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Jidong DE, Ike TJ, Murshed M, Francis C, Mwankon SB, Jidong JE, Pwajok JY, Nyam PP, Husain N. Postnatal depression in British mothers of African and Caribbean origin: a randomised controlled trial of learning through play plus culturally adapted cognitive behaviour therapy compared with psychoeducation. Front Psychiatry 2024; 15:1383990. [PMID: 38606412 PMCID: PMC11007128 DOI: 10.3389/fpsyt.2024.1383990] [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: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Background One in every three women worldwide experiences postnatal depression after childbirth, with long-term negative consequences on their children. The mainstream mental healthcare provision for British mothers of African/Caribbean origin is mostly unsuccessful due to a lack of culturally appropriate care. Methods The study adopts a mixed-methods randomised controlled trial (RCT) design. A 12-session (60 minutes each) of online Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) intervention was employed for treating postnatal depression in comparison with psychoeducation (PE). Participants aged 19-53 were screened for depression using the Patient Health Questionnaire (PHQ-9). N=130 participants who scored >5 on PHQ-9 were randomised into LTP+CaCBT (n=65) or PE (n=65) groups. N=12 focus groups (LTP+CaCBT, n=6; PE, n=6) and n=15 individual interviews (LTP+CaCBT, n=8; PE, n=7) were conducted, transcribed verbatim and analysed. Results Satisfaction with intervention (LTP+CaCBT, 72.9%; PE, 65.2%); retention rates (LTP+CaCBT, 91%; PE, 71%); reduction in postnatal depression was higher in LTP+CaCBT on PHQ-9 Md=1.00 with z= -4.046; compared to PE, Md=1.00 with z= -1.504. Both groups showed reduced levels of anxiety on GAD-7 with no significant difference. Emerging themes from the qualitative findings showed increased positive moods, reduced worries about parenting difficulties and the facilitative role of remote intervention. Conclusions LTP+CaCBT intervention is culturally appropriate and acceptable and reduces postnatal depression in British mothers of African/Caribbean origin. A fully powered RCT is recommended to evaluate the clinical and cost-effectiveness of LTP+CaCBT, including the child's outcomes compared with routine treatment as usual. Clinical trial registration www.ClinicalTrials.gov, identifier NCT04820920.
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Affiliation(s)
- Dung Ezekiel Jidong
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Tarela Juliet Ike
- School of Social Science, Humanity and Law (SSSHL), Department of Humanities and Social Sciences, Teesside University, Middlesbrough, United Kingdom
| | | | | | | | | | | | | | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
- Mersey Care National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
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Jidong DE, Ike TJ, Murshed M, Nyam PP, Husain N, Jidong JE, Pwajok JY, Francis C, Mwankon SB, Okoli E. Interventions for Self-Harm and Suicidal Ideation in Africa: A Systematic Review. Arch Suicide Res 2024:1-25. [PMID: 38506246 DOI: 10.1080/13811118.2024.2316168] [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: 03/21/2024]
Abstract
BACKGROUND Self-harm and suicidal ideation are increasing public health concerns globally and are paramount in Africa. Therefore, a review of suicidal ideation and self-harm interventions would be beneficial in identifying culturally appropriate interventions for the African context. METHOD The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy. Thus, the Population (Africans), phenomenon of Interest (intervention) and Context (self-harm and suicidal ideation). We used this PICo strategy which is a modified version of PICO for qualitative studies. Framework with Boolean operators (AND/OR/NOT) was further used to ensure rigor through search terms such as ("Suicide" OR "suicidal ideation") AND ("Intervention" OR "Treatment" OR "Therapy" OR "Psychological" OR "Psychosocial" OR "Culturally adapted") AND "Africa" OR "African countries." Six databases were searched (Embase, PsycINFO, ProQuest Central, Cochrane Controlled Trials Register, Medline, and Web of Science) for published articles between 2000 and March 2023. N = 12 studies met the inclusion criteria, and the relevant data extracted were synthesized and thematically analyzed. The review protocol was pre-registered on the PROSPERO Registry (no. CRD42021283795). RESULTS N = 12 studies met the inclusion criteria, and the following themes emerged from the synthesized literature and analyses of current African approaches to curbing self-harm and suicidal ideation: (a) Western medical and compassion-focused intervention (b) the helpful role of traditional healing and healers (c) psychoeducation and self-help techniques (d) use of technology and a nation-wide approach. CONCLUSION Self-harm and suicidal ideation are global health concerns. To address this health concern in Africa, the authors recommend culturally adapted psychological interventions to be tested via randomized control trials.
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Jidong DE, Ike TJ, Husain N, Francis C, Husain MO, Mwankon SB, Murshed M, Jidong JE, Jack DB, Nyam PP, Bassett P, Pwajok JY, Taru MY, Nwoga CN. Perspectives on Self-Harm and Suicidal Ideation in Nigeria: A Mixed-Methods Study of Patients, Family Caregivers, Clinicians, and the Public. Arch Suicide Res 2024:1-15. [PMID: 38363148 DOI: 10.1080/13811118.2024.2314520] [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: 02/17/2024]
Abstract
BACKGROUND Suicide and self-harm are global disease burden that contributes significantly to years of lost life and mortality. Despite the increasing rates of suicide and self-harm in Nigeria, this topic is understudied. METHODS A mixed-methods design was adopted. Study 1 interviewed n = 18 participants (n = 11 clinicians; n = 5 patients with a history of self-harm and suicide ideation; and n = 2 caregivers). All interviews were audio-recorded, transcribed verbatim, and analyzed using IPA. Study 2 surveyed n = 562 non-clinical sample about their tolerance toward self-harm and the data was analyzed using One-way ANOVA in SPSS. RESULTS Study 1 qualitative findings showed substance use, perceived rejection and social isolation were considered predisposing factors for suicide and self-harm. Cultural and religious beliefs shaped help-seeking behaviours. Although Study 2 found no significant differences in demographic characteristics concerning public tolerance toward persons with a history of self-harm, 64% believed that individuals who died by suicide would face punishment after death; 51% believed that victims of attempted suicide are a source of shame to their families; and 33.8% agreed that dying by suicide is the correct behaviour. CONCLUSIONS Patients with a history of self-harm and suicidal ideation consider family members and close friends as valuable sources of support. Due to the potential clinical implication of cultural and religious beliefs, as shown in the present study's findings, the authors recommend a co-development of culturally appropriate psychological intervention for persons with a history of self-harm and suicidal ideation to be tested in randomized control trials.
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Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. EClinicalMedicine 2024; 67:102264. [PMID: 38314056 PMCID: PMC10837549 DOI: 10.1016/j.eclinm.2023.102264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.
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Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Allotey
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- BIREME, Evidence and Intelligence for Action in Health Department, Pan America Health Organization/World Health Organization, São Paulo, Brazil
| | - Inderjeet Kaur
- Fernandez Hospital Educational & Research Foundation, Hyderabad, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Birmingham Women’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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Barrett S, Muir C, Burns S, Adjei N, Forman J, Hackett S, Hirve R, Kaner E, Lynch R, Taylor-Robinson D, Wolfe I, McGovern R. Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping. TRAUMA, VIOLENCE & ABUSE 2024; 25:393-412. [PMID: 36789663 PMCID: PMC10666514 DOI: 10.1177/15248380231153867] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face. AIMS AND METHODS Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified. RESULTS Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity. CONCLUSION Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.
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Nelson T, Tomi CL, Gebretensay SB. (Re)Framing Strength: How Superwoman Schema May Impact Perinatal Anxiety and Depression among African American Women. Womens Health Issues 2023; 33:568-572. [PMID: 37316335 DOI: 10.1016/j.whi.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Tamara Nelson
- Department of Psychology, Rutgers University, Camden, New Jersey.
| | - Cecelela L Tomi
- Department of Childhood Studies, Rutgers University, Camden, New Jersey
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Husain N, Lunat F, Lovell K, Sharma D, Zaidi N, Bokhari A, Syed A, Tomenson B, Islam A, Chaudhry N, Waheed W. Exploratory RCT of a group psychological intervention for postnatal depression in British mothers of South Asian origin - ROSHNI-D. Acta Psychol (Amst) 2023; 238:103974. [PMID: 37413896 PMCID: PMC10415672 DOI: 10.1016/j.actpsy.2023.103974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a global public health problem. There is a high prevalence of PND amongst ethnic minority women and major ethnic inequalities in mental health care in the U.K. Language and cultural barriers pose a significant challenge for access to timely treatment and interventions for British South Asian (BSA) women with PND. METHODS The study, carried out in Manchester and Lancashire, England, was a two-arm single-blind exploratory randomised controlled trial. BSA women (N = 83) having a baby <12 months were randomised either to the group receiving the culturally adapted Positive Health Programme (PHP) (n = 42) or to the group receiving treatment as usual (TAU) (n = 41). Follow-up assessments were at 3 months (end of intervention) and 6 months after randomisation. RESULTS Using an intention to treat analysis, there was no significant difference between PHP intervention and TAU groups in depression measured using Hamilton Depression Rating Scale both at 3 and 6 months follow up. Using modified intention to treat analysis, women who attended four or more sessions showed significant reduction in depression in the PHP group compared to the TAU group and the greater number of sessions attended was associated with greater reductions in depression scores. LIMITATIONS The sample was relatively small and the study was conducted in one geographical area in Northwest England; hence, these results may not be generalizable to other regions and populations. CONCLUSION The recruitment and trial retention figures highlighted the ability of the research team to engage with BSA women, having implications in planning services for this group. TRIAL REGISTRATION Clinicaltrials.govNCT01838889.
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Affiliation(s)
- Nusrat Husain
- The University of Manchester, Jean Mcfarlane Building, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Farah Lunat
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Lantern Centre, Vicarage Lane, Fulwood PR2 5NT, United Kingdom.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Deepali Sharma
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Nosheen Zaidi
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Asad Bokhari
- Cheetamhill Medical Centre, 244 Cheetham Hill Rd, Cheetham Hill, Manchester M8 8UP, United Kingdom
| | - Aleena Syed
- University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Barbara Tomenson
- School of Health Sciences, The University of Manchester, Jean Mcfarlane Building, Oxford Road, M13 9PL Manchester, United Kingdom
| | - Anharul Islam
- Research and Development, Lancashire & South Cumbria NHS Foundation Trust, Bridge House, Whalley Banks, King Street, Blackburn BB2 1NT, United Kingdom
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Dow University of Health Sciences, Pakistan
| | - Waquas Waheed
- Centre for Primary Care and Health Services Research, Williamson Building, The University of Manchester, M13 9PL, United Kingdom
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Abrahams N, Chirwa E, Mhlongo S, Seedat S, Myers B, Peer N, Kengne AP, Garcia-Moreno C, Lombard C, Jewkes R. Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study. Arch Womens Ment Health 2023; 26:341-351. [PMID: 37032357 PMCID: PMC10191987 DOI: 10.1007/s00737-023-01312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care.
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Affiliation(s)
- N Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa.
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7935, Cape Town, South Africa.
| | - E Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - S Mhlongo
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - S Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Dr, Parow, Cape Town, 7505, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, South African Research Chair in Posttraumatic Stress Disorder, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, 6102, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - N Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - A P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - C Garcia-Moreno
- HRP (The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), 1211, Geneva, Switzerland
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, 0001, South Africa
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Dare O, Jidong DE, Premkumar P. Conceptualising mental illness among University students of African, Caribbean and similar ethnic heritage in the United Kingdom. ETHNICITY & HEALTH 2023; 28:522-543. [PMID: 35912939 DOI: 10.1080/13557858.2022.2104817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/18/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Students of African, Caribbean and similar ethnicity (ACE) encounter unique mental health challenges within the Western higher education system, such as feeling constrained in social spaces and perceiving greater stigma about mental health. Students of ACE are also resilient to mental health problems, such as depression, when enduring social inequality. This study aimed to conceptualise mental illness and help-seeking behaviours among university students in the United Kingdom (UK) in the context of their identity as ACE. DESIGN Six university students of ACE in the UK were interviewed about the meaning of mental illness, the influence of ACE culture on mental health and help-seeking by ACE students. Thematic analysis was applied from a socio-constructionist theoretical lens to interpret the interview transcripts. RESULTS Five main themes emerged, namely 'Perceived meanings and attitudes toward mental health problems', 'Beliefs about the non-existence of mental health problem and its spiritual attributions', 'Family dynamics and the 'silencing' of mental health problems', 'Help-seeking for mental health among people of ACE' and 'Stigma and discriminatory responses to mental health issues'. Participants expressed that mental health is an imported concept that people from ACE communities tend to shy away from. A reluctance to discuss mental health problems arose over fear of rejection from families and fear of not being understood by a mental health professional from a different cultural background. CONCLUSION University students of ACE and their families struggle to adopt the Western conceptualisation of mental health. Consequently, there is poor awareness of mental health issues and stigma of mental illness among university students of ACE which pose a barrier to help-seeking for mental health. The limited sample size constrains the ability to draw sound conclusions. Nonetheless, a culturally sensitive conceptualisation of mental health is needed to address poor help-seeking for mental health among people of ACE.
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Affiliation(s)
- Oluwateniayo Dare
- Department of Psychology, Nottingham Trent University, Nottingham, UK
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Jidong DE, Husain MI, Ike TJ, Husain N, Taru MY, Nnaemeka NC, Francis C, Jack DB, Mwankon SB, Xue S, Pwajok JY, Nyam PP, Murshed M. Bipolar disorders in Nigeria: a mixed-methods study of patients, family caregivers, clinicians, and the community members' perspectives. Int J Bipolar Disord 2023; 11:2. [PMID: 36609729 PMCID: PMC9825686 DOI: 10.1186/s40345-022-00276-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Bipolar Disorders (BDs) are chronic mental health disorders that often result in functional impairment and contribute significantly to the disability-adjusted life years (DALY). BDs are historically under-researched compared to other mental health disorders, especially in Sub-Saharan Africa and Nigeria. DESIGN We adopted a mixed-methods design. Study 1 examined the public knowledge of BDs in relation to sociodemographic outcomes using quantitative data whilst Study 2 qualitatively assessed the lived experiences of patients with BDs, clinicians, and family caregivers. METHODS In Study 1, a non-clinical sample of n = 575 participants responded to a compact questionnaire that examined their knowledge of BDs and how they relate to certain sociodemographic variables. One-way ANOVA was used to analyse quantitative data. Study 2 interviewed N = 15 participants (n = 5 patients with BDs; n = 7 clinicians; n = 3 family caregivers). These semi-structured interviews were audio-recorded, transcribed, and thematically analysed. RESULTS In Study 1, findings showed no statistically significant differences, suggesting low awareness of BDs, especially among vulnerable populations such as young people and older adults. However, there was a trajectory in increased knowledge of BDs among participants between the ages of 25-44 years and part-time workers compared to other ages and employment statuses. In Study 2, qualitative findings showed that BDs are perceived to be genetically and psycho-socially induced by specific lived experiences of patients and their family caregivers. Although psychotropic medications and psychotherapy are available treatment options in Nigeria, cultural and religious beliefs were significant barriers to treatment uptake. CONCLUSIONS This study provides insight into knowledge and beliefs about BDs, including the lived experiences of patients with BDs, their caregivers and clinicians in Nigeria. It highlights the need for further studies assessing Nigeria's feasibility and acceptability of culturally adapted psychosocial interventions for patients with BDs.
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Affiliation(s)
- Dung Ezekiel Jidong
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - M. Ishrat Husain
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tarela J. Ike
- grid.26597.3f0000 0001 2325 1783Department of Criminology & Sociology, Teesside University, Middlesbrough, UK
| | - Nusrat Husain
- grid.5379.80000000121662407Department of Psychiatry, University of Manchester, Manchester, UK
| | - Maigari Yusufu Taru
- grid.411946.f0000 0004 1783 4052Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria
| | - Nwoga Charles Nnaemeka
- grid.411946.f0000 0004 1783 4052Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria
| | - Christopher Francis
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - David B. Jack
- Global Mental Health, Dung Jidong Foundation, Jos, Nigeria
| | - Shadrack B. Mwankon
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - Siqi Xue
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Juliet Y. Pwajok
- grid.412989.f0000 0000 8510 4538Department of Psychology, University of Jos, Jos, Nigeria
| | - Pam P. Nyam
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - Maisha Murshed
- grid.12361.370000 0001 0727 0669Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
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Jidong DE, Ike JT, Husain N, Murshed M, Francis C, Mwankon BS, Jack BD, Jidong JE, Pwajok YJ, Nyam PP, Kiran T, Bassett P. Culturally adapted psychological intervention for treating maternal depression in British mothers of African and Caribbean origin: A randomized controlled feasibility trial. Clin Psychol Psychother 2022. [PMID: 36478339 DOI: 10.1002/cpp.2807] [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: 08/20/2022] [Revised: 10/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women are likely to suffer from maternal depression due to childbirth difficulties and parenting responsibilities, leading to long-term negative consequences on their children and families. British mothers of African/Caribbean origin uptake of mental healthcare is low due to the lack of access to culturally appropriate care. METHODS A mixed-methods randomized controlled feasibility trial was adopted to test the appropriateness and acceptability of Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) for treating maternal depression compared with Psychoeducation (PE). Mothers (N = 26) aged 20-55 were screened for depression using the Patient Health Questionnaire (PHQ-9). Those who scored >5 on PHQ-9 were further interviewed using the Revised Clinical Interview Schedule to confirm the diagnosis and randomized into LTP+CaCBT (n = 13) or PE (n = 13) groups. Assessments were taken at baseline, end of the intervention at 3- and 6-months post-randomization. N = 2 focus groups (LTP+CaCBT, n = 12; PE, n = 7) and N = 8 individual interviews were conducted (LTP+CaCBT, n = 4; PE, n = 4). RESULTS The LTP+CaCBT group showed higher acceptability, feasibility and satisfaction levels than the PE group. Participants experienced the intervention as beneficial to their parenting skills with reduced depression and anxiety in the LTP+CaCBT compared to the PE group. CONCLUSIONS This is the first feasibility trial of an integrated online parenting intervention for British African and Caribbean mothers. The results indicated that culturally adapted LTP+CaCBT is acceptable and feasible. There is a need to study the clinical and cost-effectiveness of LTP+CaCBT in an appropriately powered randomized control trial and include the child's outcomes. TRIAL REGISTRATION www. CLINICALTRIALS gov (no. NCT04820920).
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Affiliation(s)
| | - Juliet Tarela Ike
- Department of Criminology and Sociology, Teesside University, Middlesbrough, UK
| | - Nusrat Husain
- Department of Psychiatry, University of Manchester, Manchester, UK
| | - Maisha Murshed
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | | | | | - B David Jack
- Research Unit, Dung Jidong Foundation (DJF), Jos, Nigeria
| | | | | | - P Pam Nyam
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Tayyaba Kiran
- Pakistan Institute of Living and Learning (PILL), Islamabad, Pakistan
| | - Paul Bassett
- Pakistan Institute of Living and Learning (PILL), Islamabad, Pakistan
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12
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Anto-Ocrah M, Latulipe RJ, Mark TE, Adler D, Zaihra T, Lanning JW. Exploring association of mobile phone access with positive health outcomes and behaviors amongst post-partum mothers in rural Malawi. BMC Pregnancy Childbirth 2022; 22:485. [PMID: 35698066 PMCID: PMC9191538 DOI: 10.1186/s12884-022-04782-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Access to mass media and emerging technologies (e.g., cell phones, the internet, and social media) is a social determinant of health that has been shown to profoundly influence women’s health outcomes. In the African region, where women in rural settings with limited access to care are most vulnerable to maternal mortality and other pregnancy-related morbidities, mobile phone access can be an important and life-saving health determinant. Objective The goal of this study was to examine the association between mobile/cellular phone ownership and health behaviors of post-partum mothers in rural Malawi. Methods In this cross-sectional study, we recruited and consented a convenient sample of 174 post-partum mothers of 4- and 5-month-olds who were attending well-child clinics in Gowa, situated in the rural Ntcheu district of Malawi. Using logistic regression models, we hypothesized that compared to non-cell phone owners, mobile phone ownership will be predictive (greater odds) of antenatal visit frequency, exclusive breastfeeding knowledge and practices, health-seeking behaviors, and involvement in motherhood support groups; and protective (lower odds) of infant illnesses, breastfeeding challenges, and post-partum depressive symptoms. Results Mobile phones were highly prevalent in this rural setting, with 45% (n = 79) of post-partum women indicating they owned at least one cell phone. Cell phone owners tended to have higher levels of education (p < 0.012) and wealth (p < 0.001). Interestingly, mobile phone ownership was only associated with exclusive breastfeeding practices; and phone owners had 75% lower odds of exclusively breastfeeding (adj. OR 0.25; 95% CI: 0.07–0.92, p = 0.038) in multivariable models. Though not statistically significant but clinically meaningful, cell phone ownership was associated with fewer depressive symptoms (adj. OR 0.84; 95% CI: 0.39–1.84, p = 0.67) and more social support (adj. OR 1.14; 95% CI: 0.61–2.13, p = 0.70). Conclusions Digital literacy and internet connectivity are social determinants of health, thus delving deeper into mothers’ digital experiences to identify and ameliorate their unique barriers to full digital access will be crucial to successful implementation of digital interventions to address post-partum challenges for women in hard-to-reach settings such as ours. Such interventions are of even greater relevance as the Covid-19 pandemic has increased the urgency of reaching vulnerable, marginalized populations.
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Affiliation(s)
- Martina Anto-Ocrah
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, PA, 15213, Pittsburgh, USA.
| | - Ryan J Latulipe
- Department of Emergency Medicine, New York Presbyterian/Columbia & Cornell, 525 E 68th St Box #301, New York, NY, 10065, USA
| | - Tiffany E Mark
- Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21218, USA
| | - David Adler
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, NY, 14642, Rochester, USA
| | - Tasneem Zaihra
- Lahey Hospital & Medical Center, 31 Mall Rd, MA, 01805, Burlington, USA
| | - Joseph W Lanning
- The School for International Training Graduate Institute, VT, Brattleboro, USA
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Novins DK, Althoff RR, Cortese S, Drury SS, Frazier JA, Henderson SW, McCauley E, Njoroge WFM, White T. Editors' Best of 2021. J Am Acad Child Adolesc Psychiatry 2022; 61:4-9. [PMID: 34949338 DOI: 10.1016/j.jaac.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2021 articles that we think deserve your attention or at least a second read.
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14
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Notiar A, Jidong DE, Hawa F, Lunat F, Shah S, Bassett P, Edge D, Naeem F, Husain N. Treatment of maternal depression in low-income women: A feasibility study from Kilifi, Kenya. Int J Clin Pract 2021; 75:e14862. [PMID: 34516036 DOI: 10.1111/ijcp.14862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/21/2021] [Accepted: 09/10/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS OF THE STUDY To test the feasibility and acceptability of a group psychosocial intervention called Learning Through Play (LTP) plus Culturally adapted Cognitive Behaviour Therapy (CaCBT) for depressed Kenyan mothers with children aged 0-36 months. METHODS USED TO CONDUCT THE STUDY This study was a single-arm mixed methods feasibility study to test an integrated parenting intervention for postnatal depression in a low-income rural area of Fumbini village in Kilifi District of Kenya. Women between the ages of 18 and 45 years with children up to 3 years were screened for depression using the Patient Health Questionnaire (PHQ-9). Those scoring above 10 on PHQ-9 were interviewed using the Revised Clinical Interview Schedule (CIS-R) to confirm the diagnosis of depression. Assessments were carried out at baseline and at the end of the intervention (3 months), followed by qualitative interviews with 12 women. Qualitative interviews were analysed using thematic analysis from a socio-constructionist theoretical lens. RESULTS OF THE STUDY The LTP Plus was both feasible and acceptable with high satisfaction among the participants. Qualitative results showed that the women perceived the intervention as beneficial in reducing the symptoms of depression, coping with stress and negative emotions. The results also indicated a reduction in scores on PHQ-9, GAD-7 with an increase in perceived social support, health-related quality of life and an improvement in mothers' knowledge about child development at the end of the intervention. CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS This study represents the first feasibility research on integrated parenting intervention in Kenya. The results indicated that culturally adapted LTP plus CaCBT is feasible and acceptable in a low-income setting of Kenya. There is now a need to study the clinical and cost-effectiveness of LTP plus CaCBT in an appropriately powered larger randomised control trial, with a longer follow-up period.
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Affiliation(s)
- Amber Notiar
- Centre in Africa for Learning and Living (CALL), Mombasa, Kenya
| | | | | | - Farah Lunat
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
| | - Sadia Shah
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
| | - Paul Bassett
- Pakistan Institute of Living and Learning (PILL), Islamabad, Pakistan
| | - Dawn Edge
- University of Manchester, Manchester, United Kingdom
| | - Farooq Naeem
- Centre for Addiction & Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Nusrat Husain
- University of Manchester, Manchester, United Kingdom
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Jidong DE, Husain N, Ike TJ, Murshed M, Pwajok JY, Roche A, Karick H, Dagona ZK, Karuri GS, Francis C, Mwankon SB, Nyam PP. Maternal mental health and child well-being in Nigeria: A systematic review. Health Psychol Open 2021; 8:20551029211012199. [PMID: 33996136 PMCID: PMC8111276 DOI: 10.1177/20551029211012199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Maternal mental health distress has a disease burden of severe adverse effects for both mother and child. This review identified maternal mental health concerns, their impact on child growth and the current practice of maternal healthcare for both mothers and their children in Nigeria. The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy, and five databases were searched for published articles between 1999 and 2019. Databases include Scopus, PubMed, ProQuest, Applied Social Science Index and Abstracts and Web of Science. Boolean operators (AND/OR/NOT) helped to ensure rigorous use of search terms which include 'maternal', 'pre/peri/postnatal', 'mental health', 'mental illness', 'disorders', 'intervention,' 'Nigeria', 'child', 'infant growth', and 'wellbeing'. Thirty-four studies met the inclusion criteria, and extracted data were qualitatively synthesised and analysed thematically. Five themes emerged. These include (i) marital difficulties, (ii) relationship status of the mother, (iii) child's gender, (iv) mode of child delivery and (v) child growth and development. The review showed a significant paucity of literature on the impact of specific maternal mental health problems on child physical growth and cognitive development. We concluded that culturally appropriate and evidence-based psychological interventions for maternal mental health problems would benefit Nigerian indigenous mothers. Therefore, the study recommends randomised controlled trials that are culturally appropriate and cost-effective for distressed mothers with children.
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