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Lovero KL, Stockton MA, Greene MC, Basaraba C, Khan S, Mabunda D, Mandlate F, Gouveia L, Fumo W, Wall MM, Duarte CS, Oquendo MA, Wainberg ML. Psychometric Evaluation of Screens for Common Mental Disorders, Severe Mental Disorders, Substance Use Disorders, and Suicide Risk in Mozambican Healthcare. MEDICAL RESEARCH ARCHIVES 2024; 12. [PMID: 39268201 PMCID: PMC11391859 DOI: 10.18103/mra.v12i8.5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Globally, mental and substance use disorders are a leading cause of disease burden. In low- and middle-income countries, where there is an extreme shortage of trained mental health specialists, validated, brief screening tools for mental and substance use disorders are required for non-specialists to efficiently identify patients in need of mental health care. Mozambique, one of the poorest countries in the world, has fewer than two mental health specialists for every 100,000 people. In the present study, we evaluated a comprehensive set of seven measures for depression, anxiety, somatization, alcohol use disorder, substance use disorder, psychosis and mania, and suicide risk among N=911 Mozambican adults in general healthcare settings. All instruments demonstrated acceptable internal consistency (α > 0.75). Compared to diagnoses made by the Mini International Neuropsychiatric Interview, all measures showed good criterion validity (AUC > 0.75), except the Psychosis Screening Questionnaire, which showed low sensitivity (0.58) for psychotic disorder. No substantial differences were observed in internal consistency when stratifying by gender, age, education level, primary language, facility-type, and patient status; criterion validity showed some variability when stratified by sub-population, particularly for education, primary language, and whether the participant was seeking care that day. Exploratory factor analyses indicated that the measures best differentiate categories of diagnoses (common mental disorder, severe mental disorders, substance use disorders, and suicide risk) rather than individual diagnoses, suggesting the utility of a transdiagnostic approach. Our findings support the use of these measures in Mozambique to identify common mental disorders, substance use disorders, and suicide risk, but indicate further research is needed to develop an adequate screen for severe mental disorders. Given the limited mental health specialists in this and other LMIC settings, these brief measures can support non-specialist provision of mental health services and promote closure of the treatment gap.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Melissa A Stockton
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Cale Basaraba
- Department of Population Health, Grossman School of Medicine, New York University
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Rimal P, Shrestha S, Khatri R, Sapkota S, Swar SB, Basnet M, Sigdel K, Jirel S, Acharya B. Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal. RESEARCH SQUARE 2024:rs.3.rs-4499074. [PMID: 38978610 PMCID: PMC11230512 DOI: 10.21203/rs.3.rs-4499074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. Methods We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. Results The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Conclusion Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.
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Kwobah EK, Goodrich S, Kulzer JL, Kanyesigye M, Obatsa S, Cheruiyot J, Kiprono L, Kibet C, Ochieng F, Bukusi EA, Ofner S, Brown SA, Yiannoutsos CT, Atwoli L, Wools-Kaloustian K. Adaptation of the Client Diagnostic Questionnaire for East Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001756. [PMID: 38502647 PMCID: PMC10950255 DOI: 10.1371/journal.pgph.0001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/17/2024] [Indexed: 03/21/2024]
Abstract
Research increasingly involves cross-cultural work with non-English-speaking populations, necessitating translation and cultural validation of research tools. This paper describes the process of translating and criterion validation of the Client Diagnostic Questionnaire (CDQ) for use in a multisite study in Kenya and Uganda. The English CDQ was translated into Swahili, Dholuo (Kenya) and Runyankole/Rukiga (Uganda) by expert translators. The translated documents underwent face validation by a bilingual committee, who resolved unclear statements, agreed on final translations and reviewed back translations to English. A diagnostic interview by a mental health specialist was used for criterion validation, and Kappa statistics assessed the strength of agreement between non-specialist scores and mental health professionals' diagnoses. Achieving semantic equivalence between translations was a challenge. Validation analysis was done with 30 participants at each site (median age 32.3 years (IQR = (26.5, 36.3)); 58 (64.4%) female). The sensitivity was 86.7%, specificity 64.4%, positive predictive value 70.9% and negative predictive value 82.9%. Diagnostic accuracy by the non-specialist was 75.6%. Agreement was substantial for major depressive episode and positive alcohol (past 6 months) and alcohol abuse (past 30 days). Agreement was moderate for other depressive disorders, panic disorder and psychosis screen; fair for generalized anxiety, drug abuse (past 6 months) and Post Traumatic Stress Disorder (PTSD); and poor for drug abuse (past 30 days). Variability of agreement between sites was seen for drug use (past 6 months) and PTSD. Our study successfully adapted the CDQ for use among people living with HIV in East Africa. We established that trained non-specialists can use the CDQ to screen for common mental health and substance use disorders with reasonable accuracy. Its use has the potential to increase case identification, improve linkage to mental healthcare, and improve outcomes. We recommend further studies to establish the psychometric properties of the translated tool.
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Affiliation(s)
- Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Suzanne Goodrich
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | | | - Sarah Obatsa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Lorna Kiprono
- Academic Model Providing Access to Care, Eldoret, Kenya
| | - Colma Kibet
- Academic Model Providing Access to Care, Eldoret, Kenya
| | - Felix Ochieng
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Steven A. Brown
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Constantin T. Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya
- Brain and Mind Institute and the Department of Internal Medicine, Medical College East Africa, Aga Khan University, Nairobi, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Karagiorga VE, Schafer JL, Marchionatti LE, Caye A, Serdari A, Kotsis K, Basta M, Balikou P, Kapsimalli E, Mitropoulou A, Klavdianou N, Zeleni D, Mitroulaki S, Botzaki A, Gerostergios G, Samiotakis G, Simioni A, Georgiades K, Salum GA, Koumoula A. Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece. J Patient Rep Outcomes 2024; 8:18. [PMID: 38345660 PMCID: PMC10861406 DOI: 10.1186/s41687-024-00693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale. METHODS This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes. RESULTS A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified). CONCLUSION A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.
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Affiliation(s)
- Vasiliki Eirini Karagiorga
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
| | - Julia Luiza Schafer
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lauro Estivalete Marchionatti
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Arthur Caye
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aspasia Serdari
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Kotsis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Basta
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
- Department of Child and Adolescent Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Panagiota Balikou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Efstathia Kapsimalli
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Andromachi Mitropoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Nikanthi Klavdianou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Domna Zeleni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Sotiria Mitroulaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Anna Botzaki
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Giorgos Gerostergios
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - Giorgos Samiotakis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
| | - André Simioni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA
- Child Mind Institute, New York, USA
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences and Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Giovanni Abrahão Salum
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA.
- Child Mind Institute, New York, USA.
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Anastasia Koumoula
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation and Child Mind Institute, 101 East 56th Street, New York, New York, 10022, USA.
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Yang LH, Bass JK, Le PD, Singh R, Gurung D, Velasco PR, Grivel MM, Susser E, Cleland CM, Muñoz RA, Kohrt BA, Bhana A. A Case Study of the Development of a Valid and Pragmatic Implementation Science Measure: The Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH) Measure. RESEARCH SQUARE 2024:rs.3.rs-3877031. [PMID: 38343864 PMCID: PMC10854285 DOI: 10.21203/rs.3.rs-3877031/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Background Few implementation science (IS) measures have been evaluated for validity, reliability and utility - the latter referring to whether a measure captures meaningful aspects of implementation contexts. In this case study, we describe the process of developing an IS measure that aims to assess Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), and the procedures we implemented to enhance its utility. Methods We summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure's construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility. Results Continuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure's structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as "program," "provider type," and "type of service" were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers' conceptions of utility regarding the measure's acceptability, appropriateness, and feasibility were seen to cluster across several common categories. Conclusions This case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers' preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.
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Affiliation(s)
- Lawrence H Yang
- New York University School of Global Public Health, Department of Social and Behavioral Sciences
| | - Judy K Bass
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health
| | - PhuongThao Dinh Le
- New York University School of Global Public Health, Department of Social and Behavioral Sciences
| | - Ritika Singh
- George Washington University, Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences
| | - Dristy Gurung
- Transcultural Psychosocial Organization (TPO) Nepal; King's College London, Denmark Hill Campus
| | - Paola R Velasco
- Universidad O'Higgins; Universidad Católica de Chile; Universidad de Chile
| | - Margaux M Grivel
- 1 New York University School of Global Public Health, Department of Social and Behavioral Sciences
| | - Ezra Susser
- Columbia University Mailman School of Public Health; New York State Psychiatric Institute
| | - Charles M Cleland
- New York University Grossman School of Medicine, Department of Population Health
| | | | - Brandon A Kohrt
- George Washington University, Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences
| | - Arvin Bhana
- University of KwaZulu-Natal, Centre for Rural Health; South African Medical Research Council, Health Systems Research Unit
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Rai S, Awale R, Ghimire DJ, Rao D. Pathways of association between husbands’ migration and mental health of their wives who stay behind. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Carvajal-Velez L, Ottman K, Ahs JW, Li GN, Simmons J, Chorpita B, Requejo JH, Kohrt BA. Translation and Adaptation of the Revised Children's Anxiety and Depression Scale: A Qualitative Study in Belize. J Adolesc Health 2023; 72:S34-S39. [PMID: 35934586 DOI: 10.1016/j.jadohealth.2022.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adapting data collection instruments using transcultural translation and adaptation processes is essential to ensure that respondents comprehend the items and the original meaning is retained across languages and contexts. This approach is central to UNICEF's efforts to expand the use of standard data collection tools across settings and close the global data gap on adolescent mental health. METHODS We conducted transcultural translation and adaptation processes in Belize using the Revised Children's Anxiety and Depression Scale (RCADS). Items from the original scale were translated into Belizean English and Kriol, reviewed by local mental health experts, and discussed in focus groups. Cognitive interviews were conducted with adolescents and parents. The information collected was analyzed with cultural equivalence domains: comprehensibility, acceptability, relevance, completeness, and technical equivalence. Bilingual discussions of findings informed the final item wordings, and the adapted tool was back-translated. RESULTS Adaptation of terms and specific expressions were done to improve comprehensibility and to ensure the appropriate clinical meaning. For example, the expression 'feeling scared' was perceived to imply immaturity or threaten masculinity and was adapted to 'feeling afraid.' Expressions like "shaky" were modified to "trimble" in Kriol. Statements were reworded as questions to enhance acceptability and comprehensibility. DISCUSSION A culturally adapted version of the RCADS was developed for use among adolescents in Belize in Belizean English and Kriol. The transcultural translation and adaptation procedure can be applied for other settings or tools to design contextual adaptations of mental health instruments prior to their validation or use in new settings.
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Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Katherine Ottman
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | | | - Juliet Simmons
- Department of Mental Health, Ministry of Health and Wellness, Belize City, Belize
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jennifer Harris Requejo
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
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Rimal P, Choudhury N, Agrawal P, Basnet M, Bohara B, Citrin D, Dhungana SK, Gauchan B, Gupta P, Gupta TK, Halliday S, Kadayat B, Mahar R, Maru D, Nguyen V, Poudel S, Raut A, Rawal J, Sapkota S, Schwarz D, Schwarz R, Shrestha S, Swar S, Thapa A, Thapa P, White R, Acharya B. Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study. BMJ Open 2021; 11:e048481. [PMID: 34400456 PMCID: PMC8370561 DOI: 10.1136/bmjopen-2020-048481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings. METHODS We conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period. RESULTS Providers experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p<0.0001). CONCLUSION Using the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.
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Affiliation(s)
- Pragya Rimal
- Nyaya Health Nepal, Kathmandu, Nepal
- Possible, Kathmandu, Nepal
| | - Nandini Choudhury
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Madhur Basnet
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | | | - David Citrin
- Possible, New York, New York, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Scott Halliday
- Possible, New York, New York, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Duncan Maru
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | - Viet Nguyen
- Health Services, Los Angeles County Department of Health Services, Los Angeles, California, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Anant Raut
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Sabitri Sapkota
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Ryan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Srijana Shrestha
- Possible, New York, New York, USA
- Department of Psychology, Wheaton College, Wheaton, Illinois, USA
| | | | | | - Poshan Thapa
- University of New South Wales School of Public Health and Community Medicine, Sydney, New South Wales, Australia
| | | | - Bibhav Acharya
- Possible, New York, New York, USA
- Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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Maharjan SM, Poudyal A, van Heerden A, Byanjankar P, Thapa A, Islam C, Kohrt BA, Hagaman A. Passive sensing on mobile devices to improve mental health services with adolescent and young mothers in low-resource settings: the role of families in feasibility and acceptability. BMC Med Inform Decis Mak 2021; 21:117. [PMID: 33827552 PMCID: PMC8025381 DOI: 10.1186/s12911-021-01473-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive sensor data from mobile devices can shed light on daily activities, social behavior, and maternal-child interactions to improve maternal and child health services including mental healthcare. We assessed feasibility and acceptability of the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) platform. The StandStrong passive data collection platform was piloted with adolescent and young mothers, including mothers experiencing postpartum depression, in Nepal. METHODS Mothers (15-25 years old) with infants (< 12 months old) were recruited in person from vaccination clinics in rural Nepal. They were provided with an Android smartphone and a Bluetooth beacon to collect data in four domains: the mother's location using the Global Positioning System (GPS), physical activity using the phone's accelerometer, auditory environment using episodic audio recording on the phone, and mother-infant proximity measured with the Bluetooth beacon attached to the infant's clothing. Feasibility and acceptability were evaluated based on the amount of passive sensing data collected compared to the total amount that could be collected in a 2-week period. Endline qualitative interviews were conducted to understand mothers' experiences and perceptions of passive data collection. RESULTS Of the 782 women approached, 320 met eligibility criteria and 38 mothers (11 depressed, 27 non-depressed) were enrolled. 38 mothers (11 depressed, 27 non-depressed) were enrolled. Across all participants, 5,579 of the hour-long data collection windows had at least one audio recording [mean (M) = 57.4% of the total possible hour-long recording windows per participant; median (Mdn) = 62.6%], 5,001 activity readings (M = 50.6%; Mdn = 63.2%), 4,168 proximity readings (M = 41.1%; Mdn = 47.6%), and 3,482 GPS readings (M = 35.4%; Mdn = 39.2%). Feasibility challenges were phone battery charging, data usage exceeding prepaid limits, and burden of carrying mobile phones. Acceptability challenges were privacy concerns and lack of family involvement. Overall, families' understanding of passive sensing and families' awareness of potential benefits to mothers and infants were the major modifiable factors increasing acceptability and reducing gaps in data collection. CONCLUSION Per sensor type, approximately half of the hour-long collection windows had at least one reading. Feasibility challenges for passive sensing on mobile devices can be addressed by providing alternative phone charging options, reverse billing for the app, and replacing mobile phones with smartwatches. Enhancing acceptability will require greater family involvement and improved communication regarding benefits of passive sensing for psychological interventions and other health services. Registration International Registered Report Identifier (IRRID): DERR1-10.2196/14734.
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Affiliation(s)
- Sujen Man Maharjan
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA
| | - Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Ada Thapa
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA
| | - Celia Islam
- George Washington School of Medicine and Health Sciences, Washington, DC, 20037, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA.
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
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10
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Rimal P, Khadka S, Bogati B, Chaudhury J, Rawat LK, Bhat KC, Manandhar P, Citrin D, Maru D, Ekstrand ML, Swar SB, Aryal A, Kohrt B, Shrestha S, Acharya B. Cross-cultural adaptation of motivational interviewing for use in rural Nepal. BMC Psychol 2021; 9:52. [PMID: 33794990 PMCID: PMC8017825 DOI: 10.1186/s40359-021-00557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Motivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person’s behaviors. Methods We developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment. Results Participants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not “allow” it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone’s motivations and align those with the patient’s needs. Conclusions MI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient’s autonomy and their role as a member of a complex social fabric to facilitate behavior change.
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Affiliation(s)
| | | | | | | | | | | | | | - David Citrin
- Possible, New York, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Duncan Maru
- Possible, New York, USA.,Icahn School of Medicine At Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Department of Health Systems Design and Global Health, Icahn School of Medicine At Mount Sinai, New York, USA.,Department of Internal Medicine, Icahn School of Medicine At Mount Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria L Ekstrand
- School of Medicine, University of California San Francisco, San Francisco, USA
| | - Sikhar Bahadur Swar
- Nyaya Health Nepal, Kathmandu, Nepal.,Department of Psychiatry, Kathmandu Medical College, Kathmandu, Nepal
| | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
| | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Srijana Shrestha
- Possible, New York, USA.,Department of Psychology, Wheaton College, Norton, MA, USA
| | - Bibhav Acharya
- Possible, New York, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, USA
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11
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Poudyal A, van Heerden A, Hagaman A, Islam C, Thapa A, Maharjan SM, Byanjankar P, Kohrt BA. What Does Social Support Sound Like? Challenges and Opportunities for Using Passive Episodic Audio Collection to Assess the Social Environment. Front Public Health 2021; 9:633606. [PMID: 33855008 PMCID: PMC8039317 DOI: 10.3389/fpubh.2021.633606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The social environment, comprised of social support, social burden, and quality of interactions, influences a range of health outcomes, including mental health. Passive audio data collection on mobile phones (e.g., episodic recording of the auditory environment without requiring any active input from the phone user) enables new opportunities to understand the social environment. We evaluated the use of passive audio collection on mobile phones as a window into the social environment while conducting a study of mental health among adolescent and young mothers in Nepal. Methods: We enrolled 23 adolescent and young mothers who first participated in qualitative interviews to describe their social support and identify sounds potentially associated with that support. Then, episodic recordings were collected for 2 weeks from the mothers using an app to record 30 s of audio every 15 min from 4 A.M. to 9 P.M. Audio data were processed and classified using a pretrained model. Each classification category was accompanied by an estimated accuracy score. Manual validation of the machine-predicted speech and non-speech categories was done for accuracy. Results: In qualitative interviews, mothers described a range of positive and negative social interactions and the sounds that accompanied these. Potential positive sounds included adult speech and laughter, infant babbling and laughter, and sounds from baby toys. Sounds characterizing negative stimuli included yelling, crying, screaming by adults and crying by infants. Sounds associated with social isolation included silence and TV or radio noises. Speech comprised 43% of all passively recorded audio clips (n = 7,725). Manual validation showed a 23% false positive rate and 62% false-negative rate for speech, demonstrating potential underestimation of speech exposure. Other common sounds were music and vehicular noises. Conclusions: Passively capturing audio has the potential to improve understanding of the social environment. However, a pre-trained model had the limited accuracy for identifying speech and lacked categories allowing distinction between positive and negative social interactions. To improve the contribution of passive audio collection to understanding the social environment, future work should improve the accuracy of audio categorization, code for constellations of sounds, and combine audio with other smartphone data collection such as location and activity.
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Affiliation(s)
- Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa.,Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States.,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Celia Islam
- George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Ada Thapa
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | | | - Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
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12
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Tergesen CL, Gurung D, Dhungana S, Risal A, Basel P, Tamrakar D, Amatya A, Park LP, Kohrt BA. Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042143. [PMID: 33671743 PMCID: PMC7926497 DOI: 10.3390/ijerph18042143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022]
Abstract
This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.
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Affiliation(s)
- Cori L. Tergesen
- Department of Psychology, DePaul University, Chicago, IL 60604, USA;
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal;
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Saraswati Dhungana
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; (S.D.); (P.B.)
| | - Ajay Risal
- Department of Psychiatry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; (A.R.); (D.T.)
| | - Prem Basel
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; (S.D.); (P.B.)
| | - Dipesh Tamrakar
- Department of Psychiatry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; (A.R.); (D.T.)
| | | | - Lawrence P. Park
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
- Infectious Disease Division, Department of Medicine, Duke University Medical Center, Durham, NC 27708, USA
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal;
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC 20037, USA
- Correspondence: ; Tel.: +1-202-741-2896
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13
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A cross-cultural interpersonal model of adolescent depression: A qualitative study in rural Nepal. Soc Sci Med 2021; 270:113623. [PMID: 33461033 PMCID: PMC7895817 DOI: 10.1016/j.socscimed.2020.113623] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
Most cross-cultural qualitative research on depression has been descriptive, documenting symptoms and explanatory models. There is a lack of qualitative research testing theoretical models of depression. The interpersonal model conceptualises grief, interpersonal disputes, role transitions and social isolation as the context in which depression develops and is the basis of interpersonal therapy (IPT), which is increasingly used in cross-cultural settings to treat depression. We aimed to qualitatively evaluate to what extent the interpersonal model can explain adolescent depression in Nepal. Data were collected between December 2018 and April 2019 and comprised transcripts from 126 participants: 25 semi-structured interviews with depressed adolescents aged 13–18; four focus group discussions with adolescents (N = 38), four with parents/caregivers (N = 39), and two with teachers (N = 17); and seven semi-structured interviews with health and non-governmental organisation workers. We coded data using an analytical framework comprising deductive codes representing key concepts from the interpersonal model of depression and IPT, including principles, techniques and strategies. Participants mainly related depression to interpersonal problem areas of grief, dispute, role transition and social isolation. Interpersonal disputes were common, and for many adolescents this involved parental physical and emotional abuse. Although role transitions were common few adolescents grieved loss of the prior role. Distress related to social isolation was evident despite close physical proximity and extensive social interaction with family and community members. Adolescents described coping strategies that were similar to strategies central to IPT, e.g. identifying helpful and unhelpful relationships and generating options and ways of managing problems. In conclusion, interpersonal problems are relevant to this population and conceptualisations align with core principles of the interpersonal model of depression. The findings highlight the importance of addressing abuse and maltreatment in depression aetiology. They also inform future cultural adaptations of IPT in Nepal and beyond, including the opportunity to integrate local coping strategies. Testing psychological models cross-culturally is important for adapting therapies. Interpersonal problems trigger depression among adolescents in Nepal. Experiences of depression align with core principles of interpersonal therapy (IPT). Few adolescents use IPT strategies to address interpersonal problems. Models of depression must incorporate poverty, migration and abuse as risk factors.
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14
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Shala M, Morina N, Burchert S, Cerga-Pashoja A, Knaevelsrud C, Maercker A, Heim E. Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet Interv 2020; 21:100339. [PMID: 32983906 PMCID: PMC7495109 DOI: 10.1016/j.invent.2020.100339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. AIMS With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. METHODS A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. RESULTS The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. DISCUSSION This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.
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Affiliation(s)
- Mirëlinda Shala
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Switzerland
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Arlinda Cerga-Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Eva Heim
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
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15
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Poudyal A, van Heerden A, Hagaman A, Maharjan SM, Byanjankar P, Subba P, Kohrt BA. Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal. JMIR Res Protoc 2019; 8:e14734. [PMID: 31512581 PMCID: PMC6746061 DOI: 10.2196/14734] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression. OBJECTIVE This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment. METHODS This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives. RESULTS To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019. CONCLUSIONS Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14734.
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Affiliation(s)
- Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- Center for Methods in Implementation and Prevention Science, Yale University, New Haven, CT, United States
| | | | | | | | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
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16
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Rai S, Gurung D, Kaiser BN, Sikkema KJ, Dhakal M, Bhardwaj A, Tergesen C, Kohrt BA. A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: Utilizing perspectives of family members and caregivers. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2018; 36:198-209. [PMID: 29902036 PMCID: PMC6005191 DOI: 10.1037/fsh0000338] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Service users' involvement as cofacilitators of mental health trainings is a nascent endeavor in low- and middle-income countries, and the role of families on service user participation in trainings has received limited attention. This study examined how caregivers perceive and facilitate service user's involvement in an antistigma program that was added to mental health Gap Action Program (mhGAP) trainings for primary care workers in Nepal. METHOD Service users were trained as cofacilitators for antistigma and mhGAP trainings delivered to primary care workers through the REducing Stigma among HealthcAre ProvidErs (RESHAPE) program. Key informant interviews (n = 17) were conducted with caregivers and service users in RESHAPE. RESULTS Five themes emerged: (a) Caregivers' perceived benefits of service user involvement included reduced caregiver burden, learning new skills, and opportunities to develop support groups. (b) Caregivers' fear of worsening stigma impeded RESHAPE participation. (c) Lack of trust between caregivers and service users jeopardized participation, but it could be mitigated through family engagement with health workers. (d) Orientation provided to caregivers regarding RESHAPE needed greater attention, and when information was provided, it contributed to stigma reduction in families. (e) Time management impacted caregivers' ability to facilitate service user participation. DISCUSSION Engagement with families allows for greater identification of motivational factors and barriers impacting optimal program performance. Caregiver involvement in all program elements should be considered best practice for service user-facilitated antistigma initiatives, and service users reluctant to include caregivers should be provided with health staff support to address barriers to including family. (PsycINFO Database Record
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Affiliation(s)
- Sauharda Rai
- Department of Psychiatry, George Washington University, Washington, DC, USA. Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | | | | | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal
| | - Anvita Bhardwaj
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | | | - Brandon A. Kohrt
- Corresponding Author: Brandon A. Kohrt, Department of Psychiatry, George Washington University, 2120 L St. NW, Suite 600, Washington, DC, 20037, USA,
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