S, Skeen S, Steventon Roberts K, Chideya Y, Notholi V, Sambudla A, Gordon S, Sherr L, Tomlinson M. Predictors of COVID-related changes in mental health in a South African sample of adolescents and young adults. PSYCHOL HEALTH MED 2022; 27:239-255. [PMID: 35950705 DOI: 10.1080/13548506.2022.2108087] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has substantially affected the lives of young people living in sub-Saharan Africa (SSA), leading to poorer short-term mental health outcomes. However, longitudinal data investigating changes in mental health from pre-COVID levels and their predictors are lacking. Our longitudinal sample comprised N = 233 young people (mean age: 17.8 years at baseline, 55.6% female) living in a deprived neighbourhood near Cape Town, South Africa. Symptoms of depression (PHQ-9), anxiety (GAD-7) and alcohol use (AUDIT) were assessed during two waves of data collection, pre-pandemic (2018/19) and via phone interviews in June to October 2020, during South Africa's first COVID wave and subsequent case decline. Latent change score models were used to investigate predictors of changes in mental health. Controlling for baseline levels, we found increases in depression and anxiety but not alcohol use symptoms during the COVID-19 pandemic. Higher baseline symptoms were associated with smaller increases on all measures. Socio-economic deprivation (lack of household income, food insecurity) before and during COVID were associated with higher anxiety and depression symptom increases. Having had more positive experiences during COVID was associated with lower post-COVID onset anxiety and depression increases, and marginally with less alcohol use, while negative experiences (household arguments, worries) were linked to stronger symptom increases. Overall, in a sample of young people from an adverse environment in South Africa, we found increased mental health difficulties during the COVID-19 pandemic, though higher baseline symptoms did not necessarily predict stronger increases. Several factors pre- and post-COVID onset were identified that could be relevant for determining risk and resilience. In the long term, it will be key to address these structural drivers of well-being and to ensure mental health needs of young people are being met to support SSA countries in building back successfully from COVID-19 and preparing for future shock events.
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Affiliation(s)
- Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Yeukai Chideya
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Akhona Sambudla
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
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Jokinen T, Alexander EC, Manikam L, Huq T, Patil P, Benjumea D, Das I, Davidson LL. A Systematic Review of Household and Family Alcohol Use and Adolescent Behavioural Outcomes in Low- and Middle-Income Countries. Child Psychiatry Hum Dev 2021; 52:554-570. [PMID: 32785812 PMCID: PMC8238760 DOI: 10.1007/s10578-020-01038-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Exposure to alcohol misuse is considered an adverse childhood experience impacting on neurodevelopmental and behavioural outcomes in adolescents including substance use, mental illness, problem behaviours, suicidality, and teenage pregnancy. Most research on this issue has focussed on higher income countries, whereas patterns of alcohol use and related factors may be different in low- and middle-income countries (LMICs). This systematic review therefore seeks to collate all published studies from 1990-2020 on the topic set in LMICs. 43 studies were included, totalling 70,609 participants from 18 LMICs. Outcomes assessed included: substance use; depression/anxiety; suicidal ideation; problem behaviour; emotional dysfunction; teenage pregnancy; and self-harm. Despite heterogeneity in the studies identified, this review documented some association between exposure to household alcohol misuse and adverse adolescent outcomes in LMICs, including mental health problems, problem behaviours, and suicidality. The mechanisms leading to these outcomes are likely varied, and further research in different socio-economic and cultural contexts, particularly in the form of longitudinal studies, is called for.
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Affiliation(s)
- Tahir Jokinen
- GKT School of Medical Education, King's College London, London, UK
| | - Emma C Alexander
- London North West University Healthcare NHS Trust, London, UK
- Aceso Global Health Consultants Limited, London, UK
| | - Logan Manikam
- Aceso Global Health Consultants Limited, London, UK.
- UCL Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK.
| | - Tausif Huq
- GKT School of Medical Education, King's College London, London, UK
| | - Priyanka Patil
- Aceso Global Health Consultants Limited, London, UK
- UCL Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Darrin Benjumea
- Mailman School of Public Health, Columbia University, New York, USA
| | - Ishani Das
- Mailman School of Public Health, Columbia University, New York, USA
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Prevalence of mental illness among parents of children receiving treatment within child and adolescent mental health services (CAMHS): a scoping review. Eur Child Adolesc Psychiatry 2021; 30:997-1012. [PMID: 32133563 DOI: 10.1007/s00787-020-01502-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
People affected by mental illness often come from families with patterns of mental illness that span across generations. Hence, child and adolescent mental health services (CAMHS) likely provide treatment to many children with parents who also experience mental illness. The aim of this scoping review was to: (1) identify the prevalence of mental illness among parents of children in CAMHS; (2) identify and appraise the methodologies that have been implemented to assess the prevalence of parental mental illness in CAMHS; (3) identify additional circumstances associated with families where both parent and child experience mental illness; and (4) present recommendations that have been made for CAMHS practice based on these findings. English language, peer-reviewed studies (2010-2018) that had investigated the mental health of parents in CAMHS were included in the review. Literature searching yielded 18 studies which were found to have utilised diverse methodologies to assess parental mental health. Overall, reported prevalence of parental mental illness ranged from 16 to 79%; however, a single study that was deemed to be comprehensive reported prevalence rates of 36% for mothers and 33% for fathers. Across studies, parent and child mental illness was found to be associated with additional adversities impacting family functioning and wellbeing. For children who receive treatment for mental illness, having a parent who also experiences mental illness is a frequent family circumstance that has implications for their prospects for recovery. Accordingly, the mental health of parents should be an important consideration within the mental health care CAMHS provide to children.
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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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8
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Puffer ES, Healy EF, Green EP, Giusto AM, Kaiser BN, Patel P, Ayuku D. Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:3493-3508. [PMID: 33664559 PMCID: PMC7924913 DOI: 10.1007/s10826-020-01816-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-based interventions offer a promising avenue for addressing chronic negative family interactions that contribute to lasting consequences, including family violence and the onset and maintenance of mental health disorders. The purpose of this study was to conduct a mixed-methods, single group pre-post pilot trial of a family therapy intervention (N = 10) delivered by lay counselors in Kenya. Results show that both caregivers and children reported reductions in family dysfunction and improved mental health after the intervention. Point estimates represent change of more than two standard deviations from baseline for the majority of primary outcomes. Treated families also reported a decrease in harsh discipline, intimate partner violence, and alcohol-related problems. These results were corroborated by findings from an observational measure of family functioning and in-depth qualitative interviews. This study presents preliminary evidence of pre-post improvements following a family therapy intervention consisting of streamlined, evidence-informed family therapy strategies to target family dysfunction and mental health.
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Affiliation(s)
- Eve S. Puffer
- Department of Psychology and Neuroscience, Duke University, Box 90086417 Chapel Drive, Durham, NC 27708-0086, USA
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - Elsa Friis Healy
- Department of Psychology and Neuroscience, Duke University, Box 90086417 Chapel Drive, Durham, NC 27708-0086, USA
| | - Eric P. Green
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - Ali M. Giusto
- Department of Psychology and Neuroscience, Duke University, Box 90086417 Chapel Drive, Durham, NC 27708-0086, USA
| | - Bonnie N. Kaiser
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - Puja Patel
- Duke Global Health Institute, 310 Trent Drive, Box 90519, Durham, NC 27708, USA
| | - David Ayuku
- Department of Behavioral Science, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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Ssewanyana D, Abubakar A, Newton CRJC, Otiende M, Mochamah G, Nyundo C, Walumbe D, Nyutu G, Amadi D, Doyle AM, Ross DA, Nyaguara A, Williams TN, Bauni E. Clustering of health risk behaviors among adolescents in Kilifi, Kenya, a rural Sub-Saharan African setting. PLoS One 2020; 15:e0242186. [PMID: 33180831 PMCID: PMC7660520 DOI: 10.1371/journal.pone.0242186] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adolescents tend to experience heightened vulnerability to risky and reckless behavior. Adolescents living in rural settings may often experience poverty and a host of risk factors which can increase their vulnerability to various forms of health risk behavior (HRB). Understanding HRB clustering and its underlying factors among adolescents is important for intervention planning and health promotion. This study examines the co-occurrence of injury and violence, substance use, hygiene, physical activity, and diet-related risk behaviors among adolescents in a rural setting on the Kenyan coast. Specifically, the study objectives were to identify clusters of HRB; based on five categories of health risk behavior, and to identify the factors associated with HRB clustering. METHODS A cross-sectional survey was conducted of a random sample of 1060 adolescents aged 13-19 years living within the area covered by the Kilifi Health and Demographic Surveillance System. Participants completed a questionnaire on health behaviors which was administered via an Audio Computer-Assisted Self-Interview. Latent class analysis on 13 behavioral factors (injury and violence, hygiene, alcohol tobacco and drug use, physical activity, and dietary related behavior) was used to identify clustering and stepwise ordinal logistic regression with nonparametric bootstrapping identified the factors associated with clustering. The variables of age, sex, education level, school attendance, mental health, form of residence and level of parental monitoring were included in the initial stepwise regression model. RESULTS We identified 3 behavioral clusters (Cluster 1: Low-risk takers (22.9%); Cluster 2: Moderate risk-takers (67.8%); Cluster 3: High risk-takers (9.3%)). Relative to the cluster 1, membership of higher risk clusters (i.e. moderate or high risk-takers) was strongly associated with older age (p<0.001), being male (p<0.001), depressive symptoms (p = 0.005), school non-attendance (p = 0.001) and a low level of parental monitoring (p<0.001). CONCLUSION There is clustering of health risk behaviors that underlies communicable and non-communicable diseases among adolescents in rural coastal Kenya. This suggests the urgent need for targeted multi-component health behavior interventions that simultaneously address all aspects of adolescent health and well-being, including the mental health needs of adolescents.
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Affiliation(s)
- Derrick Ssewanyana
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Mark Otiende
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - George Mochamah
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Christopher Nyundo
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - David Walumbe
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Gideon Nyutu
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - David Amadi
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Aoife M. Doyle
- London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom
| | - David A. Ross
- London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom
| | - Amek Nyaguara
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Thomas N. Williams
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
- Department of Medicine, Imperial College, South Kensington Campus, London, United Kingdom
| | - Evasius Bauni
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
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Kutcher S, Perkins K, Gilberds H, Udedi M, Ubuguyu O, Njau T, Chapota R, Hashish M. Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania. Front Psychiatry 2019; 10:542. [PMID: 31555156 PMCID: PMC6724683 DOI: 10.3389/fpsyt.2019.00542] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022] Open
Abstract
Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called "An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania" (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a "hub and spoke" model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.
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Affiliation(s)
- Stanley Kutcher
- Department of Psychiatry, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | | | | | | | - Omary Ubuguyu
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Tasiana Njau
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Mina Hashish
- Department of Psychiatry, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
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11
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Devlin AM, Wight D, Fenton C. Are parenting practices associated with the same child outcomes in sub-Saharan African countries as in high-income countries? A review and synthesis. BMJ Glob Health 2018; 3:e000912. [PMID: 30687520 PMCID: PMC6326425 DOI: 10.1136/bmjgh-2018-000912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/17/2018] [Accepted: 08/09/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction There is increasing interest in the transferability of parenting interventions from high-income countries (HICs) to low-income countries (LICs) in order to improve child development and health outcomes. This is based on the premise that associations between parenting practices and child outcomes are similar in both settings. Many parenting interventions in HICs are evidence-based, but less evidence exists on associations of parenting practices with child outcomes in LICs, in particular, sub-Saharan African (SSA) countries. This review synthesises evidence on the association of parenting practices with child outcomes in SSA in order to compare findings with those from HICs. Methods We searched electronic databases—Web of Science, ASSIA, Embase, IBSS and PsycINFO—to identify studies from SSA that reported quantitative associations between parenting practices and child health or psychosocial outcomes (eg, sexual and reproductive health (SRH), mental health, conduct disorders). Due to inconsistent conceptual framing of parenting across studies, we used a modified version of the international WHO classification of parenting dimensions to guide synthesis of the results. Results Forty-four studies met our inclusion criteria. They were conducted in 13 SSA countries and included cross-sectional and longitudinal studies, and were predominantly descriptive studies rather than intervention research. Synthesis of results showed that associations between patterns of parenting (‘positive’/‘harsh’) and child outcomes (including SRH, mental health and conduct disorders) in studies from SSA were broadly similar to those found in HICs. Conclusions These findings suggest that the impacts of parenting practices on child outcomes are similar across contrasting global regions and, therefore, parenting interventions from HICs might be successfully transferred to SSA, subject to appropriate adaptation. However, this review also highlights the paucity of evidence in this area and the urgent need for higher quality studies to confirm these findings to help develop effective parenting interventions in SSA.
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Affiliation(s)
- Alison M Devlin
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Candida Fenton
- Cochrane Vascular, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, United Kingdom
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Mutavi T, Obondo A, Kokonya D, Khasakhala L, Mbwayo A, Njiri F, Mathai M. Incidence of depressive symptoms among sexually abused children in Kenya. Child Adolesc Psychiatry Ment Health 2018; 12:40. [PMID: 30069231 PMCID: PMC6065150 DOI: 10.1186/s13034-018-0247-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 07/23/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Children who experience sexual abuse undergo various negative psychosocial outcomes such as depressive symptoms. Unfortunately, not many studies have been conducted on the incidence of depressive symptoms among sexually abused children in Kenya. This study sought to ascertain the incidence of depressive symptoms among children who have experienced sexual abuse in Kenya. METHODS This was a longitudinal study design. It was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women's Hospitals in Kenya. One hundred and ninety-one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. The study administered the Becks Depression Inventory and the Child Depression Inventory to the children. RESULTS The incidence of depressive symptoms after 1 month of sexual abuse revealed that amongst children who were below 16 years old, 14.6% had minimal-mild depressive symptoms while 85.4% had moderate-severe depressive symptoms. In comparison, children who were 16 years or older, 6.4% had minimal-mild depressive symptoms while 93.6% had moderate-severe depressive symptoms. Children below 16 years old whose parents were separated were found to have depressive symptoms (p < 0.001) as well as those who were presented early for medical care (p < 0.004), while children aged 16 years and above who were abused by strangers were more likely to have depressive symptoms (p < 0.024) and those who were not attending school (p < 0.002). CONCLUSION Sexual abuse of children is world-wide and the Kenyan situation is comparable. Being the victim of sexual abuse as a child has major psychological and emotional sequlae which need to be addressed in Kenya. Children who experience sexual abuse have very high incidence of developing depressive symptoms. All the sexually abused children studied suffered from depressive symptoms and a large majority suffered from major depressive symptoms that should be promptly and effectively addressed to ameliorate psychological suffering among children.
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Affiliation(s)
- Teresia Mutavi
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 74-00519, Mlolongo, Nairobi, Kenya
| | - Anne Obondo
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 74-00519, Mlolongo, Nairobi, Kenya
| | - Donald Kokonya
- Department of Behavioural Sciences & Community Health, School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Lincoln Khasakhala
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 74-00519, Mlolongo, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 74-00519, Mlolongo, Nairobi, Kenya
| | - Francis Njiri
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 74-00519, Mlolongo, Nairobi, Kenya
| | - Muthoni Mathai
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 74-00519, Mlolongo, Nairobi, Kenya
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Mbuthia JW, Kumar M, Falkenström F, Kuria MW, Othieno CJ. Attributions and private theories of mental illness among young adults seeking psychiatric treatment in Nairobi: an interpretive phenomenological analysis. Child Adolesc Psychiatry Ment Health 2018; 12:28. [PMID: 29881454 PMCID: PMC5984772 DOI: 10.1186/s13034-018-0229-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/17/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Mental illness affects every segment of population including young adults. The beliefs held by young patients regarding the causes of mental illness impact their treatment-seeking behaviour. It is pertinent to know the commonly held attributions around mental illness so as to effectively provide psychological care, especially in a resource constrained context such as Kenya. This helps in targeting services around issues such as stigma and extending youth-friendly services. METHODS Guided by the private theories interview (PTI-P) and attributional framework, individual semi-structured interviews were carried out with ten young adults of ages 18-25 years about their mental health condition for which they were undergoing treatment. Each interview took 30-45 min. We mapped four attributions (locus of control, stability, controllability and stigma) on PTI-P questions. Data was transcribed verbatim to produce transcripts coded using interpretive phenomenological analysis. These codes were then broken down into categories that could be used to understand various attributions. RESULTS We found PTI-P to be a useful tool and it elicited three key themes: (a) psychosocial triggers of distress (with themes of negative thoughts, emotions around mental health stigma and negative childhood experiences, parents' separation or divorce, death of a loved one etc.), (b) biological conditions and psychopathologies limiting intervention, and (c) preferences and views on treatment. Mapping these themes on our attributional framework, PTI-P themes presented as causal attributions explaining stigma, locus of control dimensions and stability. External factors were mainly ascribed to be the cause of unstable and uncontrollable attributions including persistent negative emotions and thoughts further exacerbating psychological distress. Nine out of the ten participants expressed the need for more intense and supportive therapy. CONCLUSION Our study has provided some experiential evidence in understanding how stigma, internal vs external locus of control, stability vs instability attributions play a role in shaping attitudes young people have towards their mental health. Our study points to psychosocial challenges such as stigma, poverty and lack of social support that continue to undermine mental well-being of Kenyan youth. These factors need to be considered when addressing mental health needs of young people in Kenya.
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Affiliation(s)
- Judy Wanjiru Mbuthia
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O.Box 19676, Nairobi, 00202 Kenya
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O.Box 19676, Nairobi, 00202 Kenya
- Research Department of Clinical Health and Educational Psychology, University College London, Gower Street, London, WC1E 6BT UK
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Mary Wangari Kuria
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O.Box 19676, Nairobi, 00202 Kenya
| | - Caleb Joseph Othieno
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O.Box 19676, Nairobi, 00202 Kenya
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Improving Malawian teachers' mental health knowledge and attitudes: an integrated school mental health literacy approach. Glob Ment Health (Camb) 2015; 2:e1. [PMID: 28596850 PMCID: PMC4964842 DOI: 10.1017/gmh.2014.8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mental health literacy is foundational for mental health promotion, prevention, stigma reduction and care. Integrated school mental health literacy interventions may offer an effective and sustainable approach to enhancing mental health literacy for educators and students globally. METHODS Through a Grand Challenges Canada funded initiative called 'An Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania', we culturally adapted a previously demonstrated effective Canadian school mental health curriculum resource (the Guide) for use in Malawi, the African Guide: Malawi version (AGMv), and evaluated its impact on enhancing mental health literacy for educators (teachers and youth club leaders) in 35 schools and 15 out-of-school youth clubs in the central region of Malawi. The pre- and post-test study designs were used to assess mental health literacy - knowledge and attitudes - of 218 educators before and immediately following completion of a 3-day training programme on the use of the AGMv. RESULTS Results demonstrated a highly significant and substantial improvement in knowledge (p < 0.0001, d = 1.16) and attitudes (p < 0.0001, d = 0.79) pertaining to mental health literacy in study participants. There were no significant differences in outcomes related to sex or location. CONCLUSIONS These positive results suggest that an approach that integrates mental health literacy into the existing school curriculum may be an effective, significant and sustainable method of enhancing mental health literacy for educators in Malawi. If these results are further found to be sustained over time, and demonstrated to be effective when extended to students, then this model may be a useful and widely applicable method for improving mental health literacy among both educators and students across Africa.
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Othieno CJ, Okoth RO, Peltzer K, Pengpid S, Malla LO. Depression among university students in Kenya: prevalence and sociodemographic correlates. J Affect Disord 2014; 165:120-5. [PMID: 24882188 DOI: 10.1016/j.jad.2014.04.070] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression is a common cause of morbidity but prevalence levels among Kenyan university students are poorly understood. A better understanding of depression and its correlates is essential in planning for appropriate interventions in this population group. METHOD A random sample of 923 University of Nairobi students (525 male and 365 female) were interviewed using a questionnaire to record sociodemographic variables. Depressive symptoms were measured using Centre for Epidemiological Studies Short Depression Scale (CES - D 10). RESULTS The mean age was 23 (s.d. 4.0). Using a cut-off point of 10, the overall prevalence of moderate depressive symptoms was 35.7% (33.5% males and 39.0% females) and severe depression was 5.6% (5.3% males and 5.1% female). Depressive illness was significantly more common among the first year students, those who were married; those who were economically disadvantaged and those living off campus. Other variables significantly related to higher depression levels included year of study, academic performance, religion and college attended. Logistic regression showed that those students who used tobacco, engaged in binge drinking and those who had an older age were more likely to be depressed. No difference was noted with respect to gender. LIMITATIONS This was a cross sectional study relying on self report of symptoms and could therefore be inaccurate. Although the study was conducted in the largest university in the country that admits students from diverse backgrounds in the country there could still be regional differences in other local universities. CONCLUSION Depression occurs in a significant number of students. Appropriate interventions should be set up in higher institutions of learning to detect and treat these disorders paying particular attention to those at risk.
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Affiliation(s)
- Caleb J Othieno
- Department of Psychiatry, University of Nairobi, P.O. Box 19676, 00202 Nairobi, Kenya.
| | | | - Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Thailand; Human Sciences Research Council, Pretoria, South Africa; University of Limpopo, Turfloop Campus, South Africa
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Thailand; University of Limpopo, Turfloop Campus, South Africa
| | - Lucas O Malla
- Kenya Medical Research Institute, Wellcome Trust, Nairobi, Kenya
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