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Makoha G, Denov M. War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda. Front Public Health 2024; 12:1232504. [PMID: 38375335 PMCID: PMC10875737 DOI: 10.3389/fpubh.2024.1232504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Refugees are at high risk of alcohol abuse due to their experiences of structural, physical, sexual, and psychological violence in their countries of origin, during flight, and within host communities. Given the prolonged civil war in their country, South Sudanese have continued to flee profound forms of violence and now constitute the largest population of refugees in Uganda. However, little is known about their displacement experiences, as well as the reality of alcohol use and abuse within refugee settlements. Drawing upon the direct voices of a sample of war-affected South Sudanese young people, this article explores their experiences of forced displacement and their links to alcohol abuse, as well as their perceptions regarding appropriate alcohol treatment interventions for refugees in the camp. A total of 22 semi-structured qualitative interviews were conducted with 14 refugee youth (aged 18-25) alongside eight adult key informants who work with the youth (religious leaders, sports coaches, educators, social workers, and settlement administrators). Using thematic analysis, the study revealed a series of key themes influencing and shaping the high incidence of alcohol abuse among the youth. These included traumatic wartime and migration experiences, family separation, poor prospects, and the ubiquitous availability of alcohol in the settlement. In addition, we show how alcohol operates as a strategic tool for survival for the youth, as well as highlight how these perceptions can help to inform alcohol treatment interventions in the Bidibidi refugee settlement. To our knowledge, this is the first in-depth study of alcohol abuse among war-affected South Sudanese refugee youth in Uganda, addressing a significant gap in the current literature on war-affected youth, forced displacement, and alcohol abuse. We contend that involving youth in the design of interventions can be helpful for culturally sensitive and relevant prevention, treatment, and care in refugee settings. In addition, providing employment opportunities and meaningful engagement for growth through social participation can help to address harmful alcohol use among youth in the camps.
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Affiliation(s)
- Godfrey Makoha
- School of Social Work, McGill University, Montreal, QC, Canada
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2
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Bruffaerts R, Axinn WG, Ghimire DJ, Benjet C, Chardoul S, Scott KM, Kessler RC, Schulz P, Smoller JW. Community exposure to armed conflict and subsequent onset of alcohol use disorder. Addiction 2024; 119:248-258. [PMID: 37755324 PMCID: PMC10872606 DOI: 10.1111/add.16343] [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: 02/24/2023] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
AIMS To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict. DESIGN A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence. SETTING Chitwan, Nepal. PARTICIPANTS Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%). MEASUREMENTS Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022. FINDINGS Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings. CONCLUSIONS Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.
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Affiliation(s)
- Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum KU Leuven, Leuven, Belgium
| | - William G Axinn
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Dirgha J Ghimire
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Corina Benjet
- Department of Epidemiology and Psychosocial Research, National Institute of Psychiatry Instituto Nacional de Psiquiatría Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Schulz
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Nakaganda A, Mbarusha I, Spencer A, Patterson L, Gemmell I, Jones A, Verma A. Prevalence, trends and distribution of lifestyle cancer risk factors in Uganda: a 20-year systematic review. BMC Cancer 2023; 23:311. [PMID: 37020195 PMCID: PMC10077672 DOI: 10.1186/s12885-023-10621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cancer is becoming an important public health problem in Uganda. Cancer control requires surveillance of lifestyle risk factors to inform targeted interventions. However, only one national Non-Communicable Disease (NCD) risk factor survey has been conducted in Uganda. This review assessed the prevalence, trends and distribution of lifestyle risk factors in Uganda. METHODS The review identified studies up to January 2019 by searching Medline, Embase, CINAL and Cochrane databases. Further literature was identified from relevant websites and journals; scanning reference lists of relevant articles; and citation searching using Google Scholar. To be eligible, studies had to have been conducted in Uganda, and report prevalence estimates for at least one lifestyle cancer risk factor. Narrative and systematic synthesis was used to analyse the data. RESULTS Twenty-four studies were included in the review. Overall, unhealthy diet (88%) was the most prevalent lifestyle risk factor for both males and females. This was followed by harmful use of alcohol (range of 14.3% to 26%) for men, and being overweight (range of 9% to 24%) for women. Tobacco use (range of 0.8% to 10.1%) and physical inactivity (range of 3.7% to 4.9%) were shown to be relatively less prevalent in Uganda. Tobacco use and harmful use of alcohol were more common in males and more prevalent in Northern region, while being overweight (BMI > 25 kg/m2) and physical inactivity were more common in females and more prevalent in Central region. Tobacco use was more prevalent among the rural populations compared to urban, while physical inactivity and being overweight were more common in urban than in rural settings. Tobacco use has decreased overtime, while being overweight increased in all regions and for both sexes. CONCLUSION There is limited data about lifestyle risk factors in Uganda. Apart from tobacco use, other lifestyle risk factors seem to be increasing and there is variation in the prevalence of lifestyle risk factors among the different populations in Uganda. Prevention of lifestyle cancer risk factors requires targeted interventions and a multi-sectoral approach. Most importantly, improving the availability, measurement and comparability of cancer risk factor data should be a top priority for future research in Uganda and other low-resource settings.
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Affiliation(s)
- Annet Nakaganda
- Cancer Epidemiology and Clinical Trials Unit, Uganda Cancer Institute, Kampala, Uganda.
- Department of Public Health and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Immaculate Mbarusha
- Cancer Epidemiology and Clinical Trials Unit, Uganda Cancer Institute, Kampala, Uganda
| | - Angela Spencer
- Department of Public Health and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Lesley Patterson
- Department of Public Health and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Isla Gemmell
- Department of Public Health and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrew Jones
- Department of Public Health and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Arpana Verma
- Department of Public Health and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Nam B, Kim J, Kim JY, Lee Y. Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2023:8862605231161290. [PMID: 36942848 DOI: 10.1177/08862605231161290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women's exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women's exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.
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Affiliation(s)
- Boyoung Nam
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Joonbeom Kim
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Yop Kim
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Yujin Lee
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
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Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review. Glob Ment Health (Camb) 2023; 10:e5. [PMID: 36843880 PMCID: PMC9947613 DOI: 10.1017/gmh.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.
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Im H, Swan LET. Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis. Int J Soc Psychiatry 2022; 68:1539-1551. [DOI: https:/doi.org/10.1177/00207640211037726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. Aims: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. Method: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample ( N = 305) and then assessed gender differences by running one model for male participants ( n = 124) and another for female participants ( n = 181). Results: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. Conclusions: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, Richmond, USA
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7
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Childhood Trauma and Dissociation Correlates in Alcohol Use Disorder: A Cross-Sectional Study in a Sample of 587 French Subjects Hospitalized in a Rehabilitation Center. Brain Sci 2022; 12:brainsci12111483. [DOI: 10.3390/brainsci12111483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
This study aimed to determine whether dissociative symptoms and childhood trauma (CT) may help identify a specific subgroup of patients among those hospitalized for alcohol use disorder (AUD). We assessed 587 patients hospitalized for an AUD in a French addiction rehabilitation center (cross-sectional study) regarding dissociative symptoms (DES-taxon), childhood trauma (CTQ), depression (BDI), anxiety (STAI-state and STAI-trait), posttraumatic stress disorder (PTSD; PCL-5), and AUD symptoms (AUDIT). We ran a hierarchical cluster analysis and compared the clusters in terms of dissociation and CT, as well as AUD, depressive, anxiety, and PTSD symptoms. We identified three clusters of patients: (1) patients with low AUD severity and low dissociation (LALD); (2) patients with high AUD severity and low dissociation (HALD); (3) patients with high AUD severity and high dissociation (HAHD). Patients from the HAHD group had significantly higher dissociation and more severe depression, anxiety, and PTSD symptoms than those with LALD and HALD. They also reported more emotional and sexual abuse than those with LALD. Among patients with an AUD, those with high dissociation may constitute an independent subgroup that exhibits a higher prevalence for CT and higher AUD severity, as well as higher depression, anxiety, and PTSD symptoms. Patients with more severe AUD and associated psychiatric symptoms should be systematically screened for dissociation and provided with tailor-based treatments.
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8
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Skylstad V, Nalugya JS, Skar A, Opesen C, Ndeezi G, Okello ES, Moland KM, Engebretsen I, Tumwine JK. 'As soon as they can hold a glass, they begin taking alcohol': a qualitative study on early childhood substance use in Mbale District, Uganda. BMC Public Health 2022; 22:812. [PMID: 35459136 PMCID: PMC9033416 DOI: 10.1186/s12889-022-13140-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years. Methods In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. Results Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. Conclusions To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.
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Affiliation(s)
- V Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - J S Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Ams Skar
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - C Opesen
- Department of Sociology and Anthropology, School of Social Sciences, Makerere University, Kampala, Uganda
| | - G Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - E S Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza Campus, Mwanza, Tanzania
| | - K M Moland
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ims Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - J K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.,Kabale University School of Medicine, Kabale, Uganda
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Kapfhammer HP. [Comorbidity of posttraumatic stress disorder and addiction from a biopsychosocial perspective]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:1-18. [PMID: 33439473 PMCID: PMC8916999 DOI: 10.1007/s40211-020-00384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder and substance use disorder often co-occur within the health care system. Their comorbidity is associated with more serious acute clinical symptomatology, more frequent hospital admissions in state of emergency and significantly lower chances of improvement by psychological and pharmacological treatment. Their comorbidity contributes to dramatically unfavourable courses of illness as regards all biopsychosocial levels. The survey presented will discuss empirical findings from various perspectives: general epidemiology, substance use disorder as risk factor of trauma and PTSD, trauma and PTSD as risk factor of SUD, neurobiological effects of SUD converging towards neurobiology of PTSD, shared common factors of genetics/epigenetics, personality traits, and early developmental stress and trauma. The main focus of analysis will be put on processes that are intrinsically linked to the development and course of both disorders.
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Affiliation(s)
- Hans-Peter Kapfhammer
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich.
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Florez IA, Mekawi Y, Hunnicutt-Ferguson K, Visser K, Clunie A, Dunn SE, Kaslow NJ. Childhood abuse, posttraumatic stress symptoms, and alcohol misuse among African-American women. J Ethn Subst Abuse 2022; 21:174-196. [PMID: 32065558 PMCID: PMC8493960 DOI: 10.1080/15332640.2020.1725707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The study explored associations among childhood abuse, post-traumatic stress symptoms (PTSS), and alcohol misuse in a sample of low-income African-American women (N = 172). Using bootstrapping techniques, a mediation effect was found of childhood physical and emotional abuse on alcohol misuse via PTSS symptom severity, avoidance, and hyperarousal, as well as for childhood sexual abuse on alcohol misuse via PTSS symptom severity and hyperarousal. Our results suggest that PTSS indicators, particularly symptom severity and hyperarousal, may be important mechanisms underlying the association of experiences of abuse during childhood and alcohol misuse in adulthood.
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Affiliation(s)
- Ivonne Andrea Florez
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kallio Hunnicutt-Ferguson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Amber Clunie
- Department of Psychology, Spelman College, Atlanta, GA, USA
| | - Sarah E. Dunn
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA,Correspondence should be addressed to: Nadine J. Kaslow, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Health System, 80 Jesse Hill Jr. Drive NE, Atlanta, GA, USA, 30303;
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Carvalho CM, Coimbra BM, Xavier G, Bugiga AVG, Fonseca T, Olff M, Polimanti R, Mello AF, Ota VK, Mello MF, Belangero SI. Shorter Telomeres Related to Posttraumatic Stress Disorder Re-experiencing Symptoms in Sexually Assaulted Civilian Women. Front Psychiatry 2022; 13:835783. [PMID: 35664481 PMCID: PMC9161278 DOI: 10.3389/fpsyt.2022.835783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Telomeres are short tandem repeats of "TTAGGG" that protect the chromosome ends from deterioration or fusion of chromosomes. Their repeat length shortens with cell division acting as a biomarker of cellular aging. Traumatic stress events during adulthood or childhood have been associated with posttraumatic stress disorder (PTSD) and short leukocyte telomere length (LTL). This study investigated whether LTL was associated with PTSD in a Brazilian sample of sexually assaulted civilian women at two time points: baseline and 1-year follow-up. At baseline, we assessed 64 women with PTSD following sexual assault (cases) and 60 women with no previous history of sexual trauma or mental disorders (healthy controls - HC). At follow-up visit, 13 persistent PTSD cases, 11 HCs, and 11 PTSD remitters patients were evaluated. PTSD diagnosis and severity were assessed using Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders III/IV criteria) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), respectively. LTL was measured using multiplex real-time polymerase chain reaction (PCR). In the baseline analysis, we observed that LTL was associated with re-experiencing symptoms (B = -0.16; confidence interval (CI) 95% = -0.027--0.005; Bonferroni-adjusted p-value = 0.02), but no association was observed between other PTSD symptoms and LTL. In the longitudinal analysis, telomere shortening was no longer observed in patients with PTSD and PTSD remitters. In conclusion, our findings indicate that shorter baseline LTL is associated with early stage of PTSD re-experiencing symptoms in recently sexually assaulted women.
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Affiliation(s)
- Carolina Muniz Carvalho
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychiatry, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, Netherlands
| | - Gabriela Xavier
- LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
| | - Amanda V G Bugiga
- LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tamiris Fonseca
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Miranda Olff
- Department of Psychiatry, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, VA CT Healthcare Center, West Haven, CT, United States
| | - Andrea Feijó Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vanessa Kiyomi Ota
- LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijó Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sintia Iole Belangero
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
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12
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Ertl V, Groß M, Mwaka SO, Neuner F. Treating alcohol use disorder in the absence of specialized services - evaluation of the moving inpatient Treatment Camp approach in Uganda. BMC Psychiatry 2021; 21:601. [PMID: 34852824 PMCID: PMC8638348 DOI: 10.1186/s12888-021-03593-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gap between service need and service provision for alcohol-related disorders is highest in resource-poor countries. However, in some of these contexts, local initiatives have developed pragmatic interventions that can be carried out with limited specialized personnel. In an uncontrolled treatment study, we aimed to evaluate the feasibility, acceptability, safety, costs and potential effects of an innovative locally developed community-based program (the Treatment Camp) that is based on an inpatient clinic that moves from community to community. METHODS Out of 32 treatment-seeking individuals 25 took part in the one-week Treatment Camp that included detoxification and counseling components. Re-assessments took place 5 and 12 months after their participation. We explored the course of a wide range of alcohol-related indicators, using the Alcohol Use Disorders Identification Test (AUDIT) as primary outcome complemented by a timeline follow-back approach and the Obsessive Compulsive Drinking Scale. Additionally, we assessed impaired functioning, alcohol-related stigmatization, symptoms of common mental health disorders and indicators of family functioning as reported by participants' wives and children. RESULTS All alcohol-related measures decreased significantly after the Treatment Camp and remained stable up to the 12-month-assessment with high effect sizes ranging from 0.89 to 3.49 (Hedges's g). Although 92% of the participants had lapsed at least once during the follow-up period, 67% classified below the usually applied AUDIT cutoff for hazardous drinking (≥ 8) and no one qualified for the dependent range (≥ 20) one year after treatment. Most secondary outcomes including impaired functioning, alcohol-related stigmatization, symptoms of depression and indicators of family functioning followed the same trajectory. CONCLUSIONS We found the Treatment Camp approach to be acceptable, feasible, safe and affordable (approx. 111 USD/patient) and we could obtain preliminary evidence of its efficacy. Due to its creative combination of inpatient treatment and monitoring by medical personnel with local mobility, the Treatment Camp appears to be more accessible and inclusive than other promising interventions for alcohol dependent individuals in resource-poor contexts. Effects of the approach seem to extend to interactions within families, including a reduction of dysfunctional and violent interactions.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Biopsychology, Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstraße 25, 85072, Eichstätt, Germany.
- vivo international (www.vivo.org), Konstanz, Germany.
| | - Melissa Groß
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Samuel Okidi Mwaka
- Program for Prevention, Awareness, Counseling and Treatment of Alcoholism (PACTA; www.pactaguluganda.org.ug), Plot 1 Burcoro Road, Wiaworanga, Gulu, Uganda
| | - Frank Neuner
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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Campbell A, Egan J, Murphy P, Blair C. Getting our act together: a qualitative evaluation of the impact of a play on issues relating to women, sex work and substance use. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16644.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The arts have always sought to explore significant social issues through literature, performing arts and visual art. However, more recently there has been an increase in the use of theatre as a means of gauging audiences’ perception and understanding of key social issues. The primary aim of the current evaluation was to seek the views of audience members, service users of addiction services and expert commentators as regards their perception of a number of key issues related to the content of a play entitled Madame Geneva. Methods: The evaluation used an exploratory qualitative design incorporating a dualistic approach to the research process: including post show discussion with panellists and members of the audience and a focus group comprising service users who had also viewed a live performance of the play. Results: The topics elucidated by the performance of the play included women and sex work, women and substance use, and impact on policy and practice. The discussion of the issues raised reiterated that women still experience high levels of oppression and discrimination in areas of substance use, sex work and welfare ‘reform’ which are often couched within male dominated political discourses and structures in contemporary society. Conclusions: The arts and specifically dramaturgical representations of substance use and related issues is an effective method of initiating important pragmatic and policy discussion of issues, which affect women
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Mehus CJ, Wieling E, Thomas Oloya O, Laura A, Ertl V. The impact of alcohol misuse on fathering in Northern Uganda: An ethnographic study of fathers. Transcult Psychiatry 2021; 58:14-26. [PMID: 32727316 DOI: 10.1177/1363461520943315] [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: 11/17/2022]
Abstract
The Acholi people of northern Uganda experienced decades of conflict. Alcohol misuse is high among northern Ugandan men. This is common in displaced or post-war communities. Because parents are often the most significant and proximal influence in a child's development, it is important to understand the relationships between parental behavioral health and parenting. The purpose of this ethnographic study was to understand the impact of alcohol misuse on fathering, from fathers' perspectives. We collected qualitative data from several sources, including in-depth interviews with 19 fathers. Informants identified three ways in which a father can "overdrink": drinking to drunkenness, spending too much money on alcohol, or spending too much time drinking alcohol. Fathers described the specific ways in which overdrinking impacted each of the three primary roles of a father, which were identified as providing, educating, and creating a stable home. Of the negative effects of overdrinking, a compromised ability to provide for basic needs was described as the most salient. The findings suggest that support for families in this region should include support for father's substance misuse, as a father's overdrinking is widely understood to be problematic for the entire family.
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Affiliation(s)
| | | | | | | | - Verena Ertl
- Katholische Universität Eichstätt-Ingolstadt and vivo International, Germany
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15
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Harerimana B, Kerr M, Csiernik R, Ng LC, Rutembesa E, Forchuk C. Predicting the Contribution of Age at First Substance Use and Post-Traumatic Stress Disorder to Later Addiction Severity in a Clinical Sample from Sub-Saharan Africa: Implications for Prevention and Treatment. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Dowhaniuk N, Ojok S, McKune SL. Setting a research agenda to improve community health: An inclusive mixed-methods approach in Northern Uganda. PLoS One 2021; 16:e0244249. [PMID: 33411706 PMCID: PMC7790286 DOI: 10.1371/journal.pone.0244249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The United Nations Sustainable Development Goals stress the importance of equitable partnerships in research and practice that integrate grass-roots knowledge, leadership, and expertise. However, priorities for health research in low-and-middle income countries are set almost exclusively by external parties and priorities, while end-users remain "researched on" not "researched with". This paper presents the first stage of a Community-Based Participatory Research-inspired project to engage communities and public-health end-users in setting a research agenda to improve health in their community. METHODS Photovoice was used in Kuc, Gulu District, Uganda to engage community members in the selection of a research topic for future public health research and intervention. Alcohol-Use Disorders emerged from this process the health issue that most negatively impacts the community. Following identification of this issue, a cross-sectional survey was conducted using the Alcohol Use Disorder Identification Test (n = 327) to triangulate Photovoice findings and to estimate the prevalence of Alcohol-Use Disorders in Kuc. Logistic regression was used to test for associations with demographic characteristics and Alcohol-Use Disorders. RESULTS Photovoice generated four prominent themes, including alcohol related issues, sanitation and compound cleanliness, water quality and access, and infrastructure. Alcohol-Use Disorders were identified by the community as the most important driver of poor health. Survey results indicated that 23.55% of adults in Kuc had a probable Alcohol Use Disorder, 16.45 percentage points higher than World Health Organization estimates for Uganda. CONCLUSIONS Community members engaged in the participatory, bottom-up approach offered by the research team to develop a research agenda to improve health in the community. Participants honed in on the under-researched and underfunded topic of Alcohol-Use Disorders. The findings from Photovoice were validated by survey results, thereby solidifying the high prevalence of Alcohol-Use Disorders as the health outcome that will be targeted through future long-term research and partnership.
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Affiliation(s)
- Nicholas Dowhaniuk
- Department of Geography, University of Florida, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- Tropical Conservation and Development Program, University of Florida, Gainesville, Florida, United States of America
| | - Susan Ojok
- Uganda Women's Action Program, Gulu, Uganda
| | - Sarah L. McKune
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- African Studies Program, University of Florida, Gainesville, Florida, United States of America
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Ghogare A, Patil P, Vankar G. A systematic review of childhood psychological traumas and alexithymia among persons with alcohol dependence syndrome. ANNALS OF INDIAN PSYCHIATRY 2021. [DOI: 10.4103/aip.aip_54_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Kopera M, Zaorska J, Trucco EM, Suszek H, Kobyliński P, Zucker RA, Nowakowska M, Wojnar M, Jakubczyk A. Childhood trauma, alexithymia, and mental states recognition among individuals with alcohol use disorder and healthy controls. Drug Alcohol Depend 2020; 217:108301. [PMID: 32979738 PMCID: PMC7736369 DOI: 10.1016/j.drugalcdep.2020.108301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although prior work indicates a link between childhood trauma, alexithymia, and mental states recognition, empirical support is limited. Moreover, findings based on adult samples are mixed. Previous studies demonstrate that childhood trauma might either enhance, preserve, or reduce mental states recognition in selected at-risk populations. The current study investigates whether alcohol use disorder (AUD) status moderates the association between childhood trauma, alexithymia, and mental states recognition in a treatment-seeking AUD sample and non-AUD healthy adults. METHODS Data comes from 255 individuals participating in an ongoing project that compares emotional and behavioral functioning of patients treated in an inpatient setting for AUD and a comparison sample of 172 healthy controls (HCs). Mental states recognition was measured using a computerized version of the Reading the Mind in the Eyes Task (RMET). The presence of childhood trauma was assessed with the Childhood Trauma Questionnaire. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). Demographic information, as well as alcohol drinking and psychopathological symptoms were assessed. A moderated mediation model was estimated whereby alexithymia was included as a mediator in the association between childhood trauma and RMET performance, with AUD diagnosis status moderating the link between alexithymia and RMET performance. RESULTS Findings provide support for moderated mediation. Childhood emotional trauma impacted negative mental states recognition performance via difficulty describing feelings, but only among HCs (p < 0.01). CONCLUSIONS Findings highlight the impact that AUD status has on the association between early life emotional trauma and difficulty describing feelings on individual differences in mental states recognition.
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Affiliation(s)
- Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland
| | - Justyna Zaorska
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland
| | - Elisa M. Trucco
- Department of Psychology, Center for Children and Families, Florida International University, Academic Health Center 1, 11200 Southwest 8th Street, Miami, FL, 33199, USA,Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Hubert Suszek
- Department of Psychology, University of Warsaw, 5/7 Stawki St., 00-183, Warsaw, Poland
| | - Paweł Kobyliński
- National Information Processing Institute, Laboratory of Interactive Technologies, 188 b al Niepodległości, 00-608, Warsaw, Poland
| | - Robert A. Zucker
- Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA,Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Malwina Nowakowska
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland,Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland.
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García-Balaguera C. [Health as a right in Colombia's post-conflict period]. Rev Salud Publica (Bogota) 2020; 20:771-777. [PMID: 33206904 DOI: 10.15446/rsap.v20n6.67777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/20/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To explore the elements that should be considered in post-conflict zones to guarantee the right to health of populations immersed or living in areas near the concentrations of former combatants. MATERIALS AND METHODS A retrospective study was carried out by searching databases, obtaining 26 relevant articles. RESULTS The literature review made evident that not only the legal or normative framework is important, but also the needs and interests of the people of the community, of both the civilian population and the victims of war. The right to health in these areas also involves the exercise of power, of dialogue of knowledge, forgiveness, non-repetition and respect. In addition, health promotion and disease prevention services, treatment and rehabilitation based on the primary care strategy should be offered, that is, they should be adapted to the cultural realities, the environments and the interests of the communities. CONCLUSIONS The challenge lies in the way how these goals can be achieved within a context of a weak health system, in financial, administrative and technical terms. Basic multidimensional elements in the field of primary health care are proposed to face this challenge for the Colombian public health.
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Affiliation(s)
- César García-Balaguera
- CG: MD. Ph. D. Salud Pública. M. Sc. Salud Sexual y Reproductiva. M. Sc. Epidemiología. Esp. Salud Ocupacional. Esp. Docencia Universitaria. Docente, Facultad de Medicina Universidad Cooperativa de Colombia. Villavicencio, Colombia.
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Ghebrehiwet S, Harris BL, Ojediran B, Owusu M, Augello LP, Durham MP, Henderson DC, Borba CP. Using local terminology to measure substance use behaviours among youth in post-conflict Liberia: a mixed methods study. VULNERABLE CHILDREN AND YOUTH STUDIES 2020; 16:279-291. [PMID: 35003316 PMCID: PMC8734640 DOI: 10.1080/17450128.2020.1838681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/13/2020] [Indexed: 06/14/2023]
Abstract
This mixed methods study aimed to use local terminology to accurately characterize the prevalence and risk factors associated with substance use and risky health behaviors among school-based youth in Monrovia, Liberia. An 86-question survey was validated using qualitative data obtained from focus groups at two secondary schools in central and greater Monrovia. The revised survey was then administered to 400 students from eight different secondary schools in this region. The observed prevalence estimates for lifetime and current substance use were considerably higher than previously reported among adolescents in the West African region. Among students who were former child soldiers, the rates of current substance use were 5.8-33.8% higher compared to the overall study sample. Male gender, academic seniority, and peer approval of substance use were all found to be strong predictors of current substance use among secondary students. Results suggest the need for targeted, trauma-informed interventions to reduce rates of substance use and risky health behaviors among youth in Liberia and similar post-conflict settings.
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Affiliation(s)
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Babawale Ojediran
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Micaela Owusu
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Lauren P. Augello
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Michelle P. Durham
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Christina P.C. Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
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Preusse M, Neuner F, Ertl V. Effectiveness of Psychosocial Interventions Targeting Hazardous and Harmful Alcohol Use and Alcohol-Related Symptoms in Low- and Middle-Income Countries: A Systematic Review. Front Psychiatry 2020; 11:768. [PMID: 32903779 PMCID: PMC7438922 DOI: 10.3389/fpsyt.2020.00768] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In low- and middle-income countries (LMIC), the mismatch between the number of individuals needing and those receiving treatment for alcohol use disorders (AUD) is substantial. In order to provide suggestions for the scaling up of effective service provision we systematically reviewed the current evidence on the effectiveness of AUD-focused psychosocial interventions in LMIC. METHODS We used a systematic review methodology following the PRISMA guidelines. Twelve electronic databases listing published and grey literature were searched and only randomized-controlled trials (RCTs) were included. Where possible, effect sizes were calculated using Hedges' g indices. RESULTS Twenty-one RCTs conducted in 15 different LMIC between 1992 and 2018 fulfilled inclusion criteria. Most studies employed brief one-on-one interventions facilitated by trained primary care staff. Eighty-six percent of RCTs based their interventions on the principles of motivational interviewing (MI) with the majority supplementing MI-based interventions with alcohol-tailored elements of cognitive-behavioral therapy (CBT). The remaining RCTs employed CBT-components exclusively. Just over 40% of studies included in quantitative analyses (n=17) yielded an at least medium-sized effect (g≥.50) of the respective intervention compared to alcohol-related and unrelated control conditions or waiting list. Only half of the trials implementing the widely applied MI-based approaches (or MI-based approaches blended with CBT-elements) were superior to their respective control conditions. CONCLUSION To date, a relatively small number of RCTs investigating AUD-focused treatments has been conducted in LMIC. The majority of between condition effect size estimates were small and no type of intervention can clearly be recommended over another. No RCTs were conducted in conflict-affected areas in LMIC although they would merit particular attention since AUD is often linked to trauma-related mental health disorders. More RCTs in LMIC are required and alternatives to MI-based approaches should be investigated. This systematic review summarizes properties of effective interventions and provides implications for future research.
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Affiliation(s)
- Melissa Preusse
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Verena Ertl
- vivo international, Konstanz, Germany
- Department of Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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Relationship Between Alcohol-related Family Adversity, Alcohol Use Across Adolescence, and Mental States Recognition in Young Adulthood. J Addict Med 2020; 14:e247-e256. [PMID: 32452911 DOI: 10.1097/adm.0000000000000659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although a theoretical link between childhood adversity and mental states recognition has been established, empirical findings are mixed. Some prior work indicates that childhood adversity might enhance, preserve, or reduce mentalization skills in selected at-risk populations. In the current study, we examine whether the presence of risky alcohol use during adolescence moderates the association between childhood alcohol-related family adversity and mental states recognition in young adulthood. METHODS Secondary data analysis was conducted on 266 young adults who participated in the Michigan Longitudinal Study-a multiwave prospective study on at-risk youth. Children were assessed after initial recruitment (wave 1, target child age range 3-5 years), with assessments repeated every 3 years using parallel measures. The current study focuses on data spanning wave 2 (age range 7-9 years) through wave 6 (target child age range 18-21 years). A family adversity index was derived reflecting exposure to a maladaptive family environment during childhood as assessed at wave 1. An alcohol use risk factor was established reflecting early problem alcohol use during adolescence (target child age range 12-17 years). Mental states recognition was measured with a computerized version of the Reading the Mind in the Eyes Task (RMET) at wave 6. Information about demographics, psychopathological symptoms, and IQ was obtained. The alcohol use risk factor was tested as a potential moderator of the association between childhood family adversity on RMET performance during young adulthood. RESULTS Alcohol use risk moderated the relationship between childhood alcohol-related family adversity, and negative and neutral mental states recognition. Specifically, childhood family adversity was positively associated with neutral mental states recognition among participants high in alcohol risk (P = 0.03) and positively associated with negative mental states recognition among participants at average (P = 0.02) and high (P = 0.002) levels of alcohol risk. CONCLUSIONS Findings indicate that history of childhood adversity may actually improve young adult negative and neutral mental states recognition among those demonstrating high levels of risky alcohol use, as substance use may serve as an external self-regulatory tool. Clinical interventions that target enhancing metacognitive competence and emotion regulation could ultimately help to break the cycle of alcohol-related family adversity.
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Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, Chiliza B, Koenen KC. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003090. [PMID: 32413027 PMCID: PMC7228043 DOI: 10.1371/journal.pmed.1003090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA. METHODS AND FINDINGS The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies. CONCLUSIONS In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.
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Affiliation(s)
- Lauren C. Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Anne Stevenson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sreeja S. Kalapurakkel
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Centre for Global Mental Health, Health Service and Population Research, Department Institute of Psychiatry, Psychology and Neuroscience King’s College, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Boniface Harerimana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Perez J, Beale E, Overholser J, Athey A, Stockmeier C. Depression and alcohol use disorders as precursors to death by suicide. DEATH STUDIES 2020; 46:619-627. [PMID: 32238058 DOI: 10.1080/07481187.2020.1745954] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The combined presence of depression with alcohol abuse can increase suicide risk. We used psychological autopsy to evaluate 101 individuals who died by suicide, to understand relationships between stressful life events, alcohol abuse, and depression. As compared to suicidal adults with depression only, individuals meeting criteria for both a depressive disorder and alcohol use disorder tended to be younger and experienced higher rates of stressful life events during the six months prior to death. Alcohol abuse likely influences interpersonal conflict, financial distress, and legal problems. Interventions focusing on managing life problems may help to reduce suicide risk.
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Affiliation(s)
- Jalessa Perez
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eleanor Beale
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Craig Stockmeier
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Psychiatry and Human Behavior, Division of Neurobiology and Behavior Research, Translational Research Center (TR415), University of Mississippi Medical Center, Cleveland, Ohio, USA
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Wang L, An CX, Song M, Li N, Gao YY, Zhao XC, Yu LL, Wang YM, Wang XY. Evaluation of childhood traumatic experience as a risk factor for alcohol use disorder in adulthood. BMC Psychiatry 2020; 20:15. [PMID: 31918691 PMCID: PMC6953234 DOI: 10.1186/s12888-020-2428-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 01/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to investigate the effect of early-age (prenatal, infant, and childhood) trauma on adulthood alcohol use disorder. METHODS A total number of 1534 subjects who were born and live in the city of Tangshan were selected. The subjects were divided into three age groups. General demographic data, conditions of the mothers during pregnancy, and condition of the babies at birth, were collected. The diagnosis of alcohol use disorder was based on Structured Clinical Interviews for DSM-IV Axis Disorders (patient version) (SCID). The childhood trauma questionnaire short form (CTQ-SF) [1] and the Lifetime of Experience Questionnaire (LTE-Q) [2] were used to evaluate stress in childhood and adulthood, respectively. RESULTS Only male subjects were diagnosed with lifelong alcohol abuse and alcohol dependence. There was no statistically significant difference in the prevalence of lifetime alcohol use disorder (X2 = 4.480, P = 0.345), current alcohol abuse, and current alcohol dependence among the three groups (X2abuse = 2.177, X2depedence = 2.198, P > 0.05). However, higher prevalence of lifetime alcohol use disorders was found in group with higher scores of CTQ (X2 = 9.315, P = 0.009), emotional abuse (X2 = 8.025, P = 0.018), physical abuse (X2 = 20.4080, P < 0.001), but not in the group with higher scores of emotional neglect (X2 = 1.226, P = 0.542), sexual abuse (X2 = 2.779, P = 0.249), physical neglect (X2 = 3.978, P = 0.137), LTE-Q (X2 = 5.415, P = 0.067), and PSQI (X2 = 5.238, P = 0.073). Protective factor for alcohol abuse for men was identified to be heavy drinking (OR = 0.085, 95%CI: 0.011-0.661), and the risk factors for alcohol abuse were identified to be frequent drinking (OR = 2.736, 95%CI: 1.500, 4.988), and consumption of low liquor (OR = 2.563, 95%CI: 1.387, 4.734). Risk factors for alcohol dependence in males were identified to be consumption of low liquor (OR = 5.501, 95%CI: 2.004, 15.103), frequent drinking (OR = 2.680, 95%CI: 1.164, 6.170), and childhood physical abuse (OR = 2.310, 95% CI: 1.026, 5.201). CONCLUSION Traumatic experience during infant and prenatal periods does not have a strong statistical correlation with alcohol use disorders for male adults. However, subjects with high CTQ scores, experience of emotional abuse and physical abuse show a statistically higher prevalence of lifetime alcohol use disorders. Several risk factors including consumption of low liquor, frequent drinking, and childhood physical abuse contribute to alcohol dependence in male adults.
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Affiliation(s)
- Lan Wang
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Cui-Xia An
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Mei Song
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Na Li
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Yuan-Yuan Gao
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Xiao-Chuan Zhao
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Lu-Lu Yu
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Yu-Mei Wang
- grid.452458.aDepartment of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031 China ,0000 0004 1760 8442grid.256883.2The Mental Health Institute of Hebei Medical University, Shijiazhuang, China ,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China
| | - Xue-Yi Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, China. .,The Mental Health Institute of Hebei Medical University, Shijiazhuang, China. .,Hebei Brain Ageing and Cognitive Neuroscience Laboratory, Shijiazhuang, China.
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Trajectories of alcohol use problems based on early adolescent alcohol use: Findings from a 35 year population cohort. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:18-25. [DOI: 10.1016/j.drugpo.2019.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022]
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Slabbert I, Greene MC, Womersley JS, Olateju OI, Soboka M, Lemieux AM. Women and substance use disorders in low- and middle-income countries: A call for advancing research equity in prevention and treatment. Subst Abus 2019; 41:6-10. [PMID: 31697188 PMCID: PMC7197902 DOI: 10.1080/08897077.2019.1680481] [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] [Indexed: 10/25/2022]
Abstract
Although the prevalence of substance use disorders (SUDs) is higher among men, women with SUDs in low- and middle-income countries (LMICs) face unique challenges. Poverty and adversity, inequality of women, and disparities in access to treatment and prevention services exacerbate biological, psychological and social correlates of substance use disorders for women living in low-resource settings. Increasing the inclusion of women in research has long been a goal, though even high income countries struggle to achieve parity. In LMICs, women with SUDs are often neglected from global research due to underreporting and the disproportionate focus of global substance use research on men. We will discuss risk factors for SUDs that are particularly relevant for women residing in LMICs in order to gain insight into neglected areas of research and opportunities for prevention and treatment.
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Affiliation(s)
- Ilze Slabbert
- Department of Social Work, Faculty of Art, Stellenbosch University, Stellenbosch, South Africa
| | - M. Claire Greene
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Jacqueline S. Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Oladiran I. Olateju
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matiwos Soboka
- Department of Psychiatry, Faculty of Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Andrine M. Lemieux
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, USA
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Somohano VC, Rehder KL, Dingle T, Shank T, Bowen S. PTSD Symptom Clusters and Craving Differs by Primary Drug of Choice. J Dual Diagn 2019; 15:233-242. [PMID: 31304887 PMCID: PMC6901023 DOI: 10.1080/15504263.2019.1637039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Research has demonstrated a cyclical relationship between posttraumatic stress disorder (PTSD) and substance use disorder. Identifying factors that link PTSD symptom clusters and substance use disorder may illuminate mechanisms underlying the PTSD-substance use disorder relationship, better informing interventions that target this comorbidity. The current study of individuals enrolled in an outpatient aftercare chemical dependency program in King County, Washington, assessed whether overall PTSD symptoms and specific PTSD symptom clusters predicted craving depending on individuals identified primary drug of choice (DOC). Methods: Participants eligible for the parent study were at least 18 years of age, fluent in English, medically cleared from substance withdrawal, and able to participate in treatment sessions and agreed to random assignment. Random assignment to either a mindfulness-based relapse prevention group, a standard relapse prevention group, or a treatment as usual group was conducted on a computer randomization program. A secondary analysis of baseline data was employed in the current study to determine which of the PTSD symptom clusters (avoidance, hyperarousal, and intrusion) predicted substance craving. Results: Covarying for severity of dependence, results suggest that overall PTSD scores predicted craving in participants who identified alcohol, stimulants, and opiates as their primary DOC. Further, avoidance-related PTSD symptoms alone predicted a significant proportion of the variability in craving in stimulant users, and hyperarousal symptoms alone predicted a significant proportion of the variability in craving in alcohol users. No specific PTSD cluster significantly predicted a proportion of the variability in craving in marijuana or opiates users. Conclusions: Findings suggest that craving may play a role in maintaining the relationship between specific PTSD symptom clusters and substance use disorder, and the nature of this relationship may differ by primary DOC. The clinical trial on which this secondary analysis of data was conducted is registered as NCT01159535 at www.clinicaltrials.gov.The original trial from which data for this study was drawn was supported by the National Institutes of Health [NIH/NIDA 5 R01 DA025764-02].
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Affiliation(s)
| | | | - Tyree Dingle
- Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | - Taylor Shank
- Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | - Sarah Bowen
- Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
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Sarafim-Silva BAM, Duarte GD, Sundefeld MLMM, Biasoli ÉR, Miyahara GI, Bernabé DG. Childhood trauma is predictive for clinical staging, alcohol consumption, and emotional symptoms in patients with head and neck cancer. Cancer 2018; 124:3684-3692. [DOI: 10.1002/cncr.31597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Bruna Amélia M. Sarafim-Silva
- Psychosomatic Research Center, Oral Oncology Center, School of Dentistry; São Paulo State University - UNESP; Araçatuba São Paulo Brazil
| | - Gabrielle D. Duarte
- Psychosomatic Research Center, Oral Oncology Center, School of Dentistry; São Paulo State University - UNESP; Araçatuba São Paulo Brazil
| | - Maria Lúcia M. M. Sundefeld
- Psychosomatic Research Center, Oral Oncology Center, School of Dentistry; São Paulo State University - UNESP; Araçatuba São Paulo Brazil
| | - Éder Ricardo Biasoli
- Psychosomatic Research Center, Oral Oncology Center, School of Dentistry; São Paulo State University - UNESP; Araçatuba São Paulo Brazil
| | - Glauco I. Miyahara
- Psychosomatic Research Center, Oral Oncology Center, School of Dentistry; São Paulo State University - UNESP; Araçatuba São Paulo Brazil
| | - Daniel Galera Bernabé
- Psychosomatic Research Center, Oral Oncology Center, School of Dentistry; São Paulo State University - UNESP; Araçatuba São Paulo Brazil
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Ertl V, Preuße M, Neuner F. Are Drinking Motives Universal? Characteristics of Motive Types in Alcohol-Dependent Men from Two Diverse Populations. Front Psychiatry 2018; 9:38. [PMID: 29487544 PMCID: PMC5816937 DOI: 10.3389/fpsyt.2018.00038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/29/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Since alcohol use disorders are among the most prevalent and destructive mental disorders, it is critical to address factors contributing to their development and maintenance. Drinking motives are relevant driving factors for consumption. Identifying groups of drinkers with similar motivations may help to specialize intervention components and make treatment more effective and efficient. We aimed to identify and describe distinct motive types of drinkers in dependent males from two diverse cultures (Uganda and Germany) and to explore potential differences and similarities in addiction-related measures. Moreover, we investigated specific links between motive types and childhood maltreatment, traumatic experiences, and symptoms of comorbid psychopathologies. METHODS To determine distinct drinking motive types, we conducted latent class analyses concerning drinking motives (Drinking Motive Scale) in samples of treatment-seeking alcohol-dependent men (N = 75). Subsequently we compared the identified motive types concerning their alcohol consumption and alcohol-related symptoms (Alcohol Use Disorders Identification Test), history of childhood maltreatment (Childhood Trauma Questionnaire), trauma exposure (Violence, War and Abduction Exposure Scale), psychopathology (Posttraumatic Stress Diagnostic Scale, Depression-section of the Hopkins Symptom Checklist, and Brief Symptom Inventory) and deficits in emotion regulation (Difficulties in Emotion Regulation Scale). RESULTS We found two congruent drinking motive types in both contexts. Reward-oriented drinking motives like the generation of positive feelings and enhancing performance were endorsed almost equally by both motive types, whereas high relief motive endorsement characterized one group, but not the other. The relief motive type drank to overcome aversive feelings, withdrawal, and daily hassles and was characterized by higher adversity in general. Emotional maltreatment in childhood and psychopathological symptoms were reported to a significantly greater extent by relief drinkers (effect sizes of comparisons ranging from r = 0.25 to r = 0.48). However, the motive types did not differ significantly on alcohol consumption or alcohol-related symptoms and traumatic experiences apart from childhood maltreatment. CONCLUSION The chronology of addiction development and patterns of drinking motivation seem to be similar across cultures, i.e., that motive targeting interventions might be applicable cross-culturally. Addressing comorbid symptomatology should be a key treatment component for relief drinkers, whereas finding alternatives for the creation of positive feelings and ways to counteract boredom and inactivity should be a general treatment element.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Melissa Preuße
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
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Childhood maltreatment severity and alcohol use in adult psychiatric inpatients: The mediating role of emotion regulation difficulties. Gen Hosp Psychiatry 2017; 48:42-50. [PMID: 28917394 DOI: 10.1016/j.genhosppsych.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Emotion regulation difficulties are a potentially key mechanism underlying the association between childhood maltreatment and alcohol use in adulthood. The current study examined the mediating role of emotion regulation difficulties in the association between childhood maltreatment severity (i.e., Childhood Trauma Questionnaire total score) and past-month alcohol use severity, including alcohol consumption frequency and alcohol-related problems (i.e., number of days of alcohol problems, ratings of "bother" caused by alcohol problems, ratings of treatment importance for alcohol problems). METHOD Participants included 111 acute-care psychiatric inpatients (45.0% female; Mage=33.5, SD=10.6), who reported at least one DSM-5 posttraumatic stress disorder Criterion A traumatic event, indexed via the Life Events Checklist for DSM-5. Participants completed questionnaires regarding childhood maltreatment, emotion regulation difficulties, and alcohol use. RESULTS A significant indirect effect of childhood maltreatment severity via emotion regulation difficulties in relation to alcohol use severity (β=0.07, SE=0.04, 99% CI [0.01, 0.21]) was documented. Specifically, significant indirect effects were found for childhood maltreatment severity via emotion regulation difficulties in relation to alcohol problems (β's between 0.05 and 0.12; all 99% bootstrapped CIs with 10,000 resamples did not include 0) but not alcohol consumption. CONCLUSION Emotion regulation difficulties may play a significant role in the association between childhood maltreatment severity and alcohol outcomes. Clinical implications are discussed.
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Boothby N, Mugumya F, Ritterbusch AE, Wanican J, Bangirana CA, Pizatella AD, Busi S, Meyer S. Ugandan households: A Study of parenting practices in three districts. CHILD ABUSE & NEGLECT 2017; 67:157-173. [PMID: 28273491 DOI: 10.1016/j.chiabu.2017.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/19/2017] [Accepted: 02/05/2017] [Indexed: 06/06/2023]
Abstract
Ugandan households play a central role in child care and protection, and household-level practices influence the ways in which children are protected from adversities. This study was designed to identify community perceptions of protective and harmful parenting practices in three districts in Uganda. It employed free-listing interviews to determine priorities and practices deemed to be important in providing care and protection to children. Findings suggest that parenting practices can be grouped into seven basic themes, which are: Investing in children's future, Protection, Care, Enterprising, Relationship with neighbors, Intimate partner relationship, and Child Rearing. Investing in children's future, including educating children, was cited most often as a hallmark of positive parenting; while failure to care for children was most often cited as a hallmark of negative parenting. Concrete behaviors, such as walking a daughter to school; sewing a son's torn pants before going to church; and structuring study time at home were identified as concrete actions Ugandan parents undertake daily to promote their children's well-being. Conversely, specific contextual aspects of neglect and abuse were identified as central components of negative parenting, including lack of investment in children's education and not serving as a good role model. Building on community strengths is recommended as a principal means of enhancing household resilience and reducing childhood risk.
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Affiliation(s)
- Neil Boothby
- Mailman School of Public Health, Columbia University, 60 Haven Ave B-4, New York, NY 10032, USA.
| | - Firminus Mugumya
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, P.O. Box 7062, Kampala 256-7823-51444, Uganda.
| | - Amy E Ritterbusch
- School of Government, Universidad de los Andes, Cra. 1 No. 19-27, EdificioAulas, Bogotá 57-3138783502, Colombia.
| | - Joyce Wanican
- Centre for the Study of the African Child, College of Humanities and Social Sciences, Makerere University, P.O. Box 7062, Kampala 256-0792-666610, Uganda.
| | - Clare Ahabwe Bangirana
- AfriChild Centre for the Study of the African Child, College of Humanities and Social Sciences, Makerere University, P.O. Box 7062, Kampala 256-0792-666610, Uganda.
| | - Adrienne D Pizatella
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue B-4, New York, NY 10032 304-657-9500, USA.
| | - Sophie Busi
- AfriChild Centre for the Study of the African Child, P.O. Box 21378, Kampala 256-7516-00618, Uganda.
| | - Sarah Meyer
- Mailman School of Public Health, Columbia University, 60 Haven Ave B-4, New York, NY 10032, USA.
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Brunetti M, Martinotti G, Sepede G, Vellante F, Fiori F, Sarchione F, di Giannantonio M. Alcohol abuse in subjects developing or not developing posttraumatic stress disorder after trauma exposure. ARCHIVES OF TRAUMA RESEARCH 2017. [DOI: 10.4103/atr.atr_12_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Portnova AA, Sivolap YP. Substance abuse: a relationship with childhood traumas. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:92-95. [DOI: 10.17116/jnevro20171174192-95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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