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He Y, Wei Y, Wang Y, Liang F, Ma T. A cross-sectional study of non-suicidal self-injury in adolescent depression: association with demographic characteristics and physiological indicators. Front Psychiatry 2024; 15:1359400. [PMID: 39119074 PMCID: PMC11306130 DOI: 10.3389/fpsyt.2024.1359400] [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: 12/21/2023] [Accepted: 06/18/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Non-suicidal self-injury (NSSI) is a prevalent concern among adolescents with depression, yet its relationship with demographic characteristics and physiological indicators remains underexplored. This study aimed to investigate these relationships among inpatient adolescents aged 13 to 18 at a hospital affiliated with Guizhou Medical University. Methods A cross-sectional study was conducted involving 222 adolescent inpatients diagnosed with depression. Data on NSSI occurrence, demographic variables (gender, only-child status, age), and physiological indicators (ALT, TSH, FT4, PLR, TG, HDLC, LDLC, FT3, NLR, MLR) were collected and analyzed. Statistical analyses, including correlations and group comparisons, were performed to assess the associations between NSSI and these factors. Results The prevalence of NSSI among the participants was 40.5%. Significant correlations were found between NSSI and several demographic and physiological factors. Specifically, NSSI was significantly associated with female gender, non-only-child status, younger age, lower ALT levels, higher TSH levels, lower FT4 levels, and higher PLR values. However, no significant differences were observed in TG, HDLC, LDLC, FT3, NLR, or MLR between the NSSI and non-NSSI groups. Discussion The findings highlight distinct demographic and physiological profiles associated with NSSI among adolescents with depression. The prevalence rate of NSSI underscores its significance as a behavioral manifestation in this population. Further research should explore the underlying mechanisms linking these factors to better inform targeted interventions and treatment strategies for adolescents experiencing NSSI in the context of depression.
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Affiliation(s)
- Yangliuqing He
- Clinical Medicine College of Guizhou Medical University, Guiyang, China
| | - Yuhan Wei
- Clinical Medicine College of Guizhou Medical University, Guiyang, China
| | - Yiming Wang
- Clinical Medicine College of Guizhou Medical University, Guiyang, China
- Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Fenrong Liang
- Clinical Medicine College of Guizhou Medical University, Guiyang, China
| | - Tianpei Ma
- Clinical Medicine College of Guizhou Medical University, Guiyang, China
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Nabunya P, Byansi W, Muwanga J, Bahar OS, Namuwonge F, Ssentumbwe V, Ssewamala FM. Family Factors and Gender Norms as Protective Factors Against Sexual Risk-Taking Behaviors Among Adolescent Girls in Southern Uganda. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2024; 11:111-121. [PMID: 38859819 PMCID: PMC11164544 DOI: 10.1007/s40609-022-00237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 06/11/2024]
Abstract
Adolescent girls and young women are at a higher risk for HIV infection stemming from barriers to accessing comprehensive sexual health education, unequal cultural, social, and economic statuses, limited access to education and health care services, and gender-based violence. This makes adolescent girls susceptible to high-risk sexual behaviors. This study examines the protective role of family, social support factors and gender norms against sexual risk-taking behaviors among secondary school adolescent girls in Uganda. Baseline data from the National Institute of Mental Health-funded Suubi4Her study were analyzed. A total of 1260 girls aged 14-17 years and enrolled in the first or second year of secondary school were recruited across 47 secondary schools. Hierarchical linear regression models were conducted to determine the role of family, social support factors and gender norms on sexual risk-taking behaviors. Results indicate that traditional gender norms, family care and relationships, and social support were all associated with lower levels of sexual risk-taking intentions-a proxy for engaging in sexual risk behaviors. Findings point to the need to develop family level support interventions to equip adolescent girls with adequate sexual health-related knowledge and skills to facilitate safer sexual practices and reduce high-risk sexual-taking behaviors, as they develop and transition into young adulthood.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - William Byansi
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Joelynn Muwanga
- Department of Health and Human Services, New Hampshire, Division of Public Health, Littleton, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Fred M. Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis, Brown School, 1 Brookings Drive, St. Louis, MO 63130, USA
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Byansi W, Sensoy Bahar O, Small L, Namatovu P, Nabayinda J, Kiyingi J, Mwebembezi A, Nakigozi G, Hoagwood K, McKay MM, Ssewamala FM. The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016-2022). FAMILY PROCESS 2024. [PMID: 38761066 DOI: 10.1111/famp.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/29/2023] [Accepted: 04/22/2024] [Indexed: 05/20/2024]
Abstract
Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.
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Affiliation(s)
- William Byansi
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Latoya Small
- Luskin School of Public Affairs, University of California at Los Angeles, Los Angeles, California, USA
| | - Phionah Namatovu
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | | | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | - Kimberly Hoagwood
- Grossman School of Medicine, New York University, New York City, New York, USA
| | - Mary M McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Bahar OS, Byansi W, Nartey PB, Ibrahim A, Boateng A, Kumbelim K, Nabunya P, McKay MM, Ssewamala FM. Self-esteem and self-concept as correlates of life satisfaction and attitudes toward school among Ghanaian girls. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:185-191. [PMID: 38205871 PMCID: PMC11114458 DOI: 10.1111/jora.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024]
Abstract
During adolescence, youth experience several physical, psychosocial, and cognitive changes. Self-esteem and self-concept are identified as protective factors for adolescents in high-income countries, but studies are limited in sub-Saharan Africa. We examined the associations of self-esteem and self-concept with life satisfaction and attitudes toward school using baseline data from 97 Ghanaian adolescent girls at risk of school dropout. Ordinary Least Squares regression models were fitted to examine the association between self-esteem and self-concept on school attitudes and life satisfaction. Self-esteem was positively associated with life satisfaction. Self-concept was associated with more positive attitudes toward school. Hence, self-esteem and self-concept may be critical protective factors in promoting adolescent girls' life satisfaction and positive attitudes toward school.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - William Byansi
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, USA
| | | | | | - Alice Boateng
- Department of Social Work, University of Ghana, Accra, Ghana
| | | | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary M. McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Obeng-Okon NAS, Opoku DA, Ayisi-Boateng NK, Osarfo J, Amponsah OKO, Ashilevi J, Agyemang S, Bernard F, Addai-Manu H, Mohammed A. Prevalence and correlates of depression among students in a senior high school in Ghana: A school-based cross-sectional study. SAGE Open Med 2024; 12:20503121241229841. [PMID: 38347848 PMCID: PMC10860490 DOI: 10.1177/20503121241229841] [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: 08/09/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Objectives Depression is one of the most widely reported mental health issues that affect adolescents globally. However, there is a dearth of data on its prevalence and associated factors among senior high school students in Ghana, since previous studies have focused more on adult populations. This can hinder policies needed to champion mental health and mental health care in senior high schools. Hence, this study sought to assess the prevalence of depression and associated factors among senior high school students in Ghana. Methods An analytical cross-sectional study involving 289 students at the Manya Krobo Senior High School was conducted from December 2022 to February 2023. The students were selected using a two-stage random sampling method. A questionnaire was used to collect data on sociodemographics and individual characteristics. The primary outcome was depression, and this was assessed using the Patient Health Questionnaire-9. Summary statistics were presented as means, frequencies, and percentages. Multivariate logistic regression was used to identify factors associated with depression and odds ratios presented with 95% confidence intervals. Statistical significance was considered at p-value < 0.05. Results The mean age of the students was 16.6 (±1.2) with a range of 14-20 years. Over a quarter (26.3%) of the students reported financial difficulties. The prevalence of depression among the students was 68.9%. The factors associated with depression in this study were female sex (adjusted odds ratio: 1.74, 95% confidence interval: 1.01-2.97), age (adjusted odds ratio: 1.41, 95% confidence interval: 1.10-1.81), history of chronic health condition (adjusted odds ratio: 3.74, 95% confidence interval: 1.36-10.25), and financial difficulties (adjusted odds ratio: 2.31, 95% confidence interval: 1.15-4.63). Conclusion This study shows that depression is rife among students at the Manya Krobo Senior High School, Manya Krobo District, Ghana. These findings call for pragmatic interventions such as strengthening counseling units and professional mental health services to ameliorate the impact of depression on the lives of students.
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Affiliation(s)
| | - Douglas Aninng Opoku
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Allen Clinic, Family Healthcare Services, Kumasi, Ghana
| | - Nana Kwame Ayisi-Boateng
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Osarfo
- Department of Community Health, School of Medicine, University of Health and Allied Health Science, Ho, Ghana
| | - Obed Kwabena Offe Amponsah
- Faculty of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Frempong Bernard
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Helena Addai-Manu
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aliyu Mohammed
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Kim AW, Rieder AD, Cooper-Vince CE, Kakuhikire B, Baguma C, Satinsky EN, Perkins JM, Kiconco A, Namara EB, Rasmussen JD, Ashaba S, Bangsberg DR, Tsai AC, Puffer ES. Maternal adverse childhood experiences, child mental health, and the mediating effect of maternal depression: A cross-sectional, population-based study in rural, southwestern Uganda. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:19-31. [PMID: 37212482 PMCID: PMC10524293 DOI: 10.1002/ajpa.24758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/09/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health. METHODS Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis. RESULTS Among 218 mother-child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership. CONCLUSIONS Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, California, USA
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amber D Rieder
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Jessica M Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute of Global Health, Nashville, Tennessee, USA
| | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, North Carolina, USA
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Byansi W, Galvin M, Chiwaye L, Luvuno Z, Kim AW, Sundararajan R, Tsai AC, Moolla A. Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis. BMC Psychiatry 2023; 23:581. [PMID: 37563695 PMCID: PMC10413614 DOI: 10.1186/s12888-023-05085-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Adverse childhood experiences and adult trauma, including sexual abuse, physical abuse, neglect, and interpersonal violence, are highly prevalent in low-resource settings and associated with adverse psychological outcomes. However, there is limited focus on the impact of ACEs and trauma on mental health in sub-Saharan Africa. Therefore, this study examines the impact of traumatic events and ACEs on depression, anxiety, and stress scores among outpatients receiving psychiatric care at two public mental health treatment facilities in Johannesburg, South Africa. METHODS A sample of 309 participants were recruited between January and June 2022 at Helen Joseph Hospital and Alexandra 18th Avenue Clinic. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 7-item General Anxiety Disorder scale (GAD-7) and the 10-item Perceived Stress Scale. We fitted modified Poisson and linear regression models to estimate the impact of ACEs and adult experiences of trauma on depression, anxiety, and stress scale scores. RESULTS 47.57% (n = 147) of participants screened positive for anxiety, 44.66% (n = 138) for depression, and 17% (n = 54) for severe stress. More females screened positive for anxiety (65.31%), depression (65.94%), and stress (77.78%). Each ACE was associated with a 12% increased risk of depression, a 10% increased risk of anxiety, and a 17% increased risk of stress. In separately estimated models, each additional traumatic event during adulthood was associated with a 16% increased risk for depression, an 8% increased risk of anxiety, and a 26% increased risk of stress. Across all models, being male and self-reported physical health were consistently associated with a reduced risk for depression, anxiety, and stress. CONCLUSIONS ACEs and experiences of traumatic events as adults were associated with significantly increased risks of anxiety, depression, and severe stress. Given high exposure to ACEs and trauma and the associated impact on the mental health of individuals, families, and communities, there is a need to strengthen and scale innovative combination interventions that address multiple stressors impacting people in low-resource settings.
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Affiliation(s)
- William Byansi
- School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Michael Galvin
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Chiwaye
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Zoleka Luvuno
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew W Kim
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anthropology, University of California, Berkeley, United States
| | - Radhika Sundararajan
- Weill Cornell Center for Global Health, New York City, New York, United States
- Department of Emergency Medicine, Weill Cornell Medicine, New York City, New York, United States
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aneesa Moolla
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
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Zhong Y, Huang X, Chen J, Li Y, Li Y, Chen R, Cong E, Xu Y. The role of only-child status in the effect of childhood trauma and parental rearing style on depressive symptoms in Shanghai adolescents. Front Psychiatry 2023; 14:1196569. [PMID: 37415684 PMCID: PMC10320292 DOI: 10.3389/fpsyt.2023.1196569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction After decades of the one-child policy, China changed its rules to allow two children in 2016, which altered family dynamics. Few studies have examined the emotional problems and the family environment of multi-child adolescents. This study aims to explore the role of only-child status in the impact of childhood trauma and parental rearing style on depressive symptoms of adolescents in Shanghai, China. Methods A cross-sectional study was conducted on 4,576 adolescents (M = 13.42 years, SD = 1.21) from seven middle schools in Shanghai, China. Childhood Trauma Questionnaire-Short Form, the Short Egna Minnen Beträffande Uppfostran, and Children's Depression Inventory were used to evaluate childhood trauma, perceived parental rearing style, and depressive symptoms of adolescents, respectively. Results Results showed that girls and non-only children reported more depressive symptoms, while boys and non-only children perceived more childhood trauma and negative rearing styles. Emotional abuse, emotional neglect, and father's emotional warmth significantly predicted depressive symptoms in both only children and non-only children. Father's rejection and mother's overprotection were related to adolescents' depressive symptoms in only-child families, but not non-only child families. Discussion Therefore, depressive symptoms, childhood trauma, and perceived negative rearing styles were more prevalent among adolescents in non-only child families, while negative rearing styles were especially associated with depressive symptoms in only children. These findings suggest that parents pay attention to their impacts on only children and give more emotional care to non-only children.
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Affiliation(s)
- Yingyan Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinxin Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianhua Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuting Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rumeng Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enzhao Cong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yifeng Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Filiatreau LM, Tutlam N, Brathwaite R, Byansi W, Namuwonge F, Mwebembezi A, Sensoy-Bahar O, Nabunya P, Neilands TB, Cavazos-Rehg P, McKay M, Ssewamala FM. Effects of a Combination Economic Empowerment and Family Strengthening Intervention on Psychosocial Well-being Among Ugandan Adolescent Girls and Young Women: Analysis of a Cluster Randomized Controlled Trial (Suubi4Her). J Adolesc Health 2023; 72:S33-S40. [PMID: 37062582 PMCID: PMC10157657 DOI: 10.1016/j.jadohealth.2022.11.250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/15/2022] [Accepted: 11/08/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Economic empowerment and family strengthening interventions have shown promise for improving psychosocial well-being in a range of populations. This study investigates the effect of a combination economic and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls and young women (AGYW). METHODS We harnessed data from a three-arm cluster randomized controlled trial among AGYW aged 14-17 years in 47 Ugandan secondary schools. Schools were randomized to either a youth development account intervention (YDA) [N = 16 schools], YDA plus a multiple family group intervention (YDA + MFG) [N = 15 schools], or bolstered standard of care (BSOC) [N = 16 schools]. We estimated the effect of each intervention (BSOC = referent) on three measures of psychosocial well-being: hopelessness (Beck's Hopelessness Scale), self-concept (Tennessee Self-Concept Scale), and self-esteem (Rosenberg Self-Esteem Scale) at 12 months following enrollment using multi-level linear mixed models for each outcome. RESULTS A total of 1,260 AGYW (mean age, 15.4) were enrolled-471 assigned to YDA (37%), 381 to YDA + MFG (30%), and 408 to usual care (32%). Over the 12-month follow-up, participants assigned to the YDA + MFG group had significantly greater reductions in hopelessness and improvements in self-esteem outcomes compared to BSOC participants. Those enrolled in the YDA arm alone also had significantly greater reductions in hopelessness compared to BSOC participants. DISCUSSION Combination interventions, combining economic empowerment (represented here by YDA), and family-strengthening (represented by MFG) can improve the psychosocial well-being of AGYW. The long-term effects of these interventions should be further tested for potential scale-up in an effort to address the persistent mental health treatment gap in resource-constrained settings.
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Affiliation(s)
- Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Nhial Tutlam
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - William Byansi
- Boston College School of Social Work, Chestnut Hill, Massachusetts
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | | | - Ozge Sensoy-Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Mary McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri.
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Ssewamala FM, Brathwaite R, Sensoy Bahar O, Namatovu P, Neilands TB, Kiyingi J, Huang KY, McKay MM. The Post-intervention Impact of Amaka Amasanyufu on Behavioral and Mental Health Functioning of Children and Adolescents in Low-Resource Communities in Uganda: Analysis of a Cluster-Randomized Trial From the SMART Africa-Uganda Study (2016-2022). J Adolesc Health 2023; 72:S3-S10. [PMID: 37062581 PMCID: PMC10442860 DOI: 10.1016/j.jadohealth.2022.09.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Disruptive behavioral disorders (DBDs) are common among children/adolescents in sub-Saharan Africa. A 16-week manualized multiple family group (MFG) intervention called Amaka Amasanyufu designed to reduce DBDs among school-going children/adolescents in low-resource communities in Uganda was efficacious in reducing symptoms of poor mental health relative to usual care in the short-term (4 months post-intervention-initiation). We examined whether intervention effects are sustained 6 months postintervention. METHODS We used longitudinal data from 636 children positive for DBDs: (1) Control condition, 10 schools, n = 243; (2) MFG delivered via parent peers (MFG-PP), eight schools, n = 194 and; (3) MFG delivered via community healthcare workers (MFG-CHW), eight schools, n = 199 from the SMART Africa-Uganda study (2016-2022). All participants were blinded. We estimated three-level linear mixed-effects models and pairwise comparisons at 6 months postintervention and time-within-group effects to evaluate the impact on Oppositional Defiant Disorder (ODD), impaired functioning, depressive symptoms, and self-concept. RESULTS At 6 months postintervention, children in MFG-PP and MFG-CHW groups had significantly lower means for ODD (mean difference [MD] = -1.08 and -1.35) impaired functioning (MD = -1.19 and -1.16), and depressive symptoms (MD = -1.06 and -0.83), than controls and higher means for self-concept (MD = 3.81 and 5.14). Most outcomes improved at 6 months compared to baseline. There were no differences between the two intervention groups. DISCUSSION The Amaka Amasanyufu intervention had sustained effects in reducing ODD, impaired functioning, and depressive symptoms and improving self-concept relative to usual care at 6 months postintervention. Our findings strengthen the evidence that the intervention effectively reduces DBDs and impaired functioning among young people in resource-limited settings and was sustained over time.
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Affiliation(s)
- Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri; Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri; Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri; Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Phionah Namatovu
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri; International Center for Child Health and Development - Uganda Field Office, Masaka, Uganda
| | - Torsten B Neilands
- Division of Prevention Science, University of California, San Francisco, California
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Keng-Yen Huang
- Department of Child and Adolescent Psychiatry, and Department of Population Health, New York University School of Medicine, New York, New York
| | - Mary M McKay
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, Missouri; Brown School, Washington University in St. Louis, St. Louis, Missouri
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Nabayinda J, Kizito S, Ssentumbwe V, Namatovu P, Sensoy Bahar O, Damulira C, Nabunya P, Kiyingi J, Namuwonge F, Mwebembezi A, McKay MM, Ssewamala FM. The Relationship Between Family Cohesion and Depression Among School-Going Children With Elevated Symptoms of Behavioral Challenges in Southern Uganda. J Adolesc Health 2023; 72:S11-S17. [PMID: 37062578 PMCID: PMC10161871 DOI: 10.1016/j.jadohealth.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Depression is among the leading causes of disability and contributes significantly to the overall disease burden affecting children. Family cohesion has been identified as a protective factor against depression. Examining this relationship is necessary in sub-Saharan Africa, specifically in Uganda-a country characterized by a high prevalence of HIV/AIDS, and high rates of chronic poverty, all of which stress family functioning and elevate child behavioral challenges. This study examined the relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in southern Uganda. METHODS At baseline, 2089 children were enrolled in the National Institutes of Health-funded Strengthening Mental Health and Research Training Africa study in Southwestern Uganda. This article analyzed data from 626 children aged 8-13 years with elevated behavioral challenges. We conducted multilevel mixed-effects Poisson regression to determine the association between family cohesion and depression. We controlled for sociodemographic and household characteristics. RESULTS The mean age was 10.3 years. The overall mean depression score was 3.2 (standard deviation = 2.7, range = 0-15). Family cohesion (β = -0.03, 95% confidence interval [CI]: -0.04, -0.02, p < .001) and owning essential items by the child (β = -0.13, 95% CI: -0.23, -0.04, p = .005) were protective against depression among children. Additionally, we observed being a single orphan (β = -0.44, 95% CI: -0.03, -0.86, p = .036) and having both parents (β = -0.43, 95% CI: -0.06, -0.81, p = .023) were associated with depression among children. DISCUSSION Findings from this study reveal that family cohesion was protective against depression. Therefore, it is vital to strengthen family support systems by developing programs aimed at strengthening family relationships as a catalyst for addressing depression among children.
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Affiliation(s)
| | - Samuel Kizito
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Vicent Ssentumbwe
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Phionah Namatovu
- International Centre for Child Health and Development, Masaka Field Office, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | | | - Proscovia Nabunya
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Joshua Kiyingi
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Centre for Child Health and Development, Masaka Field Office, Masaka, Uganda
| | | | - Mary M McKay
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- Brown School Washington University in St. Louis, St. Louis, Missouri.
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Anyanwu MU. Psychological distress in adolescents: prevalence and its relation to high-risk behaviors among secondary school students in Mbarara Municipality, Uganda. BMC Psychol 2023; 11:5. [PMID: 36624544 PMCID: PMC9830719 DOI: 10.1186/s40359-023-01039-z] [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: 09/03/2021] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Psychological distress among adolescents negatively affects their academic performance, relationships with family and friends, and ability to participate fully in the community. Stressful life events in low-income countries and risk-taking behavior of adolescents have raised concerns regarding the impact of psychological distress among adolescents. Therefore, the present study estimated the prevalence of psychological distress and examined the high-risk behaviors associated with psychological distress among Ugandan adolescents. METHODS A community based cross-sectional study was conducted among secondary school students in Mbarara Municipality, Uganda. Multistage cluster sampling was used to recruit 921 adolescents from 12 schools. Psychological distress was assessed using the 10-item Kessler Psychological Distress Scale (K10). Logistic regression was used with p-value estimating regression coefficient and 95% confidence interval for odds ratio and adjusted odds ratio (AOR). RESULTS The prevalence of psychological distress using the K10 was 57%. Logistic regression analyses showed that risky sexual behavior [AOR = 1.52; 95% confidence interval (CI) 1.02-2.28], substance use (AOR = 2.06; 95% CI 1.49-2.84) were associated with psychological distress. Students in mixed schools (comprising both sexes) (AOR = 1.94; 95% CI 1.19-3.15) and adolescents with chronic illness (AOR = 1.68; 95% CI 1.18-2.38) were more likely to report psychological distress. CONCLUSION The prevalence of psychological distress among school-going adolescents is high. Risky sexual behavior, substance use as well as chronic illness were associated with psychological distress. In addition, the type of school was significantly associated with psychological distress. The findings suggest the need for policy makers and stakeholders in health and education sectors to institute measures that will address mental health issues among adolescents.
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Affiliation(s)
- Michael U. Anyanwu
- grid.33440.300000 0001 0232 6272Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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14
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Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One 2022; 17:e0276552. [PMID: 36264962 PMCID: PMC9584512 DOI: 10.1371/journal.pone.0276552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
- African Centre for Suicide Prevention and Research, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, Forensic Psychiatry Program, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Sarah Maria Najjuka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
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Byansi W, Ssewamala FM, Neilands TB, Bahar OS, Nabunya P, Namuwonge F, McKay MM. The Short-Term Impact of a Combination Intervention on Depressive Symptoms Among School-Going Adolescent Girls in Southwestern Uganda: The Suubi4Her Cluster Randomized Trial. J Adolesc Health 2022; 71:301-307. [PMID: 35660128 PMCID: PMC9771640 DOI: 10.1016/j.jadohealth.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to examine the short-term impact of a combined intervention consisting of evidence-based family economic empowerment (FEE) and multiple family group (MFG) interventions on depressive symptoms among school-going adolescent girls in southwestern Uganda. METHODS We analyzed longitudinal data from a cluster randomized trial. The sample consisted of 1,260 adolescent girls (aged 14-17 years at enrollment) recruited from senior one and senior two classes across 47 secondary schools in the southwestern region of Uganda. Participants were randomized at the school level to either the control condition receiving bolstered standard of care or one of the two treatment conditions-the treatment one condition receiving the FEE intervention or the treatment two conditions receiving both the FEE plus MFG interventions. Descriptive statistics and a three-level mixed-effects model were conducted to examine the effect of a combination intervention on depressive symptoms. RESULTS At baseline, there were no significant differences between the control condition and both treatment conditions. While all three groups experienced a substantial reduction in depressive symptoms from baseline to 12 months, the reductions were stronger for the two intervention groups. However, FEE + MFG was not significantly different from FEE at 12 months. DISCUSSION Results imply that the FEE intervention may be a promising tool in addressing depressive symptoms among adolescent girls. Therefore, to reduce the long-term implications of adverse psychosocial health during adolescence, policymakers and program implementers should explore scaling up economic empowerment interventions in similar settings to bridge the mental health treatment gap for adolescent girls.
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Affiliation(s)
- William Byansi
- Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B. Neilands
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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Mugisha J, Van Damme T, Vancampfort D. Associations between mild depression and anxiety and physical inactivity among school-going Ugandan adolescents aged 14 to 17 years. J Child Adolesc Ment Health 2022; 34:115-125. [PMID: 38632955 DOI: 10.2989/17280583.2023.2288969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Objective: The aim of this cross-sectional study was to investigate associations between physical activity levels and emotional and behavioural problems in school-going adolescents aged 14 to 17 years in Uganda.Methods: Two-hundred and five adolescents [median (interquartile range) age = 16.0 (1.0) years; female = 61.9%] completed the interviewer-administered Strengths and Difficulties Questionnaire (SDQ), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 questionnaire (GAD-7), and the Physical Activity Vital Sign (PAVS) measure. Spearman's rho correlations and Mann-Whitney U-tests were applied.Results: Among 205 adolescents, 97.1% were physically inactive (PAVS < 420min/week), while 64.4% reported either mild depressive (PHQ-9 ≥ 5) or anxiety (GAD-7 ≥ 5) symptoms. Higher PAVS scores correlated significantly with lower SDQ emotional problems (ρ = -0.23, p < 0.001), lower PHQ-9 (ρ = -0.26, p < 0.001), and lower GAD-7 (ρ = -0.22, p < 0.001) scores. Those with emotional problems (SDQ ≥ 5) (n = 86) were significantly less physically active than those without (n = 119) [30.0 (62.5) versus 60.0 (105.0) min/week, p < 0.001]. Those with depressive symptoms (PHQ-9 ≥ 5) were significantly less physically active than those without [35.0 (70.0) versus 60.0 (120.0) min/week, p < 0.001].Conclusion: Physical inactivity and mental health problems are related important public health concerns in school-going adolescents in low-income countries such as Uganda. The efficacy and effectiveness of school-based mental health literacy programs, including physical activity promotion, should be explored in these low-resource settings.
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Affiliation(s)
- James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
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Velloza J, Hosek S, Donnell D, Anderson PL, Chirenje M, Mgodi N, Bekker L, Delany‐Moretlwe S, Celum C. Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre-exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial. J Int AIDS Soc 2021; 24 Suppl 2:e25731. [PMID: 34164929 PMCID: PMC8222844 DOI: 10.1002/jia2.25731] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION African adolescent girls and young women (AGYW) eligible for HIV pre-exposure prophylaxis (PrEP) experience high levels of depressive symptoms. Depression can reduce PrEP adherence among adults, although analyses have considered depression as a time-varying exposure rather than modelling distinct patterns of symptoms. The association between depressive symptoms and PrEP adherence has not been explored for AGYW. To address these gaps, we sought to understand depressive symptom trajectories among African AGYW initiating PrEP and the impact of time-varying depressive symptoms and symptom trajectories on PrEP adherence. METHODS HPTN 082 was an open-label PrEP study among AGYW (ages 16 to 24) in Zimbabwe and South Africa from 2016 to 2018. Depressive symptoms were measured at enrolment and Weeks 13, 26 and 52, using the 10-item Center for Epidemiologic Studies scale; a score ≥10 is indicative of elevated depressive symptoms. PrEP adherence was defined as any detectable tenofovir diphosphate (TFV-DP) levels. Group-based trajectory modelling was used to model longitudinal patterns of depressive symptoms. We assessed psychosocial and behavioural predictors of depressive symptom trajectory membership (e.g. PrEP stigma, intimate partner violence [IPV], sexual behaviour). We modelled associations between (1) group trajectory membership and PrEP adherence at Week 52 and (2) time-varying depressive symptoms and PrEP adherence through follow-up. RESULTS At enrolment, 179 (41.9%) participants had elevated depressive symptoms. Group-based trajectory models revealed persistent elevated depressive symptoms in 48.5%, declining symptoms in 9.4% and no consistent or mild depressive symptoms in 43.3%. AGYW who engaged in transactional sex, reported IPV, or had traumatic stress symptoms were more likely to be assigned to the persistent elevated symptom group compared with the consistent no/mild symptom group (Wald test p-value all <0.01). Participants assigned to the persistent elevated depressive symptom trajectory had a significantly lower risk of detectable TFV-DP at Week 52 than those in the no/mild symptom trajectory (adjusted prevalence ratio = 0.89; 95% CI: 0.80 to 0.98). Elevated depressive symptoms were significantly inversely associated with PrEP use throughout follow-up (adjusted relative risk = 0.73; 95% CI = 0.53 to 0.99). CONCLUSIONS Persistent depressive symptoms were common among African AGYW seeking PrEP. Integration of depressive symptom screening and treatment into PrEP programmes may improve PrEP effectiveness among African women.
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Affiliation(s)
| | - Sybil Hosek
- Stroger Hospital of Cook CountyDepartment of PsychiatryChicagoILUSA
| | - Deborah Donnell
- University of WashingtonDepartment of Global HealthSeattleWAUSA
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Peter L Anderson
- Department of Pharmaceutical SciencesUniversity of ColoradoAuroraCOUSA
| | - Mike Chirenje
- University of Zimbabwe College of Health Sciences Clinical Trials Research CentreHarareZimbabwe
| | - Nyaradzo Mgodi
- University of Zimbabwe College of Health Sciences Clinical Trials Research CentreHarareZimbabwe
| | - Linda‐Gail Bekker
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Sinead Delany‐Moretlwe
- Wits Reproductive Health & HIV Institute (Wits RHI)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Connie Celum
- University of WashingtonDepartment of Global HealthSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
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