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Lu W, Bullock D, Ruszczyk L, Ettinger S, Srijeyanthan J, Caldwell B, Oursler J, Minor T, Beninato J, Hauck E. Positive PTSD Screening and Its Health Correlates in Patients With HIV in Urban Primary Care Settings. J Psychosoc Nurs Ment Health Serv 2024; 62:25-36. [PMID: 38095852 DOI: 10.3928/02793695-20231206-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Posttraumatic stress disorder (PTSD) is underdiagnosed and undertreated in primary care, especially among African American individuals. The current study assessed documentation rates of PTSD and clinical health correlates among 135 predominantly African American patients with HIV and positive PTSD screens in a primary care unit. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and a retrospective chart review of 135 patients with HIV were conducted. On the PCPTSD-5 (cut point of 3), approximately one half of patients (49.6%; n = 67) had probable PTSD; however, only 11.9% of patients (n = 16) had a chart diagnosis of PTSD. A positive PTSD screen was associated with higher rates of depression and insomnia, but not anxiety, alcohol use, drug use, or pain in patients with HIV. Multi-morbidity of HIV, major depression, and positive PTSD screens was associated with increased risk for asthma, number of medical diagnoses, depression, insomnia, and anxiety. Findings highlight the need for trauma-informed care in primary care settings for people with PTSD and HIV. Larger samples are warranted to further explore health correlates of PTSD. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 25-36.].
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Melese M, Maru L, Esubalew D. Posttraumatic stress disorder and its associated factors among people living in Dabat district, northwest Ethiopia. Front Psychiatry 2024; 15:1359382. [PMID: 39140107 PMCID: PMC11320060 DOI: 10.3389/fpsyt.2024.1359382] [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: 01/16/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
Background The conflict between the Ethiopian government and the Tigray People's Liberation Front (TPLF) in the Dabat district of Ethiopia has led to significant civilian casualties, instances of rape, sexual abuse, and property theft. These traumatic events contribute to the development of post-traumatic stress disorder (PTSD) among local residents. However, there is currently no available data on the prevalence of PTSD and its associated factors in this region. This study seeks to fill this gap by assessing PTSD prevalence and identifying related factors among residents of the war-affected Dabat district in northwest Ethiopia. Method A community-based correctional study was conducted in the Woken and China kebeles of Dabat district, northwest Ethiopia, spanning from July 13 to September 19, 2023. A total of 410 participants were selected using systematic random sampling, making a 100% response rate. The study utilized an interviewer-administered questionnaire, which included the Post-Traumatic Stress Disorder Checklist (PCL-5) to assess PTSD. The research investigated the association between PTSD and various demographic and psychosocial characteristics using both bivariate and multivariable binary logistic regression analyses. Statistical significance was set at a P-value of 0.05. Results The majority of participants in the study were male (62%) with a mean age of 33 ( ± 1.67) years. The overall prevalence of PTSD was 30.7% (95% CI: 26.6-35.10). Multivariable logistic regression analysis identified several factors significantly associated with PTSD: symptoms of depression (AOR=3.5; 95% CI: 1.13-6.89), age between 45 and 67 years (AOR=1.68; 95% CI: 1.04-5.78), experiencing stressful life events (AOR=1.63; 95% CI: 1.05-7.86), experiencing sexual abuse or rape (AOR=1.53; 95% CI: 1.07-6.75), chewing khat (AOR=1.48; 95% CI: 1.08-4.56), being female (AOR=1.43; 95% CI: 1.13-3.67), and having an income of 34.6 USD (AOR=1.28; 95% CI: 1.07-4.67). Conclusion and recommendation This study reported that the prevalence of PTSD was high. As a result, the study suggested that governments and other stakeholders should be involved in implementing efficient interventions and quick measures to mitigate the effects of war on mental health following the conflict. The government and nongovernmental organizations were also advised by these studies to continue providing humanitarian assistance, which should include access to food, clean water, clothing, shelter, and education. This study also suggested that people living in conflict zones should be legally protected from rape, sexual abuse, arson, detention without cause, and kidnapping.
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Affiliation(s)
- Mihret Melese
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Lemlemu Maru
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia Region, Ethiopia
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Tadesse G, Yitayih S, Gashaw F, Fentahun S, Amare A, Kibralew G, Amare Zeleke T. Magnitude and factors associated with post-traumatic stress disorder among war-affected internally displaced people in northwest Ethiopia, 2022. SAGE Open Med 2024; 12:20503121241259629. [PMID: 39086554 PMCID: PMC11289820 DOI: 10.1177/20503121241259629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/19/2024] [Indexed: 08/02/2024] Open
Abstract
Background A large number of people are often directly involved in armed conflict and, therefore, are at greater risk of developing a wide range of mental disorders, including post-traumatic stress disorder. Despite this, few have been reported about it in low- and middle-income countries, including Ethiopia. Objective This study was carried out to assess the magnitude and factors associated with post-traumatic stress disorder among war-affected internally displaced people in northwest Ethiopia, 2022. Methods Cross-sectional study design was conducted from May 23 to June 22, 2022, and simple random sampling was used to select a sample of 412 participants. Data were collected by structured interviewer-administered questionnaires. The post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with extended criteria-A was used to assess post-traumatic stress disorder. Multivariable logistic regression analysis was done to identify factors associated with post-traumatic stress disorder. Results A total of 412 participants were interviewed with the response rate of 100%. The mean age of the respondents was 34.7 (±10.9) years. The prevalence of post-traumatic stress disorder was found to be 60.98% (95% CI: 56.1%, 65.5%) with an estimated prevalence of 23.5% and 76.5% among males and females, respectively. In multivariable analysis, female sex (AOR = 2.39; 95% CI: 1.48, 3.86), having depression (AOR = 2.86; 95% CI: 1.78, 4.60), family history of mental illness (AOR = 3.67; 95% CI: 1.43, 9.42), and poor social support (AOR = 3.61; 95% CI: 1.74, 7.47) were factors significantly associated with post-traumatic stress disorder at p-value < 0.05. Conclusion and recommendation Based on this study, at least 6 out of 10 war-affected populations have experienced post-traumatic stress disorder. Especially females, those who had depression, family history of mental illness, and poor social support, were more vulnerable to post-traumatic stress disorder. Therefore, it is recommended to do on-site screening and provide treatment for all displaced populations suffering from post-traumatic stress disorder by giving special concern for females, individuals having depression, poor social support, and family history of mental illness.
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Affiliation(s)
- Gebresilassie Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewbesew Yitayih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fanuel Gashaw
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agegnehu Amare
- Department of Psychiatry, School of Medicine, Health Science College, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Getasew Kibralew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare Zeleke
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Pinto JV, Hoeboer C, Hunt C, O’Toole B, Olff M. Examining the clinical validity of the global psychotrauma screen in refugees. Front Psychol 2024; 15:1394014. [PMID: 39105148 PMCID: PMC11299515 DOI: 10.3389/fpsyg.2024.1394014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/26/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction The Global Psychotrauma Screen (GPS) is a brief transdiagnostic screener that covers a broad range of trauma-related disorders as well as risk factors known to influence the course of symptoms. Methods We analyzed data from African war refugees in Australia (n = 70), including the GPS, the Structured Clinical Interview for DSM-5 Disorders (SCID-5), the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and the Brief Resilience Scale (BRS). Results Using the Youden's J Index to examine the clinical validity of the GPS subscales measuring PTSD, dissociation, depression, and generalized anxiety disorder (GAD), we found that a PTSD subscale score of 3 or higher, and a depression and dissociation subscale score of 1 or higher, was optimally efficient for detecting a probable diagnosis (Youden's J = 0.76, J = 0.72, and J = 0.90, respectively) with high sensitivity and specificity. We were unable to test the GPS clinical validity for GAD due to the low GAD occurrence. The GPS resilience item was not related to the total score (r = 0.02), indicating low convergent validity for resilience. Risk factors, including current stressors and childhood trauma history, were related to more severe GPS symptom scores, while lack of resilience, social support, and history of mental illness were not. Conclusion We conclude that the GPS may be a useful screening tool for PTSD, depression, and the dissociative subtype in refugees.
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Affiliation(s)
- Janaina V. Pinto
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | | | - Caroline Hunt
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Brian O’Toole
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Miranda Olff
- Amsterdam University Medical Center, Amsterdam, Netherlands
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Anbesaw T, Kassa MA, Yimam W, Kassaw AB, Belete M, Abera A, Abebe G, Yimer N, Melkam M, Ayano G. Factors associated with depression among war-affected population in Northeast, Ethiopia. BMC Psychiatry 2024; 24:376. [PMID: 38773453 PMCID: PMC11106904 DOI: 10.1186/s12888-024-05812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia. METHOD A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULT The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression. CONCLUSION This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.
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Affiliation(s)
- Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, P.O. Box 1145, Dessie, Ethiopia.
| | - Mulat Awoke Kassa
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Wondossen Yimam
- Department of Comprehensive Nursing, College of Medicine and Health Sciences (CMHS), Wollo University (WU), P.O. Box 1145, Dessie, Ethiopia
| | - Altaseb Beyene Kassaw
- College of Medicine and Health Science, Department of Biomedical Science, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Mekonnen Belete
- College of Medicine and Health Science, School of Medicine, Department of Physiology, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Amare Abera
- College of Medicine and Health Science, School of Medicine, Department of Physiology, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Gashaw Abebe
- College of Medicine and Health Science, School of Medicine, Department of Biochemistry, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Nega Yimer
- Department of Adult Health Nursing, College of Medicine and Health Sciences (CMHS), Wollo University (WU), P.O. Box 1145, Dessie, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, University of Gondar College of Medicine and Health Sciences, PO. Box 196, Gondar, Ethiopia
| | - Getinet Ayano
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, Australia
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Alanazi SZ, Abusharha A, Afsar T, Trembley JH, Razak S. The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia. Front Psychiatry 2024; 15:1391586. [PMID: 38779548 PMCID: PMC11109750 DOI: 10.3389/fpsyt.2024.1391586] [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: 02/26/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia. Methods This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire. Results The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001). Conclusion The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.
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Affiliation(s)
- Sattam Zaid Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Tayyaba Afsar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Janeen H. Trembley
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- Minneapolis VA Health Care System Research Service, Minneapolis, MN, United States
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Andualem F, Melkam M, Takelle GM, Nakie G, Tinsae T, Fentahun S, Rtbey G, Begashaw TD, Seid J, Tegegn LF, Gedef GM, Bitew DA, Godana TN. Prevalence of posttraumatic stress disorder and associated factors among displaced people in Africa: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1336665. [PMID: 38516263 PMCID: PMC10956696 DOI: 10.3389/fpsyt.2024.1336665] [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: 11/11/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Background The number of people who have been displaced from their homes due to violence, conflict, and natural disasters. The displaced persons are vulnerable to PTSD; however, being women, individuals with lower socio-economic status and intense exposure to physical assault are more vulnerable. The reviews stated that the pooled prevalence of PTSD among refugees in high-income countries was higher than the general population. However, there has been no review done on PTSD among displaced persons in Africa. Therefore, the aim of this review was to summarise the most recent data evidence on the pooled prevalence of posttraumatic stress disorder and the pooled effect of associated factors on adult displaced people in Africa. Methods We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023411371). The publications were identified from PubMed/Medline, EMBASE, the Cochrane Library, Scopus databases, and other grey searches of Google Scholar and World Health Organisation (WHO) reports. The data was extracted in Microsoft Excel, and then it will be imported into STATA 11.0 for analysis. Results We have included 10 studies conducted in African countries with 5287 study participants. In this meta-analysis, the pooled prevalence of PTSD among displaced people in Africa was 55.64 (95% CI: 42.76-68.41%). Further, in subgroup analysis regarding the study participants, the pooled prevalence of PTSD among internally displaced people and refugees was 56.35% and 54.04%, respectively. Among the associated factors, being female, unemployed, and depression were significantly related to PTSD among displaced people. Conclusions In this review, the pooled prevalence of PTSD among displaced people in Africa was high. Demographic characteristics (female, single, and unemployed), substance use disorder, and depression were risk factors for PTSD among displaced people. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address the prevention, early screening, and management of PTSD among displaced people and to give attention to more vulnerable bodies. Systematic review registration PROSPERO, identifier CRD42023411371.
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Affiliation(s)
- Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Derbie Begashaw
- Department of Psychiatry College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Jemal Seid
- Department of Psychiatry College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Lidiya Fasil Tegegn
- Department of Nursing, College of Medicine and Health Science, Arsi University, Asella, Ethiopia
| | - Getachew Muluye Gedef
- Department of General Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tilahun Nega Godana
- Department of Internal Medicine, University of Gondar College of Medicine and Health Science, Comprehensive Specialized Hospital, Gondar, Ethiopia
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Bröcker E, Olff M, Suliman S, Kidd M, Greyvenstein L, Seedat S. A counsellor-supported 'PTSD Coach' intervention versus enhanced Treatment-as-Usual in a resource-constrained setting: A randomised controlled trial. Glob Ment Health (Camb) 2024; 11:e7. [PMID: 38283877 PMCID: PMC10808979 DOI: 10.1017/gmh.2023.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/19/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024] Open
Abstract
To widen treatment access for posttraumatic stress disorder (PTSD) in resource-constrained South Africa, we evaluated the feasibility and effectiveness of a counsellor-supported PTSD Coach mobile application (app) (PTSD Coach-CS) intervention on PTSD and associated sequelae in a community sample. Participants (female = 89%; black = 77%; aged 19-61) with PTSD were randomised to PTSD Coach-CS (n = 32) or enhanced Treatment-as-Usual (n = 30), and assessed with the Clinician-Administered PTSD Scale (CAPS-5), PTSD Checklist (PCL-5) and Depression, Anxiety and Stress Scale-21 items, at pre- to post-treatment and follow-up (1 and 3 months). We also collected data on user experiences of the PTSD Coach app with self-administered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F3.136 = 3.33, p = 0.02) indicated a greater reduction in PTSD symptom severity over time for the intervention group with a significant between-group effect size detected at 3-month follow-up. Significant between-group effect sizes were detected in self-reported stress symptom reduction in the intervention group at post-treatment and 3-month follow-up. Participants perceived the app as helpful and were satisfied with the app. Findings suggest PTSD Coach-CS as a suitable low-cost intervention and potential treatment alternative for adults with PTSD in a resource-constrained country. Replication in larger samples is needed to fully support effectiveness. Pan African Trial Registry: PACTR202108755066871.
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Affiliation(s)
- Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Psychiatry, Stellenbosch University
| | - Lyrése Greyvenstein
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Lathan EC, Petri JM, Haynes T, Sonu SC, Mekawi Y, Michopoulos V, Powers A. Evaluating the Performance of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) in a Trauma-Exposed, Socioeconomically Vulnerable Patient Population. J Clin Psychol Med Settings 2023; 30:791-803. [PMID: 36715813 PMCID: PMC9885055 DOI: 10.1007/s10880-023-09941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
The properties and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) remain unstudied in community-based populations. This study evaluates the performance of the PC-PTSD-5 to determine whether it can be used as a brief alternative to the PTSD Checklist for DSM-5 (PCL-5) in a large public hospital in the southeastern United States. Participants (N = 422; 92.7% Black; 85.8% female; Mage = 42.0 years, SDage = 13.4 years) completed the PCL-5 and PC-PTSD-5 after recruitment from medical clinic waiting rooms and admission lists. Using chance-corrected test quality indices and item response theory (IRT) analyses, we determined optimal cut-scores for screening and examined item performance. Approximately 45.0% of the sample screened positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 demonstrated high internal consistency and strong associations with PCL-5 scores (total, r = .79; items, rs = .51-.61). A cut-score of one was optimally sensitive for screening (κ[1] = .96), and a cut-score of four had the highest quality of probable efficiency (κ[.5] = .66) for detecting self-reported DSM-5 PTSD on the PCL-5. IRT analyses indicated Item 1 (nightmares, intrusive memories) provided the most information, and other items may not be incrementally useful for this sample. Findings provide preliminary support for the use of the PC-PTSD-5 as a brief alternative to the PCL-5 among chronically trauma-exposed patients in the public healthcare setting.
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Affiliation(s)
- Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA.
| | - Jessica M Petri
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Tamara Haynes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
- Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Stan C Sonu
- Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of General Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
- Emory National Primate Research Center, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Behav 2023; 27:2360-2369. [PMID: 36609704 PMCID: PMC10224854 DOI: 10.1007/s10461-022-03963-4] [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] [Accepted: 11/25/2022] [Indexed: 01/09/2023]
Abstract
Little is known about the coping strategies used among people with HIV (PWH), especially in sub-Saharan Africa, and the extent to which adaptive or maladaptive coping strategies are associated with symptoms of mental health disorders. We interviewed 426 PWH initiating HIV care in Cameroon and reported the prevalence of adaptive and maladaptive coping strategies, overall and by presence of symptoms of depression, anxiety, and PTSD. Log binominal regression was used to estimate the association between each type of coping strategy (adaptive or maladaptive) and symptoms of each mental health disorder, separately. Adaptive and maladaptive coping strategies were commonly reported among PWH enrolling in HIV care in Cameroon. Across all mental health disorders assessed, greater maladaptive coping was associated with higher prevalence of depression, anxiety, and PTSD. Adaptive coping was not associated with symptoms of any of the mental health disorders assessed in bivariate or multivariable models. Our study found that PWH endorsed a range of concurrent adaptive and maladaptive coping strategies. Future efforts should explore the extent to which coping strategies change throughout the HIV care continuum. Interventions to reduce maladaptive coping have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Gomez
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Azizian A, Terzyan L, Gasparyan K, Khachatryan S, English P. Inpatient residential treatment program for combat-related posttraumatic stress disorder (PTSD): Results from the 2020 Artsakh (Nagorno-Karabakh) War. MILITARY PSYCHOLOGY 2023; 35:252-261. [PMID: 37133545 PMCID: PMC10197988 DOI: 10.1080/08995605.2022.2117536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
Inpatient residential treatment programs to evaluate active military service members for potential return to service or discharge are considered an integral component of rehabilitation for trauma related conditions. This retrospective study was conducted on combat-exposed military service members who were admitted to an inpatient residential treatment program for evaluation of fitness to serve and treatment of trauma related conditions. The PTSD Checklist for DSM-5 (PCL-5) was used to screen for PTSD, determine symptom severity, and monitor symptom change. At the time of admission, 54.3% of the service members met the provisional PTSD diagnosis, whereas at the time of discharge, 16.28% of the service members met the provisional diagnostic criteria. The most common symptoms rated moderately or higher were sleep troubles, followed by super alert, disturbing memories, feeling upset, disturbing dreams, physical reactions, avoiding memories, and negative feelings. Paired t-test results comparing the PCL-5 five Subscales and Total Score at the time of admission and discharge showed significant reductions. The five symptoms that improved the least were sleep troubles, feeling upset, avoiding memories, difficulty concentrating, and trouble remembering. The successful creation and implementation of an Armenian version of the PCL-5 was realized and, when put to the test, aided in screening, diagnosing, and monitoring PTSD symptoms among Armenian Army Service members. The results suggest that PTSD symptoms in an inpatient residential treatment program decreased over time. The symptoms that bothered the service members at most during the time of admission, however, improved the least at the time of discharge.
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Affiliation(s)
- Allen Azizian
- Department of Criminology, California State University, Fresno, California, USA
- Department of Medical Psychology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Liana Terzyan
- Department of Medical Psychology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Khachatur Gasparyan
- Department of Medical Psychology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
- Sleep Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia
| | - Peter English
- Department of Criminology, California State University, Fresno, California, USA
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12
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Workie K, Tinsae T, Salelew E, Asrat B. Gender-based violence and its associated factors among internally displaced women in Northwest Ethiopia: a cross-sectional study. BMC Womens Health 2023; 23:166. [PMID: 37024889 PMCID: PMC10080783 DOI: 10.1186/s12905-023-02306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Gender-based violence (GBV) is a common human right violence in conflict-affected communities. Women with GBV are prone to experience mental health problems such as post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of evidence as to what extent the problem is affecting internally displaced women (IDW) in Ethiopia. This study aimed to assess the prevalence of GBV and its associated factors among IDW in Northwest Ethiopia. METHODS A cross-sectional study was conducted among IDW residing at three humanitarian sites from May to June 2022 in Northwest Ethiopia. Study participants were selected using a stratified simple random sampling technique from the three sites. GBV was assessed using a 6-item Assessment Screen to Identify Survivors Toolkit questionnaire for Gender-based violence (ASIST-GBV). Data were analyzed using binary logistic regression. All variables with a p-value of ≤ 0.05 in the multivariable analysis were defined to have a statistically significant association with GBV at a 95% confidence interval (CI). RESULTS Of 424 approached candidates, 412 (97.2%) of them participated in the study. A one-year prevalence of GBV was 37.9% (95%CI = 33.2-42.6) among IDW in Northwest Ethiopia. The mean age of the participants was 31.3 (± 7.6) years. Young women, 18-24 years old (AOR = 3.52, 95%CI = 2.15-5.34, p ≤ 0.001) and 25-29 years old (AOR = 2.41, 95%CI = 1.57-3.24, p ≤ 0.001) had a statistically significant association with GBV. Moreover, having no social protection (AOR = 3.18, 95%CI = 2.65-6.22, p ≤ 0.001), being current alcohol user (AOR = 2.54, 95%CI = 1.22-4.78, p ≤ 0.001) and being single in marital status (AOR = 1.69, 95%CI = 1.18-2.87, p < 0.01) showed a statistical association with GBV. CONCLUSION We found a high prevalence of GBV among IDW in Northwest Ethiopia which indicates that IDW are prone to GBV. We call for immediate action and special attention to young women in conflict-affected parts of Ethiopia. It is crucial to establish a system that ensures the safety, security, and well-being of women in humanitarian settings.
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Affiliation(s)
- Keralem Workie
- Department of Psychiatry, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia
| | - Endalamaw Salelew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia
| | - Biksegn Asrat
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia.
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13
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Reitsma L, Boelen PA, de Keijser J, Lenferink LIM. Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial. Behav Res Ther 2023; 163:104286. [PMID: 36906949 PMCID: PMC9985540 DOI: 10.1016/j.brat.2023.104286] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE This randomized-waitlist controlled trial is the first study examining short-term effects of a self-guided online grief-specific cognitive behavioral therapy (CBT) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic. METHOD Sixty-five Dutch adults, bereaved at least three months earlier during the pandemic, with clinically-relevant PCBD, PTSD, and/or depression symptoms, were allocated to a treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (using validated instruments) at baseline, post-treatment, and post-waiting period. Participants received an eight-week self-guided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed. RESULTS Intention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting, while taking baseline symptom-levels and use of professional psychological co-intervention into account. CONCLUSIONS The online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, early online interventions may be widely implemented in practice to improve treatments for distressed bereaved people.
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Affiliation(s)
- L Reitsma
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands.
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, 3508 TC, Diemen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
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14
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Dussault JM, Zimba C, Akello H, Stockton M, Hill S, Aiello AE, Keil A, Gaynes BN, Udedi M, Pence BW. Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi. PLoS One 2023; 18:e0282016. [PMID: 36928834 PMCID: PMC10019662 DOI: 10.1371/journal.pone.0282016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment-related stigma in depression care in Malawi by estimating the effect of patients' baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression. METHODS We conducted depression screening and treatment at 10 noncommunicable disease (NCD) clinics across Malawi from April 2019 through December 2021. Eligible cohort participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at the baseline and 3-month interviews included a vignette-based quantitative stigma instrument that measured treatment-related stigma, i.e., concerns about external stigma because of receiving depression treatment. Using inverse probability weighting to adjust for confounding and multiple imputation to account for missing data, this analysis relates participants' baseline levels of anticipated treatment stigma to the 3-month probability of achieving depression remission (i.e., PHQ-9 score < 5). RESULTS Of 743 included participants, 273 (37%) achieved depression remission by their 3-month interview. The probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among the low/neutral stigma group (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003). CONCLUSION In Malawi, a reduction in anticipated depression treatment-related stigma among NCD patients initiating depression treatment could improve depression outcomes. Further investigation is necessary to understand the modes by which stigma can be successfully reduced to improve mental health outcomes and quality of life among people living with depression.
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Affiliation(s)
- Josée M. Dussault
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | | | | | - Melissa Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
- New York State Psychiatric Institute, New York, New York, United States of America
| | - Sherika Hill
- Center for Child and Family Policy, Duke University, Durham, NC, United States of America
| | - Allison E. Aiello
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Alexander Keil
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Bradley N. Gaynes
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States of America
| | - Michael Udedi
- NCDs & Mental Health Unit, Ministry of Health Malawi, Lilongwe, Malawi
| | - Brian W. Pence
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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15
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Prevalence of potentially traumatic events and symptoms of depression, anxiety, hazardous alcohol use, and post-traumatic stress disorder among people with HIV initiating HIV care in Cameroon. BMC Psychiatry 2023; 23:150. [PMID: 36894918 PMCID: PMC9996899 DOI: 10.1186/s12888-023-04630-1] [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: 04/11/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND This study explored the relationship between specific types of potentially traumatic events (PTEs) and symptoms of mental health disorders among people with HIV (PWH) in Cameroon. METHODS We conducted a cross-sectional study with 426 PWH in Cameroon between 2019-2020. Multivariable log binominal regression was used to estimate the association between exposure (yes/no) to six distinct types of PTE and symptoms of depression (Patient Health Questionnaire-9 score > 9), PTSD (PTSD Checklist for DSM-5 score > 30), anxiety (Generalized Anxiety Disorder-7 scale score > 9), and hazardous alcohol use (Alcohol Use Disorders Identification Test score > 7 for men; > 6 for women). RESULTS A majority of study participants (96%) reported exposure to at least one PTE, with a median of 4 PTEs (interquartile range: 2-5). The most commonly reported PTEs were seeing someone seriously injured or killed (45%), family members hitting or harming one another as a child (43%), physical assault or abuse from an intimate partner (42%) and witnessing physical assault or abuse (41%). In multivariable analyses, the prevalence of PTSD symptoms was significantly higher among those who reported experiencing PTEs during childhood, violent PTEs during adulthood, and the death of a child. The prevalence of anxiety symptoms was significantly higher among those who reported experiencing both PTEs during childhood and violent PTEs during adulthood. No significant positive associations were observed between specific PTEs explored and symptoms of depression or hazardous alcohol use after adjustment. CONCLUSIONS PTEs were common among this sample of PWH in Cameroon and associated with PTSD and anxiety symptoms. Research is needed to foster primary prevention of PTEs and to address the mental health sequelae of PTEs among PWH.
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Affiliation(s)
- Angela M Parcesepe
- Gillings School of Global Public Health, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Departments of Medicine and Epidemiology & Population Health, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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16
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Forkus SR, Raudales AM, Rafiuddin HS, Weiss NH, Messman BA, Contractor AA. The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:110-121. [PMID: 37378352 PMCID: PMC10292741 DOI: 10.1037/cps0000111] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.
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Affiliation(s)
| | | | | | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, RI, USA
| | - Brett A. Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. HIV-Related Stigma, Social Support, and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Patient Care STDS 2023; 37:146-154. [PMID: 36802206 PMCID: PMC10024262 DOI: 10.1089/apc.2022.0187] [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: 02/23/2023] Open
Abstract
HIV-related stigma has been associated with poor mental health among people with HIV (PWH). Social support is a potentially modifiable factor that may buffer negative mental health sequelae of HIV-related stigma. Little is known about the extent to which the modifying effect of social support differs across mental health disorders. Interviews were conducted with 426 PWH in Cameroon. Log binomial regression analyses were used to estimate the association between high anticipated HIV-related stigma and low social support from family or friends and symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and harmful alcohol use, separately. Anticipated HIV-related stigma was commonly endorsed with ∼80% endorsing at least 1 of 12 stigma-related concerns. In multivariable analyses, high anticipated HIV-related stigma was associated with greater prevalence of symptoms of depression {adjusted prevalence ratio (aPR) 1.6 [95% confidence interval (CI) 1.1-2.2]} and anxiety [aPR 2.0 (95% CI 1.4-2.9)]. Low social support was associated with greater prevalence of symptoms of depression [aPR 1.5 (95% CI 1.1-2.2)], anxiety [aPR 1.7 (95% CI 1.2-2.5)], and PTSD [aPR 1.6 (95% CI 1.0-2.4)]. However, social support did not meaningfully modify the relationship between HIV-related stigma and symptoms of any mental health disorders explored. Anticipated HIV-related stigma was commonly reported among this group of PWH initiating HIV care in Cameroon. Social concerns related to gossip or losing friends were of the greatest concern. Interventions focused on reducing stigma and strengthening support systems may be particularly beneficial and have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amanda Gomez
- Department of Maternal and Child Health and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
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18
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Hansen M, Vaegter HB, Ravn SL, Andersen TE. Validation of the Danish PTSD Checklist for DSM-5 in trauma-exposed chronic pain patients using the Clinician-Administered PTSD Scale for DSM-5. Eur J Psychotraumatol 2023; 14:2179801. [PMID: 36892217 PMCID: PMC10013435 DOI: 10.1080/20008066.2023.2179801] [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: 03/10/2023] Open
Abstract
Background: Validation of post-traumatic stress disorder (PTSD) screening tools across various populations to ensure accurate PTSD estimates is important. Because of the high symptom overlap between PTSD and pain, it is particularly important to validate PTSD screening tools in trauma-exposed chronic pain patients.Objective: The present study is the first seeking to validate the PTSD Checklist for DSM-5 (PCL-5) in a sample of trauma-exposed, treatment-seeking chronic pain patients.Method: The validation and optimal scoring of the PCL-5 were investigated using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in chronic pain patients exposed to traffic or work-related traumas (n = 84). Construct validity was investigated using confirmatory factor analyses testing six competing DSM-5 models in a sample of mixed trauma-exposed chronic pain patients (n = 566), and a subsample of chronic pain patients exposed to traffic or work-related trauma only (n = 202). Furthermore, concurrent validity and discriminant validity were investigated using correlation analysis.Results: The results showed moderate (κ = .46) diagnostic consistency between the PCL-5 and the CAPS-5 using the DSM-5 symptom cluster criteria, and the overall accuracy of the scale (area under the curve = .79) was highly acceptable. Furthermore, the Danish PCL-5 showed excellent construct validity both in the full sample and in the subsample of traffic and work-related accidents, with superior fit of the seven-factor hybrid model. Excellent concurrent validity and discriminant validity were also established in the full sample.Conclusion: The PCL-5 appears to have satisfactory psychometric properties in trauma-exposed, treatment-seeking chronic pain patients.
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Affiliation(s)
- Maj Hansen
- THRIVE, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sophie Lykkegaard Ravn
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark.,INSIDE, Department of Psychology, University of Southern Denmark, Odense, Denmark
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Teshome AA, Abebe EC, Mengstie MA, Seid MA, Yitbarek GY, Molla YM, Baye ND, Yazie TS, Ayehu GW, Taye MJ. Post-traumatic stress disorder and associated factors among adult war survivors in Northwest Ethiopia: Community-based, cross-sectional study. Front Psychiatry 2023; 14:1083138. [PMID: 37113553 PMCID: PMC10126353 DOI: 10.3389/fpsyt.2023.1083138] [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] [Received: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder in low and middle-income countries such as Ethiopia. However, armed conflict, abuse of human rights, and violence motivated by race are becoming more commonplace. This study aimed to assess the prevalence of PTSD and associated factors among war survivors in Nefas Meewcha Town, South Gondar Zone, Ethiopia, 2022. Methods A community based cross-sectional study was carried out. 812 study participants were chosen using a multi-stage sampling process. A face-to-face interview used a post-traumatic stress disorder checklist (PCL-5) to evaluate PTSD. The association between PTSD and other demographic and psychosocial characteristics was investigated using bivariate and multivariable binary logistic regression analysis. A P-value of 0.05 was declared as statistical significance. Result The prevalence of PTSD in this study was 40.8% with a 95% CI of 36.2 to 46.7. The likelihood of developing PTSD was significantly associated with the fallowing factors. A close family member killed or seriously injured (AOR = 4.53, 95% CI = 3.25-6.46), being female (AOR = 1.98, 95% CI = 1.3-3.0), moderate (AOR = 3.51, 95% CI = 2.52-4.68) and high perceived stress (AOR = 5.23, 95% CI = 3.47-8.26), depression symptoms (AOR = 4.92, 95% CI = 3.57-6.86), anxiety disorder symptoms (AOR = 5.24, 95% CI = 3.72-7.63), a chronic medical illness (AOR = 3.51, 95% CI = 2.52-5.41), physical assault (AOR = 2.12, 95% CI = 1.05-3.72) and being in a war fighting situation (AOR = 1.41, 95% CI = 1.21-3.14). Conclusion This study reported that the prevalence of PTSD was high. Being female, having a previous history of chronic medical illness, depressive symptoms, anxiety symptoms, history of a family member or friend was injured or killed, poor social support, high perceived stress, physical assault, and being in a war fighting situation were statistically associated with PTSD. Hence, regular patient assessment by mental health organizations for those with a history of trauma and facilitation of ways to support such residents is highly recommended.
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Affiliation(s)
- Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
- *Correspondence: Assefa Agegnehu Teshome,
| | - Endeshaw Chekol Abebe
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yalew Melkamu Molla
- Department of Paediatrics and Child Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nega Dagnaw Baye
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molla Jemberie Taye
- Department of Human Anatomy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Kabunga A, Okalo P, Nalwoga V, Apili B. Landslide disasters in eastern Uganda: post-traumatic stress disorder and its correlates among survivors in Bududa district. BMC Psychol 2022; 10:287. [PMID: 36471406 PMCID: PMC9721068 DOI: 10.1186/s40359-022-01001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder is the commonly reported psychiatric morbidity among the survivors of natural disasters. However, its prevalence particularly in Bududa, Eastern Uganda is largely unknown. AIMS AND OBJECTIVES To assess the prevalence and correlates of post-traumatic stress disorder among Bududa landslide survivors. METHODS A community-based cross-sectional study was conducted on a sample of 587 participants. The study setting was the Bududa district, with a multistage sampling method. Pre-tested, administered interviewer PTSD Checklist-civilian version was used as screening tools between 4th and April 29th 2022. Data were analyzed using descriptive and binary logistic approaches at a 5% level of significance. RESULTS Of the study participants, 276 (46.8%) had PTSD symptoms. Among the respondents, 250 (42.6%) were in the age range of 40 and above, 396 (67.3%) were female, 284 (48.4%) had no formal education, and 333 (56.7%) were married. Results showed that male gender (AOR: 0.47; 95% CI 0.31-0.73; p = 0.001), widowhood (AOR: 0.44; 95% CI 0.21-0.94; p = 0.034), lack of counseling (AOR: 0.44; 95% CI 0.21-0.94; p = 0.001), and duration since the landslide (AOR: 0.35; 95% CI 0.23-0.52; p = 0.001) were associated with an increased likelihood of screening for PTSD in landslide survivors. CONCLUSION Landslides pose significant effects on the mental health of survivors. In the present study, the extent of PTSD among survivors is substantially high. male gender,, widowhood, lack of counselling, low social support, and duration since the landslide were significantly associated with PTSD. Effective screening and awareness programs among survivors should be strengthened for the prevention and treatment of psychiatric morbidity among the survivors of landslides.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, P. O. Box 1035, Lira City, Uganda
| | - Ponsiano Okalo
- Department of Psychiatry, Lira University, P. O. Box 1035, Lira City, Uganda
| | - Viola Nalwoga
- Department of Psychiatry, Lira University, P. O. Box 1035, Lira City, Uganda
| | - Brenda Apili
- Department of Psychiatry, Lira University, P. O. Box 1035, Lira City, Uganda
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21
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Hoffman J, Ben-Zion Z, Arévalo A, Duek O, Greene T, Hall BJ, Harpaz-Rotem I, Liddell B, Locher C, Morina N, Nickerson A, Pfaltz MC, Schick M, Schnyder U, Seedat S, Shatri F, Sit HF, von Känel R, Spiller TR. Mapping the availability of translated versions of posttraumatic stress disorder screening questionnaires for adults: A scoping review. Eur J Psychotraumatol 2022; 13:2143019. [PMID: 38872602 PMCID: PMC9724641 DOI: 10.1080/20008066.2022.2143019] [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] [Received: 11/15/2021] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background: The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature.Objective: This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults.Methods: All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted.Results: A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request.Conclusions: The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed.HIGHLIGHTS We mapped the availability of translated PTSD screening questionnaires.The quality of the translation and validation processes is very heterogenous.We created a repository for translated, validated PTSD screening questionnaires.
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Affiliation(s)
- Joel Hoffman
- School of Psychology, UNSW Australia, Sydney, Australia
| | - Ziv Ben-Zion
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | - Adrián Arévalo
- Facultad de Medicina & Neuron Research Group Lima, Universidad de Piura, Lima, Perú
- Facultad de Medicina "San Fernando", Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Brian J Hall
- Center for Global Health equity, New York University (Shanghai), Shanghai, People's Republic of China
- School of Global Public Health, New York University, New York, NY, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | | | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Monique C Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fatlinda Shatri
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hao Fong Sit
- Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Isabirye RA, Namuli JD, Kinyanda E. Prevalence and factors associated with post traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan region. BMC Psychiatry 2022; 22:706. [PMID: 36380315 PMCID: PMC9666967 DOI: 10.1186/s12888-022-04317-z] [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: 03/02/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Occupation groups like police officers and fire fighters are exposed to a number of traumatic events which put them at a risk of developing post-traumatic stress disorder (PTSD). Previous studies have found the prevalence of PTSD in police officers to vary between 7 and 19%. However, most of these studies have been undertaken in western setting with little research having been undertaken in sub-Saharan Africa including Uganda. OBJECTIVE To determine the prevalence and factors associated with post-traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan Police (KMP) North Region. METHODS This was a cross sectional study that was conducted on 392 field police patrol officers serving in KMP North Region. Diagnosis of PTSD was undertaken using the Clinician Administered PTSD Scale for DSM-5. In order to assess for psychiatric comorbidities, the study used the Mini International Neuropsychiatric Interview (M.I.N.I.) RESULTS: In this study, the prevalence of PTSD was 7.4%. An additional 62.5% had sub-threshold PTSD, which was defined as, the presence of at least one PTSD symptom but not meeting full criteria for PTSD diagnosis. The factors found to be significantly associated with PTSD were all related to the presence of psychiatric comorbidities, namely the presence of: a current major depressive episode (aOR = 4.7; 95% CI: 1.5- 14.8; p = .009); an alcohol use disorder (aOR = 5.1; 95% CI: 2.0-13.0; p = .001); and presence of dissociation symptoms (aOR = 6.7; 95% CI: 2.0-22.2; p = .002). CONCLUSION PTSD is one of the common psychiatric disorders experienced by serving police officers in Uganda. The tendency of PTSD in this group to co-occur with other psychiatric disorders means that any treatment program to address it should be part of a comprehensive multi-disorder mental health treatment programme in the police office.
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Affiliation(s)
- Rogers Agenda Isabirye
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda.
| | - Justine Diana Namuli
- grid.11194.3c0000 0004 0620 0548Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Eugene Kinyanda
- grid.415861.f0000 0004 1790 6116 Mental Health Section, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Malaju MT, Alene GD. Longitudinal patterns of the relation between anxiety, depression and posttraumatic stress disorder among postpartum women with and without maternal morbidities in Northwest Ethiopia: a cross-lagged autoregressive structural equation modelling. Arch Public Health 2022; 80:225. [PMID: 36309711 PMCID: PMC9617360 DOI: 10.1186/s13690-022-00978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The postpartum period is a time where mothers can undergo significant changes that increase vulnerability for depression, anxiety and posttraumatic stress disorder symptoms. However, the direct and indirect factors of depression, anxiety and posttraumatic stress disorder symptoms and their direction of relationships following childbirth is not well investigated in Ethiopia. The aim of this study was to determine the direct and indirect factors of depression, anxiety and posttraumatic stress disorder symptoms and their direction of relationships following childbirth. METHODS A total of 775 women consented to participate at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 - March, 2021. Women were recruited after childbirth and before discharge using the World Health Organization maternal morbidity working group criteria to identify exposed and non-exposed groups. A cross-lagged autoregressive path analysis and linear structural equation modelling were carried out using Stata version 16 software. RESULTS Prevalence rates of anxiety were 18.5%, 15.5% and 8.5% at the 6th, 12th and 18th week of postpartum respectively. The prevalence rates for depression were also found to be 15.5%, 12.9% and 8.6% respectively during the same follow up period and for posttraumatic stress disorder it was found to be 9.7%, 6.8% and 3.5% at the 6th, 12th and 18th week of postpartum respectively. Moreover, anxiety and depression were found to be a causal risk factors for posttraumatic stress disorder in the postpartum period. Direct maternal morbidity, fear of childbirth, higher gravidity, perceived traumatic childbirth and indirect maternal morbidity were found to have a direct and indirect positive association with depression, anxiety and posttraumatic stress disorder. In contrast, higher parity, higher family size and higher social support have a direct and indirect negative association. CONCLUSION Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers' needs during childbirth are essential to improve maternal mental health in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- grid.510430.3Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getu Degu Alene
- grid.442845.b0000 0004 0439 5951School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Stanton AM, O'Cleirigh C, Knight L, Davey DLJ, Myer L, Joska JA, Mayer KH, Bekker L, Psaros C. The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities. J Int AIDS Soc 2022; 25:e26026. [PMID: 36251124 PMCID: PMC9575939 DOI: 10.1002/jia2.26026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA,Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA
| | - Conall O'Cleirigh
- Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Lucia Knight
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Dvora L. Joseph Davey
- School of Public HealthUniversity of Cape TownCape TownSouth Africa,Division of Infectious Diseases, Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Landon Myer
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Kenneth H. Mayer
- Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA,HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa,Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | | - Christina Psaros
- Massachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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25
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Malaju MT, Alene GD, Bisetegn TA. Longitudinal path analysis for the directional association of depression, anxiety and posttraumatic stress disorder with their comorbidities and associated factors among postpartum women in Northwest Ethiopia: A cross-lagged autoregressive modelling study. PLoS One 2022; 17:e0273176. [PMID: 35969630 PMCID: PMC9377604 DOI: 10.1371/journal.pone.0273176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Vulnerability for depression, anxiety and posttraumatic stress disorder symptoms due to perceived traumatic birth increase during the postpartum period. Traumatic birth has been defined as an event occurring during labour and birth that may be a serious threat to the life and safety of the mother and/or child. However, the comorbidity and multimorbidity of depression, anxiety and PTSD with their direct and indirect predictors is not well investigated in the postpartum period. In addition, the longitudinal directional association of depression, anxiety and PTSD with their comorbidities is not studied in Ethiopia. Objective The aim of this study was to assess prevalence of postnatal comorbid and multimorbid anxiety, depression and PTSD. It also aimed to determine the directional association of postnatal anxiety, depression and PTSD with the comorbidity and multimorbidity of these mental health problems over time and to explore the factors that are directly or indirectly associated with comorbidity and multimorbidity of anxiety, depression and PTSD. Methods A total of 775 women were included at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 –March, 2021. A cross-lagged autoregressive path analysis was carried out using Stata 16.0 software in order to determine the autoregressive and cross-lagged effects of depression, anxiety and PTSD with their comorbidities. In addition, a linear structural equation modelling was also carried out to determine the direct and indirect effects of independent variables on the comorbidities of depression, anxiety and PTSD. Results Comorbidity of anxiety with depression was the most common (14.5%, 12.1% and 8.1%) at the 6th, 12th and 18th week of postnatal period respectively. With regard to the direction of association, comorbidity of PTSD (due to perceived traumatic birth) with depression, PTSD with anxiety, depression with anxiety and triple comorbidity predicted depression and anxiety in subsequent waves of measurement. Direct and indirect maternal morbidity, fear of childbirth and perceived traumatic childbirth were found to have a direct and indirect positive association with comorbidities of depression, anxiety and PTSD. In contrast, higher parity, higher family size and higher social support had a direct and indirect negative association with these mental health disorders. Conclusion Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers’ needs during childbirth are essential to avert comorbidity of anxiety, depression and PTSD in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. J Affect Disord 2022; 308:421-431. [PMID: 35452755 PMCID: PMC9520993 DOI: 10.1016/j.jad.2022.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes. METHODS We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models. RESULTS Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8). LIMITATIONS Given the design of our study, findings are subject to recall and social desirability bias. CONCLUSIONS Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.
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Affiliation(s)
- Lindsey M Filiatreau
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, United States of America; Washington University in St. Louis, Brown School, International Center for Child Health and Development, St. Louis, MO, United States of America; University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Columbia University, Department of Psychiatry, New York, NY, United States of America
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, New York, NY, United States of America
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America; Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M Parcesepe
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America; University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, United States of America
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27
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon. PLoS One 2022; 17:e0270042. [PMID: 35771857 PMCID: PMC9246197 DOI: 10.1371/journal.pone.0270042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa. METHODS We conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity. RESULTS Among 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity. CONCLUSION Psychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, United States of America
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
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Improving outcomes for care partners of persons with traumatic brain injury: Protocol for a randomized control trial of a just-in-time-adaptive self-management intervention. PLoS One 2022; 17:e0268726. [PMID: 35679283 PMCID: PMC9182304 DOI: 10.1371/journal.pone.0268726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Informal family care partners of persons with traumatic brain injury (TBI) often experience intense stress resulting from their caregiver role. As such, there is a need for low burden, and easy to engage in interventions to improve health-related quality of life (HRQOL) for these care partners. This study is designed to evaluate the effectiveness of a personalized just-in-time adaptive intervention (JITAI) aimed at improving the HRQOL of care partners. Participants are randomized either to a control group, where they wear the Fitbit® and provide daily reports of HRQOL over a six-month (180 day) period (without the personalized feedback), or the JITAI group, where they wear the Fitbit®, provide daily reports of HRQOL and receive personalized self-management pushes for 6 months. 240 participants will be enrolled (n = 120 control group; n = 120 JITAI group). Outcomes are collected at baseline, 1-, 2-, 3-, 4-, 5- & 6-months, as well as 3- and 6-months post intervention. We hypothesize that the care partners who receive the intervention (JITAI group) will show improvements in caregiver strain (primary outcome) and mental health (depression and anxiety) after the 6-month (180 day) home monitoring period. Participant recruitment for this study started in November 2020. Data collection efforts should be completed by spring 2025; results are expected by winter 2025. At the conclusion of this randomized control trial, we will be able to identify care partners at greatest risk for negative physical and mental health outcomes, and will have demonstrated the efficacy of this JITAI intervention to improve HRQOL for these care partners. Trial registration: ClinicalTrial.gov NCT04570930; https://clinicaltrials.gov/ct2/show/NCT04570930.
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Malaju MT, Alene GD, Bisetegn TA. Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method. PLoS One 2022; 17:e0266399. [PMID: 35404954 PMCID: PMC9000968 DOI: 10.1371/journal.pone.0266399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION In recent years, literatures identified childbirth as a potentially traumatic experience resulting in posttraumatic stress disorder (PTSD), with 19.7 to 45.5% of women perceiving their childbirth as traumatic. A substantial variation in PTSD symptoms has been also indicated among women who experience a traumatic childbirth. However, there has been no research that has systematically investigated these patterns and their underlying determinants in postpartum women in Ethiopia. OBJECTIVE The aim of this study was to investigate the trajectories of PTSD symptoms and mediating relationships of variables associated with it among postpartum women in Northwest Ethiopia. METHODS A total of 775 women were recruited after childbirth and were followed at the 6th, 12th and 18th week of postpartum period during October, 2020 -March, 2021. A group-based trajectory modeling and mediation analysis using KHB method were carried out using Stata version 16 software in order to determine the trajectories of PTSD symptoms and mediation percentage of each mediator on the trajectories of PTSD symptoms. RESULTS Four distinct trajectories of postpartum posttraumatic stress disorder symptoms were identified. Perceived traumatic childbirth, fear of childbirth, depression, anxiety, psychological violence, higher WHODAS 2.0 total score, multigravidity, stressful life events of health risk, relational problems and income instability were found to be predictors of PTSD with recovery and chronic PTSD trajectory group membership. Depression and anxiety not only were strongly related to trajectories of PTSD symptoms directly but also mediated much of the effect of the other factors on trajectories of PTSD symptoms. In contrast, multiparity and higher mental quality of life scores were protective of belonging to the PTSD with recovery and chronic PTSD trajectory group membership. CONCLUSION Women with symptoms of depression, anxiety, fear of childbirth and perceived traumatic childbirth were at increased risk of belonging to recovered and chronic PTSD trajectories. Postnatal screening and treatment of depression and anxiety may contribute to decrease PTSD symptoms of women in the postpartum period. Providing adequate information about birth procedures and response to mothers' needs during childbirth and training of health care providers to be mindful of factors that contribute to negative appraisals of childbirth are essential to reduce fear of childbirth and traumatic childbirth so as to prevent PTSD symptoms in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- School of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Yunitri N, Chu H, Kang XL, Jen HJ, Pien LC, Tsai HT, Kamil AR, Chou KR. Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis. Int J Nurs Stud 2022; 126:104136. [PMID: 34856503 PMCID: PMC8585564 DOI: 10.1016/j.ijnurstu.2021.104136] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic has negatively impacted the psychological well-being of individuals and society. Previous studies conducted on coronavirus outbreaks including Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome pandemic found that posttraumatic stress disorder (PTSD), depression, and anxiety were the most common mental health problems and long-term consequences of these outbreaks. Currently, comprehensive and integrated information on the global prevalence of PTSD due to the COVID-19 pandemic is lacking. OBJECTIVE In the present meta-analysis, we examined the global prevalence and associated risk factors of PTSD in patients/survivors of COVID-19, health professionals, and the population at large. DESIGN Meta-analysis. DATA SOURCE Cochrane, CINAHL, Embase, MEDLINE, PubMed, Scopus, Web of Science, and manual search up to June 2021. METHODS We included studies evaluating the prevalence of PTSD during the COVID-19 pandemic in either patients/survivors, health professionals, and the population at large. The data were analyzed using logit transformation with the random-effects model. Risk of bias assessment was conducted using Hoy and colleagues. RESULTS A total of 63 studies (n = 124,952) from 24 different countries were involved. The overall pooled estimate of PTSD prevalence was 17.52% (95% CI 13.89 to 21.86), with no evidence of publication bias (t=-0.22, p-value=0.83). This study found a high prevalence of PTSD among patients with COVID-19 (15.45%; 95% CI 10.59 to 21.99), health professionals (17.23%; 95% CI 11.78 to 24.50), and the population at large (17.34%; 95% CI 12.21 to 24.03). Subgroup analyses showed that those working in COVID-19 units (30.98%; 95% CI, 16.85 to 49.86), nurses (28.22%; 95% CI, 15.83 to 45.10), those living in European countries (25.05%; 95% CI 19.14 to 32.06), and studies that used Clinician-Administered PTSD Scale for DSM-5 (30.18%, 95% CI 25.78 to 34.98) demonstrated to have the highest PTSD prevalence compared to other subgroups. Meta-regression analyses revealed that the elderly (above age 65) had lower PTSD prevalence (-1.75, 95% CI -3.16 to -0.34) than the adult population. CONCLUSION AND IMPLICATIONS Substantial PTSD prevalence was found in patients with COVID-19, health professionals, and the population at large. Moderator analysis revealed that age, unit of work, health profession, continent, and assessment tools as significant moderators. Mental health services are needed for everyone, especially adults under the age of 65, those who work in COVID-19 units, nurses, and people in the European continent. REGISTRATION The study protocol was registered with the International database of prospective registered systematic reviews (PROSPERO): CRD42020218762. Tweetable abstract: The pooled PTSD prevalence during COVID-19 pandemic for patients with COVID-19, health professionals, and the population at large was 17.52%.
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Affiliation(s)
- Ninik Yunitri
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Mental Health and Psychiatric Nursing Department, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Abdu Rahim Kamil
- Medical Surgical Nursing Department, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan,Corresponding author at: School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, No.250, Wu-Hsing Street, Taipei 110, Taiwan, R.O.C
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Anbesaw T, Zenebe Y, Asmamaw A, Shegaw M, Birru N. Post-traumatic stress disorder and associated factors among people who experienced traumatic events in Dessie town, Ethiopia, 2022: A community based study. Front Psychiatry 2022; 13:1026878. [PMID: 36386993 PMCID: PMC9644990 DOI: 10.3389/fpsyt.2022.1026878] [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] [Received: 08/24/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) may develop as a serious long-term consequence of traumatic experiences, even many years after trauma exposure. Dessie town residents have experienced prolonged armed conflict due to inter-communal conflict in 2021. Those people are exposed to different kinds of trauma, and violence, making them more prone to psychological disorders. Despite the highest number of people affected due to conflict and its negative impact on mental health, post-traumatic stress disorders among people are overlooked in Ethiopia. This study aimed to assess the prevalence and associated factors of post-traumatic stress disorder among people who experienced traumatic events in Dessie town, Ethiopia, 2022. MATERIALS AND METHODS Community based cross-sectional study was conducted on June 8-July 7, 2022, by using a multi-stage cluster sampling with a total sample of 785. Pretested, structured questionnaires and face-to-face interviews were used for data collection. PTSD was assessed by the Post-traumatic stress disorder Checklist for DSM-5 (PCL-5). Data was entered using Epi-data version 3.1 and, then exported to SPSS version 26 for analysis. The association between outcome and independent variables was analyzed with bi-variable and multivariable logistic regression. P-values less than 0.05 was considered statistically significant. RESULT The prevalence of PTSD among Dessie town residents was found to be 19.4% (95% CI, 16.7, 22.0). In multivariable analysis, being females (AOR = 1.63, 95% CI 1.10-2.44), previous history of mental illness (AOR = 3.14, 95% CI 1.14-7.06) depressive symptoms (AOR = 3.12, 95% CI 1.92-5.07), witnessing a serious physical injury of a family member or friend (AOR = 2.82, 95% CI 1.18-6.70) and high perceived life threats (AOR = 5.73, 95% CI 3.05-10.78) were found to be significant predictors of PTSD. CONCLUSION The prevalence of PTSD among Dessie town residents was found to be huge. Being female, having a previous history of mental illness, depressive symptoms, witnessing a serious physical injury of a family member or friend, and high perceived life threats were variables that are independent predictors of PSTD. People who have experienced such a severe traumatic event require psychosocial support to aid in their recovery from the terrible experiences.
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Affiliation(s)
- Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Amare Asmamaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Maregu Shegaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Nahom Birru
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Malaju MT, Alene GD, Azale T. Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling. BMJ Glob Health 2022; 7:e007483. [PMID: 35039310 PMCID: PMC8764995 DOI: 10.1136/bmjgh-2021-007483] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Unlike physiological recovery, return to full functional status following childbirth takes longer than 6 weeks (42 days) of the traditionally defined postnatal period, and women with maternal morbidity usually require a longer period to recover. However, the extent to which this morbidity collectively impacts on women's functional status is not well investigated in Ethiopia. We aim to determine the distinct trajectories and predictors of functional status among postpartum women in Northwest Ethiopia. METHODS Health facility linked community-based follow-up study was conducted in Northwest Ethiopia from October 2020-March 2021. A sample of 779 delivering women was recruited after childbirth and before discharge using the criteria published by the WHO Maternal Morbidity Working Group. Functional status was measured by the Amharic version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) instrument. The Stata Traj package was used to determine trajectories of functional status using group-based multi-trajectory modelling. The multinomial logistic regression model was used to identify predictors of trajectory group membership. RESULTS A total of 775 women participated at the first, second and third follow-up of the study (6th week, 12th week and 18th week of postpartum period). Three distinct functional status trajectory groups with different longitudinal patterns were identified across the six domains of WHODAS 2.0. Direct and indirect maternal morbidities, lower educational status, poor social support, vaginal delivery, stress, anxiety, posttraumatic stress disorder and fear of childbirth were found to be predictors of poor functioning trajectories. CONCLUSION Early diagnosis and treatment of maternal morbidities and mental health problems, developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to improve functioning trajectories of postpartum women.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale
- School of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Wainberg M, Pence B, Pefura-Yone E, Yotebieng M, Nsame D, Anastos K, Nash D. Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National 'Treat All' Policy. AIDS Behav 2021; 25:4018-4028. [PMID: 34091803 PMCID: PMC8938985 DOI: 10.1007/s10461-021-03328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Ajeh R, Nash D. Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national "treat all" policy: a cross-sectional analysis. J Int AIDS Soc 2021; 24:e25842. [PMID: 34811945 PMCID: PMC8609224 DOI: 10.1002/jia2.25842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Rapid antiretroviral treatment (ART) initiation reduces time from HIV infection to viral suppression, decreasing HIV transmission risk. Mental health symptoms may influence timing of ART initiation. This study estimated the prevalence of ART initiation at enrolment into HIV care and the relationship between mental health and ART initiation at enrolment into HIV care. Methods We conducted interviews with 426 individuals initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the association between mental health and timing of ART initiation. Depression (Patient Health Questionnaire‐9; cut‐point 10), anxiety (Generalized Anxiety Disorder‐7; cut‐point 10), post‐traumatic stress disorder (PTSD) (PTSD Checklist for DSM‐5; cut‐point 31) and harmful alcohol use (Alcohol Use Disorders Identification Test; cut‐point 16) were dichotomized to represent those with and without each exposure at first HIV care appointment. Date of ART initiation (date ART prescribed) was ascertained from medical records. Separate multivariable log‐binomial regression models were used to estimate the association between mental health exposures and ART initiation at enrolment into care. Results and discussion Overall, 87% initiated ART at enrolment into HIV care. Approximately 20% reported depressive symptoms, 15% reported PTSD symptoms, 12% reported anxiety symptoms and 13% reported harmful alcohol use. In multivariable analyses, individuals with moderate to severe depressive symptoms had 1.7 (95% confidence interval [CI] 1.1, 2.7) times the prevalence of not initiating ART at enrolment into HIV care compared to those with no or mild depressive symptoms. Those with symptoms of PTSD, compared to those without, had 1.9 (95% CI 1.2, 2.9) times the prevalence of not initiating ART at enrolment into HIV care. Symptoms of anxiety or harmful drinking were not associated with ART initiation at enrolment into HIV care in multivariable models. Conclusions Symptoms of depression and PTSD were associated with lower prevalence of ART initiation at enrolment into HIV care among this sample of individuals initiating HIV care in Cameroon under a “treat all” policy. Research should examine barriers to timely ART initiation, whether incorporating mental health services into HIV care improves timely ART initiation, and whether untreated symptoms of depression and PTSD drive suboptimal HIV care outcomes.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, North Carolina, USA
| | - Lindsey M Filiatreau
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, New York, New York, USA
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Huang RW, Shen T, Ge LM, Cao L, Luo JF, Wu SY. Psychometric Properties of the Chinese Version of the Primary Care Post-Traumatic Stress Disorder Screen-5 for Medical Staff Exposed to the COVID-19 Pandemic. Psychol Res Behav Manag 2021; 14:1371-1378. [PMID: 34512047 PMCID: PMC8421668 DOI: 10.2147/prbm.s329380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose The COVID-19 pandemic may increase the development of psychiatric disorders, such as posttraumatic stress disorder (PTSD) among medical staff. A brief validated screening tool is essential for the early diagnosis of PTSD. The purpose of the present study was to evaluate the validation of a Chinese version of the Primary Care-PTSD-5 (C-PC-PTSD-5) and determine an appropriate cutoff score with optimal sensitivity and specificity for medical staff in China during the COVID-19 pandemic. Participants and Methods An online cross-sectional survey was conducted on medical staff (n = 1104) from 17 medical institutions in Shanghai. Questionnaires comprising general information, medical-related traumatic event experiences, the PTSD Checklist (PCL-5), and C-PC-PTSD-5 were distributed to participants using the online Questionnaire Star electronic system. Internal consistency, convergent validity, and test–retest reliability were calculated. Receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy and the optimal cutoff score of the C-PC-PTSD-5 for medical staff. Results We included 1062 valid questionnaires for the analysis. Data of 838 traumatic experiences were analyzed. Internal consistency of the C-PC-PTSD-5 was satisfied (Cronbach’s α = 0.756). The total score of the C-PC-PTSD-5 showed good test–retest reliability (r = 0.746). We found a strong correlation between the C-PC-PTSD-5 score and PCL-5 total score (r = 0.669, p < 0.001), which indicated good convergent validity. The ROC analysis showed an area under the curve of 0.81 ± 0.016. A cutoff score of 2 provided optimal sensitivity and specificity for the C-PC-PTSD-5 (sensitivity = 0.632, specificity = 0.871, Youden index = 0.503, and overall efficiency = 0.768). Conclusion Our results indicated that the C-PC-PTSD-5 can be employed as a brief and efficient screening instrument for medical staff exposed to the COVID-19 pandemic. A score of 2 was identified as the optimal threshold for probable clinical PTSD symptoms.
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Affiliation(s)
- Rui-Wen Huang
- Department of Science and Education, RuiJin Hospital LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Tao Shen
- Department of Psychiatry, Shanghai Huangpu District Mental Health Center, Shanghai, People's Republic of China
| | - Lei-Ming Ge
- Department of General practice, Changfeng Community Health Service Center of Putuo, Shanghai, People's Republic of China
| | - Lu Cao
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian-Feng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, People's Republic of China
| | - Shi-Yu Wu
- Department of Science and Education, RuiJin Hospital LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
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Molebatsi K, Ng LC, Chiliza B. A culturally adapted brief intervention for post-traumatic stress disorder in people with severe mental illness in Botswana: protocol for a randomised feasibility trial. Pilot Feasibility Stud 2021; 7:170. [PMID: 34479640 PMCID: PMC8414703 DOI: 10.1186/s40814-021-00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research consistently reports elevated rates of exposure to traumatic events and post-traumatic stress disorder (PTSD) in people with severe mental illness (SMI). PTSD may be adequately managed with psychotherapy; however, there is a gap when it comes to management in culturally diverse settings like Botswana. This paper describes a study protocol whose aim is to culturally adapt the BREATHE intervention, a brief psychological intervention for people living with comorbid PTSD and SMI that was developed and tested in the USA; assess the feasibility and acceptability of the adapted BREATHE intervention and explore its efficacy. METHODS The study will be conducted in three phases using a mixed methods approach. The first phase will identify and describe the most common traumatic experiences and responses to traumatic experiences, amongst patients with SMI, and patients' and mental health care providers' perceptions about suitable PTSD interventions for Botswana. The second phase will entail cultural adaption of the intervention using findings from phase 1, and the third phase will be a pilot trial to assess the feasibility and acceptability of the culturally adapted intervention and explore its efficacy. Quantitative and qualitative data will be analysed using basic descriptive statistics and thematic analysis, respectively. DISCUSSION Literature highlights cultural variations in the expression and management of mental illness suggesting the need for culturally adapted interventions. The findings of this feasibility study will be used to inform the design of a larger trial to assess the efficacy of an adapted brief intervention for PTSD in patients with SMI in Botswana. TRIAL REGISTRATION Clinicaltrials.gov registration: NCT04426448 . Date of registration: June 7, 2020.
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Affiliation(s)
- Keneilwe Molebatsi
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Private Bag, 00713, Gaborone, Botswana.
| | - Lauren C Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence B, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatry 2021; 21:293. [PMID: 34090367 PMCID: PMC8180128 DOI: 10.1186/s12888-021-03306-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon. METHODS We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression. RESULTS Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80). CONCLUSIONS Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.
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Affiliation(s)
- Lindsey M. Filiatreau
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian Pence
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Milton Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Denis Nash
- grid.212340.60000000122985718Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY USA
| | - Marcel Yotebieng
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn Anastos
- grid.251993.50000000121791997Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Gameon JA, Skewes MC. Historical trauma and substance use among American Indian people with current substance use problems. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:295-309. [PMID: 33829816 PMCID: PMC8084991 DOI: 10.1037/adb0000729] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the United States, American Indian and Alaska Native (AI/AN) people suffer health inequities associated with alcohol and other drug use and also experience historical trauma symptoms resulting from colonization. Research suggests that historical trauma may be associated with substance use among AI/ANs. METHOD As part of a Community-Based Participatory Research project with tribal partners from a rural AI reservation, our team collected cross-sectional survey data from 198 tribal members who self-identified as having substance use problems. We examined associations between historical trauma thoughts, historical trauma symptoms, and substance use outcomes. We also examined historical trauma symptoms, current trauma symptoms, awareness of systemic discrimination, and ethnic identity as moderators of the associations between historical trauma thoughts and substance use variables. RESULTS Historical trauma thoughts, controlling for symptoms, were associated with greater abstinent days, fewer heavy alcohol use days, fewer drinks per drinking day, and fewer drug use days; historical trauma symptoms, controlling for thoughts, were associated only with fewer abstinent days. Moderation analyses showed that historical trauma thoughts were associated with better substance use outcomes when historical trauma symptoms were low, current trauma symptoms were low, awareness of systemic discrimination was high, and ethnic identity was high. CONCLUSION When distressing trauma symptoms are low, historical trauma thoughts may act as a protective factor or as a marker for other factors associated with better substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Khazaei A, Navab E, Esmaeili M, Masoumi H. Prevalence and Related Factors of Post-Traumatic Stress Disorder in Emergency Medical Technicians; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e35. [PMID: 34027430 PMCID: PMC8126347 DOI: 10.22037/aaem.v9i1.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction: Ongoing exposure to a variety of Pre-hospital Emergencies (PE) has placed Emergency Medical Technicians (EMTs) at serious psychiatric compromise such as Post-Traumatic Stress Disorder (PTSD). The present study aimed to evaluate the prevalence and associated factors of PTSD among EMTs. Methods: This prospective cross-sectional study was conducted on EMTs in the Emergency Medical Services (EMS) in west of Iran. A baseline information questionnaire including personal work-related characteristics and the PTSD checklist of DSM-5 (PCL-5) were used for data collection. Non-parametric tests and multivariate linear regression were used to evaluate the associated factors of PTSD in these participants. Results: Among the participants, 22% of technicians had PTSD-diagnostic criteria. The mean total PCL-5 score was 21.60 ± 11.45, while the scores were 38.02 ± 6.08 and 17.47 ± 8.36 in the PTSD-diagnosed and undiagnosed groups, respectively. The most common symptom of the clusters was negative alterations in cognition with a mean score of 7.42 ± 4.63. After adjusting confounders, the number of missions (t= 2.50, P= 0.013), work experience (t= -3.24, P= 0.001) and number of shifts (t: 26.38, P < 0.001) were significantly corelated with PCL-5 score. Conclusion: The results indicated that the prevalence of PTSD among EMTs personnel of Hamedan province is high. EMTs with the age of ≤ 30 years, work experience of ≤ 10 years, married status, informal employment, emergency medical technician's degree, and more than 8 shifts per month, as well as no previous training history had a higher total PCL-5 score.
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Affiliation(s)
- Afshin Khazaei
- Intensive Care and Management Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Navab
- Critical Care Department, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Disaster and Emergency Management Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Habib Masoumi
- Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Tran A, Redley M, de Wit K. The psychological impact of pulmonary embolism: A mixed-methods study. Res Pract Thromb Haemost 2021; 5:301-307. [PMID: 33733029 PMCID: PMC7938621 DOI: 10.1002/rth2.12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients diagnosed with pulmonary embolism (PE) are reported to experience symptoms of posttraumatic stress disorder (PTSD) and existential anxiety following their diagnosis. They may also experience negative changes in perspective and hypervigilance of PE symptoms. OBJECTIVE The aim of this study was to document the mental and emotional experience associated with PE diagnosis through the lens of PTSD, to better understand the factors involved in psychological distress following receipt of a PE diagnosis. PATIENTS/METHODS This was a mixed-methods study in two parts: (i) measurement of self-reported PTSD symptoms among patients attending thrombosis clinic and (ii) semistructured interviews with patients about their experience of receiving a diagnosis of PE and its psychological aftermath. RESULTS Of 72 patients who participated in the survey, two met the criteria for a tentative diagnosis of PTSD. The semistructured interviews with 37 patients suggested that around half of respondents experienced some degree of ongoing psychological distress. Those with psychological distress often recalled painful symptoms, recalled diagnosis delivery as stressful, worried about PE recurrence, and had anxieties about stopping their anticoagulant medication. Few patients reported inclination to seek support from professional mental health services. CONCLUSIONS We found ongoing and untreated psychological distress among people who were previously diagnosed with PE.
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Affiliation(s)
- Anna Tran
- Hamilton Health SciencesHamiltonONCanada
- McMaster UniversityHamiltonONCanada
| | - Marcus Redley
- University of East Anglia School of Health SciencesNorwichUK
| | - Kerstin de Wit
- Hamilton Health SciencesHamiltonONCanada
- McMaster UniversityHamiltonONCanada
- Department of Emergency MedicineQueen’s UniversityKingstonONCanada
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Roberts NP, Kitchiner NJ, Lewis CE, Downes AJ, Bisson JI. Psychometric properties of the PTSD Checklist for DSM-5 in a sample of trauma exposed mental health service users. Eur J Psychotraumatol 2021; 12:1863578. [PMID: 34992744 PMCID: PMC8725778 DOI: 10.1080/20008198.2020.1863578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background: PTSD self-report measures are frequently used in mental health services but very few have been evaluated in clinical samples that include civilians. The PCL-5 was developed to assess for DSM-5 PTSD. Objective: The aim of this study was to evaluate the psychometric properties of the PCL-5 in a sample of trauma-exposed mental health service users who were evidencing symptoms of PTSD. Method: Reliability and validity of the PCL-5 were investigated in a sample of 273 participants who reported past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. Diagnostic utility was evaluated in comparison to the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Results: The PCL-5 demonstrated high internal consistency, good convergent and divergent validity, acceptable stability and good diagnostic utility. However, operating characteristics differed from those found in other samples. Scores of 43-44 provided optimal efficiency for diagnosing PTSD. A post hoc regression analysis showed that depression explained more of the variance in PCL-5 total score than the CAPS-5. Conclusion: Whilst the PCL-5 is psychometrically sound it appears to have difficulty differentiating self-reported depression and anxiety symptoms from PTSD in trauma-exposed mental health service users and clinicians should take care to assess full symptomatology when individuals screen positively on the PCL-5. Clinicians and researchers should also take care not to assume that operating characteristics of self-report PTSD measures are valid for mental health service users, when these have been established in other populations.
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Affiliation(s)
- Neil P. Roberts
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Neil J. Kitchiner
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Veterans’ NHS Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Catrin E. Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Anthony J. Downes
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jonathan I. Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Wadley AL, Iacovides S, Roche J, Scheuermaier K, Venter WDF, Vos AG, Lalla-Edward ST. Working nights and lower leisure-time physical activity associate with chronic pain in Southern African long-distance truck drivers: A cross-sectional study. PLoS One 2020; 15:e0243366. [PMID: 33270793 PMCID: PMC7714191 DOI: 10.1371/journal.pone.0243366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background In South Africa, the trucking industry employs over 70,000 people and the prevalence of chronic pain in this occupational group was reported at 10%. We investigated factors associated with chronic pain in truck drivers including mental health, physical activity, and sleep, as no study has done so. Methods Southern African male, long-distance truck drivers were recruited at truck stops in Gauteng and Free State Provinces, South Africa (n = 614). Chronic pain was defined as pain present for at least the last three months. Depressive symptoms were assessed with the Patient Health Questionnaire-9, post-traumatic stress disorder with the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), exposure to traumatic events with the Life Events Checklist-5 (LEC-5) and daytime sleepiness with the Epworth Sleepiness Scale. Sleep quality was measured on a four-point Likert scale. Leisure-time physical activity was measured using the Godin-Shephard leisure-time physical activity questionnaire. Associations between these factors, demographic factors and chronic pain were investigated. Results Multivariate analysis showed that working ≥ 2 nights/week (OR = 2.68, 95% CI = 1.55–4.68) was associated with chronic pain and physical activity was protective (OR = 0.97, 95% CI 0.95–0.98). In an exploratory analysis, greater depressive symptoms (p = 0.004), daytime sleepiness (p = 0.01) and worse sleep quality (p = 0.001) was associated with working ≥ 2 nights/week. Lower leisure-time physical activity was associated with worse sleep quality (p = 0.006), but not daytime sleepiness or depressive symptoms (p>0.05). Conclusions There is a clear relationship between working nights and activity levels, and chronic pain, sleep quality, and depression in truck drivers.
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Affiliation(s)
- Antonia L. Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna Roche
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karine Scheuermaier
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - W. D. Francois Venter
- Ezintsha, A Sub-Division of Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alinda G. Vos
- Ezintsha, A Sub-Division of Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Samanta T. Lalla-Edward
- Ezintsha, A Sub-Division of Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sangarlangkarn A, Appelbaum JS. Comprehensive Geriatric Assessment in Older Persons With HIV. Open Forum Infect Dis 2020; 7:ofaa485. [PMID: 33241066 PMCID: PMC7672420 DOI: 10.1093/ofid/ofaa485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
With increased longevity related to the advent of antiretroviral therapy, there are increasing proportions of older persons with HIV (PWH). Prior studies have demonstrated increased prevalence of geriatric syndromes in older PWH and recommended the Comprehensive Geriatric Assessment (CGA) in this population. However, there is currently no peer-reviewed literature that outlines how to perform the CGA in PWH in the clinical setting. In this article, we offer a review on how to perform the CGA in PWH, outline domains of the CGA and their importance in PWH, and describe screening tools for each domain focusing on tools that have been validated in PWH, are easy to administer, and/or are already commonly used in the field of geriatrics.
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Affiliation(s)
- Aroonsiri Sangarlangkarn
- Section of Geriatrics, Division of General Internal Medicine, Department of Internal Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Appelbaum
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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Duko B, Toma A, Abraham Y, Kebble P. Post-Traumatic Stress Disorder and its Correlates Among People Living with HIV in Southern Ethiopia, an Institutionally Based Cross-Sectional Study. Psychiatr Q 2020; 91:783-791. [PMID: 32221765 DOI: 10.1007/s11126-020-09735-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Post-traumatic stress disorder is a common psychiatric problem more highly prevalent among HIV infected individuals than the general population. This study aims to assess the probable prevalence of post-traumatic stress disorder and associated factors among individuals living with HIV in Hawassa, Ethiopia, 2018. An institution based cross-sectional study was employed. A total of 205 HIV positive individuals who attend follow-up sessions at HIV clinics were recruited for the study through systematic sampling techniques. The presence of probable post-traumatic stress disorder was assessed by using the post-traumatic stress disorder checklist -5. The potential traumatic life events and any stressful events that occurred in participants' lives were assessed by the life event checklist for DSM-5 (LEC-5). The mean age of the respondents was 32.33 years (SD ±8.67). Prevalence of post-traumatic stress disorder (PTSD) was 46.3%. Being female [AOR = 1.27, (95% CI: 1.01, 3.98)], poor social support [AOR = 1.71, (95% CI: 1.08, 4.45)], poor medication adherence [AOR = 3.87, (95% CI: 1.75, 6.79)], current alcohol use [AOR = 2.34, (95% CI: 1.32, 5.16)], HIV/TB coinfection [AOR = 1.23, (95% CI: 1.09, 6.84)] and having negative life events [AOR = 1.76, (95% CI: 1.41, 6.98)] had statistically significant association with probable post-traumatic stress disorder. The prevalence of post-traumatic stress disorder among HIV positive individuals was high. The researchers highly recommend the integration of psychiatric services to HIV clinics and develop guidelines to screen and treat PTSD among HIV patients. Further research on risk factors of PTSD and longitudinal studies should be conducted to strengthen and broaden the current findings.
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Affiliation(s)
- Bereket Duko
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia.
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
| | - Alemayehu Toma
- Faculty of Medical Sciences, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia
| | - Yacob Abraham
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, P. O. Box 1560, Hawassa, Ethiopia
| | - Paul Kebble
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
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Mughal AY, Devadas J, Ardman E, Levis B, Go VF, Gaynes BN. A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries. BMC Psychiatry 2020; 20:338. [PMID: 32605551 PMCID: PMC7325104 DOI: 10.1186/s12888-020-02753-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 06/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs). Screening has been proposed to improve identification and management of these disorders, but little is known about the validity of screening tools for these disorders. We conducted a systematic review of validated screening tools for detecting anxiety and PTSD in LMICs. METHODS MEDLINE, EMBASE, Global Health and PsychINFO were searched (inception-April 22, 2020). Eligible studies (1) screened for anxiety disorders and/or PTSD; (2) reported sensitivity and specificity for a given cut-off value; (3) were conducted in LMICs; and (4) compared screening results to diagnostic classifications based on a reference standard. Screening tool, cut-off, disorder, region, country, and clinical population were extracted for each study, and we assessed study quality. Accuracy results were organized based on screening tool, cut-off, and specific disorder. Accuracy estimates for the same cut-off for the same screening tool and disorder were combined via meta-analysis. RESULTS Of 6322 unique citations identified, 58 articles including 77 screening tools were included. There were 46, 19 and 12 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (35). Regionally, South Asia (11) had the most validations, followed by South Africa (10) and West Asia (9). The Kessler-10 (7) and the Generalized Anxiety Disorder-7 item scale (GAD-7) (6) were the most commonly validated tools for anxiety disorders, while the Harvard Trauma Questionnaire (3) and Posttraumatic Diagnostic Scale (3) were the most commonly validated tools for PTSD. Most studies (29) had the lowest quality rating (unblinded). Due to incomplete reporting, we could meta-analyze results from only two studies, which involved the GAD-7 (cut-off ≥10, pooled sensitivity = 76%, pooled specificity = 64%). CONCLUSION Use of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations. However, many have been validated in inadequately designed studies, precluding any general recommendation for specific tools in LMICs. Locally validated screening tools for anxiety and PTSD need further evaluation in well-designed studies to assess whether they can improve the detection and management of these common disorders. TRIAL REGISTRATION PROSPERO registry number CRD42019121794 .
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Affiliation(s)
- Anisa Y. Mughal
- The University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA
| | - Jackson Devadas
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - Eric Ardman
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136 USA
| | - Brooke Levis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2 Canada
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG UK
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Dr, Chapel Hill, NC 27514 USA
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Spies JP, Woud ML, Kessler H, Rau H, Willmund GD, Köhler K, Herpertz S, Blackwell SE, Bovin M, Marx BP, Cwik JC. Psychometric properties of the German version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in clinical routine settings: study design and protocol of a multitrait-multimethod study. BMJ Open 2020; 10:e036078. [PMID: 32571861 PMCID: PMC7311000 DOI: 10.1136/bmjopen-2019-036078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/08/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The aim of this study is to investigate the diagnostic accuracy, psychometric properties and clinical utility of the German version of the Clinician-Administered Post-Traumatic Stress Disorder (PTSD) Scale for Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (CAPS-5) in routine clinical settings. METHODS AND ANALYSIS This study is a non-interventional, multitrait-multimethod design, multicentre study that will be carried out at German civil and military inpatient and outpatient clinics. A total sample size of n=219 participants who have experienced at least one traumatic event according to criteria as defined in the DSM-5 will be recruited. For the investigation of the diagnostic accuracy and clinical utility of the CAPS-5, participants will be categorised into one of three groups, depending on their traumatic experiences and post-traumatic symptomatology: (1) monotraumatisation with PTSD; (2) multiple traumatisation with PTSD and (3) traumatisation without PTSD. Interviews will be conducted face to face by interviewers in routine clinical settings. All participants will also be asked to complete a comprehensive set of questionnaires in order to investigate different facets of construct validity and clinical utility. First, differences between all three groups in CAPS-5 sum and subscale scores will be investigated. Test-retest reliability and inter-rater reliability will be determined. Internal consistency will be calculated using structural equation modeling (SEM) based internal consistency coefficients. Construct validity will be measured with Spearman's rank correlation analyses and multivariate analyses of variance with Holm-Bonferroni corrected post hoc analysis of variances. In order to test diagnostic accuracy, receiver operating characteristics and sensitivity and specificity analyses will be conducted. The model structure of the German CAPS-5 will be analysed using confirmatory factor analyses. ETHICS AND DISSEMINATION The study received ethical approval by the Ethics Committees of the Faculty of Psychology at the Ruhr-Universität Bochum (reference numbers: 331 and 358). The results of the study will be presented nationally and internationally at scientific conferences and will be published in scientific journals. TRIAL REGISTRATION NUMBER DRKS00015325.
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Affiliation(s)
- Jan-Peter Spies
- Clinical Psychology and Psychotherapy, Universität zu Köln, Köln, Germany
| | - Marcella Lydia Woud
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Heinrich Rau
- German Armed Forces Center for Military Mental Health, Berlin, Germany
| | | | - Kai Köhler
- German Armed Forces Center for Military Mental Health, Berlin, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Simon E Blackwell
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Michelle Bovin
- VA Boston Healthcare System, Massachusetts and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- VA Boston Healthcare System, Massachusetts and Boston University School of Medicine, Boston, Massachusetts, USA
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Abas MA, Weiss HA, Simms V, Verhey R, Rusakaniko S, Araya R, Chibanda D. The effect of co-morbid anxiety on remission from depression for people participating in a randomised controlled trial of the Friendship Bench intervention in Zimbabwe. EClinicalMedicine 2020; 23:100333. [PMID: 32637890 PMCID: PMC7329733 DOI: 10.1016/j.eclinm.2020.100333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a lack of data from low- and middle-income countries on whether anxiety independently predicts a more chronic course for depression. METHODS We undertook secondary data analysis of a cluster randomised controlled trial in Zimbabwe which had tested the effectiveness of the Friendship Bench intervention for common mental disorders compared to enhanced usual care. Inclusion for the current study was participants from the trial who had probable major depression at baseline, defined as scoring => 11 on the locally validated Patient Health Questionnaire (PHQ9). This emerged to be 354 of the original 573 (61.78%) of the original trial sample. Anxiety was measured using the locally validated cut-point on the Generalised Anxiety Disorder scale (GAD-7). Persistent depression was defined as scoring => 11 on the PHQ-9 at six-months follow-up. Analysis in Stata 15 used random-effects logistic regression to adjust for clustering by clinic. OUTCOMES Of the 354 participants who were eligible for treatment, 329 (92·9%) completed 6-month follow-up assessment. 37% of the trial sample had persistent depression at 6-months follow-up; 59% in the control arm and 17% in the intervention arm. Co-morbid anxiety present at trial baseline was independently associated with persistent depression after adjusting for age, gender and baseline depression severity (adjusted OR = 2·83, 95% CI 1·32-6·07). There was no evidence of effect modification by trial arm. Baseline depression severity also predicted persistent depression. Interpretation Treatment for depression in low and middle-income countries (LMIC) should be directed towards those with greatest need. This includes people with co-morbid anxiety and greater depression severity at initial assessment who are less likely to remit at six months. Advice on coping with anxiety, psychological treatments which target common anxiety symptoms such as fear, avoidance, excessive worry and intrusive thoughts, and Selective Serotonin Reuptake Inhibitors (SSRIs) should be made more widely available in LMIC and offered to those with persistent mixed depression and anxiety.
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Affiliation(s)
- Melanie Amna Abas
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
- Corresponding author at: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Simms
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Verhey
- Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Zimbabwe AIDS Prevention Project-University of Zimbabwe Department of Community Medicine, Harare, Zimbabwe
| | - Ricardo Araya
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Dixon Chibanda
- Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
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Linnemørken LTB, Granan LP, Reme SE. Prevalence of Posttraumatic Stress Symptoms and Associated Characteristics Among Patients With Chronic Pain Conditions in a Norwegian University Hospital Outpatient Pain Clinic. Front Psychol 2020; 11:749. [PMID: 32431641 PMCID: PMC7215085 DOI: 10.3389/fpsyg.2020.00749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Comorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders. Nevertheless, the co-occurrence of the two conditions is often overlooked in clinical settings. Further, little is known about how PTSD is associated with biopsychosocial characteristics in this patient group. The first objective was to assess the prevalence of posttraumatic stress symptoms (PTSS) in patients with chronic pain in a Norwegian university hospital outpatient pain clinic. The second objective was to investigate possible associations between PTSS and adverse outcomes such as pain intensity, disability, and distress. The third objective was to compare the PTSS prevalence rates between primary versus secondary pain conditions. Materials and methods Six hundred and ninety-two patients meeting for pain assessment completed self-report questionnaires about PTSS and possibly associated factors. The Life Events Checklist and the Stressful Life Events Screening Questionnaire were used to screen for potentially traumatic life events. The Impact of Events Scale - Revised and the PTSD Checklist for DSM-5 were used to assess PTSS. Differences between patients with and without severe PTSS on the possibly associated variables were analyzed by chi-squared-, and t-tests. Results 20.7% of the participants reported a level of PTSS qualifying for a PTSD diagnosis. These patients reported higher levels of pain intensity, pain bothersomeness, disability, and psychological distress, as well as lower levels of self-efficacy. They also reported higher levels of pain catastrophizing, perceived injustice, fatigue, and sleep difficulties. Finally, there was not a significant difference in prevalence rates between primary and secondary pain conditions. Discussion PTSS are frequent in patients with chronic pain, and a range of psychological characteristics is associated with a high level of such symptoms in this patient group. Patients with both conditions report a significantly higher symptom load, and the potential impact on the individual's life is major. In terms of pain condition, there were no differences in PTSS between primary pain conditions and secondary pain conditions in this pain population. This study emphasizes the importance of increased attention on PTSS when seeing patients with chronic pain conditions in clinical practice.
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Affiliation(s)
- Lene Therese Bergerud Linnemørken
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Granan
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Silje Endresen Reme
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Tang C, Goldsamt L, Meng J, Xiao X, Zhang L, Williams AB, Wang H. Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis. BMJ Open 2020; 10:e032435. [PMID: 32345695 PMCID: PMC7213849 DOI: 10.1136/bmjopen-2019-032435] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Although people living with HIV (PLWH) have been disproportionately affected by post-traumatic stress disorder (PTSD), the global prevalence of PTSD among PLWH is unknown. This study aimed to systematically review the prevalence of PTSD among PLWH worldwide and explore variation in prevalence across sociodemographic and methodological factors. DESIGN A meta-analysis using a random-effects model was conducted to pool the prevalence estimated from individual studies, and subgroup analyses were used to analyse heterogeneities. SETTING, PARTICIPANTS AND MEASURES Observational studies providing PTSD prevalence data in an adult HIV population were searched from January 2000 to November 2019. Measurements were not restricted, although the definition of PTSD had to align with the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases diagnostic criteria. RESULTS A total of 38 articles were included among 2406 records identified initially. The estimated global prevalence of PTSD in PLWH was 28% (95% CI 24% to 33%). Significant heterogeneity was detected in the proportion of PLWH who reported PTSD across studies, which was partially explained by geographic area, population group, measurement and sampling method (p<0.05). CONCLUSION PTSD among PLWH is common worldwide. This review highlights that PTSD should be routinely screened for and that more effective prevention strategies and treatment packages targeting PTSD are needed in PLWH.
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Affiliation(s)
- Chulei Tang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Lloyd Goldsamt
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Jingjing Meng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Xueling Xiao
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Li Zhang
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | | | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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Verhey R, Chibanda D, Vera A, Manda E, Brakarsh J, Seedat S. Perceptions of HIV-related trauma in people living with HIV in Zimbabwe's Friendship Bench Program: A qualitative analysis of counselors' and clients' experiences. Transcult Psychiatry 2020; 57:161-172. [PMID: 31180824 DOI: 10.1177/1363461519850337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study investigated the experience of lay health workers (LHWs) delivering problem-solving therapy (PST) for common mental disorders (CMD) as well as clients' views of the PST program referred to as the Friendship Bench (FB). Semi-structured interviews were conducted with LHWs (n = 5) and clients living with HIV (PLWH) (n = 10). Data were analyzed using thematic content analysis. LHWs described a severe form of CMD amongst PLWH with a history of trauma, naming it kufungisisa kwe njodzi (excessive thinking due to trauma), a local cultural equivalent of PTSD. The term kufungisisa (thinking too much) has been used as the local equivalent for CMD. Trauma or njodzi was seen both as a circumscribed event and as linked to ongoing pervasive experiences such as living with HIV, stigma, and poverty. Although LHWs recognized symptoms of PTSD such as intrusion, avoidance, and hyper-arousal, they did not know how to address these specifically and chose to address them as a severe form of kufungisisa. There is a need to integrate aspects of PTSD management within care packages for CMD delivered by LHWs.
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