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Desrosiers A, Carrol B, Ritsema H, Higgins W, Momoh F, Betancourt TS. Advancing sustainable implementation of an evidence-based mental health intervention in Sierra Leone's schools: protocol for a hybrid type 3 implementation-effectiveness trial. BMC Public Health 2024; 24:362. [PMID: 38310232 PMCID: PMC10837990 DOI: 10.1186/s12889-024-17928-w] [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: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Mental health disorders among youth contribute substantially to the global burden of disease, which is exacerbated in low- and middle-income countries (LMICs) due to large mental health treatment gaps. In Sierra Leone, a West African country with a long history of complex adversity, the mental health treatment gap is estimated at 98%. Implementing innovative mental health interventions that can be sustained at scale is a priority. The Youth Readiness Intervention (YRI) is an evidence-based mental health intervention for youth that can be delivered feasibly by lay health workers/nonspecialists. Using mobile-based technologies to assist implementation could improve the reach and sustainability of the YRI in Sierra Leone. This study aims to train teachers to deliver the YRI in Sierra Leone's secondary schools and test the feasibility, acceptability, cost, and fidelity to the YRI of a mobile-based supervision model compared with standard, in-person supervision. METHODS We will conduct a hybrid type 3 implementation-effectiveness cluster randomized trial to assess the feasibility, acceptability, costs and fidelity to the YRI implemented by teachers receiving mobile-based supervision vs. standard supervision. Enrolled schools (N = 50) will be randomized to YRI + mobile supervision (N = 20), YRI + standard supervision (N = 20) or waitlist control (N = 10). We will recruit and enroll four teachers per intervention-condition school (N = 160) and 1200 youth. We will collect data on implementation outcomes among teachers, principals and youth via a mixed methods approach at baseline and post-intervention. We will also collect quantitative data on youth mental health and functioning as secondary outcomes at baseline and post-intervention, as well as cost-effectiveness data at 12-month follow-up. DISCUSSION Study findings have the potential to expand the reach of mental health services among youth in low-resource settings via a teacher workforce. The use of mobile tools, if successful, could support further scale out and sustainment of the YRI to other regions of Sierra Leone and West Africa more broadly, which could help address the mental health treatment gap. TRIAL REGISTRATION Clinical Trial Network: NCT05737667.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA.
| | - Bidemi Carrol
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Haley Ritsema
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA
| | - Walker Higgins
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Fatoma Momoh
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02496, USA
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Hopwood H, Harris D, Sevalie S, Iyawa G, Langan Martin J. The Barriers and Facilitators to Decentralised Nurse-Led Mental Health Service Delivery in Sierra Leone. Community Ment Health J 2023; 59:1071-1082. [PMID: 36692702 PMCID: PMC10289970 DOI: 10.1007/s10597-023-01087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response to this situation, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHUs) to every district. This study evaluates the barriers and facilitators to mental health service delivery in decentralised MHUs in Sierra Leone using key informant interviews and focus group discussions with 13 purposefully sampled clinical staff and senior management personnel. The interviews were audio-recorded, translated from Krio if necessary, transcribed, and analysed using manifest content analysis. The findings suggest that factors affecting nurse-led mental health service delivery include small workforce and high workload, culture and beliefs, risks, lack of safety measures and required resources, outdated policies, poor salaries, lack of funds for medication, distance, power, influence, and stigma. Factors that could facilitate nurse-led mental health services include: increasing motivation, increasing the workforce, knowledge sharing, mentorship, availability of medication, passion and modern psychiatry. The findings contribute towards understanding the challenges and opportunities faced by the recently established nurse-led decentralised mental health services across Sierra Leone, in order to address the large mental health treatment gap. We hope the findings will inform further policy and planning to improve the quality of decentralised mental healthcare.
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Affiliation(s)
- Helen Hopwood
- King’s Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King’s College London, London, UK
| | - Dawn Harris
- King’s Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King’s College London, London, UK
| | - Stephen Sevalie
- Regimental Military Hospital, Freetown, Sierra Leone
- Kings Sierra Leone Partnership, Freetown, Sierra Leone
- Sustainable Health Systems, Freetown, Sierra Leone
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Desrosiers A, Schafer C, Bond L, Akinsulure-Smith A, Hinton M, Vandi A, Betancourt TS. Exploring potential mental health spillover effects among caregivers and partners of youth in Sierra Leone: A qualitative study. Glob Ment Health (Camb) 2023; 10:e40. [PMID: 37854398 PMCID: PMC10579673 DOI: 10.1017/gmh.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 10/20/2023] Open
Abstract
Given the large mental health treatment gap in low- and middle-income countries (LMICs), particularly in post-conflict settings like Sierra Leone, and the limited healthcare infrastructure, understanding the wider benefits of evidence-based mental health interventions within households is critical. This study explored potential mental health spillover effects - the phenomenon of beneficial effects among nonparticipants - among cohabitating caregivers and partners of youth who participated in an evidence-based mental health intervention in Sierra Leone. We recruited a sub-sample of cohabitating caregivers and partners (N = 20) of youth intervention participants; caregivers had enrolled in a larger study investigating indirect benefits of the evidence-based intervention in Sierra Leone (MH117359). Qualitative interviews were conducted at two time points to explore the following: (a) potential mental health spillover effects and (b) through which mechanisms spillover may have occurred. Two trained coders reviewed transcripts and analyzed qualitative data, assisted by MaxQDA. Qualitative findings suggested that spillover effects likely occurred and supported three potential mechanisms: decreased caregiving burden, behavior changes among Youth Readiness Intervention participants and improved interpersonal relationships. Mental health spillover effects may occur following youth intervention participation in a post-conflict LMIC. Investing in evidence-based services may offer indirect benefits that extend beyond those directly receiving services.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Carolyn Schafer
- Institute for Public Health and Medicine, Northwestern University, Evanston, IL, USA
| | - Laura Bond
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | | | | | - Alpha Vandi
- Caritas Sierra Leone, Freetown, Sierra Leone
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Desrosiers A, Bond L, Hoffman M, Kumar P, Schafer C, Metzger IW, Vandi A, Hinton M, Betancourt TS. Exploring Naturalistic Diffusion of an Evidence-Based Mental Health Intervention across Peer Networks of Youth in Sierra Leone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4059. [PMID: 36901069 PMCID: PMC10002214 DOI: 10.3390/ijerph20054059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Understanding the mechanisms by which evidence-based interventions (EBIs) for mental health are naturally diffused among youth in low-and middle-income countries-particularly those with histories of violence and civil unrest-can illuminate which intervention elements are most transferrable and inform scale-up decisions that support youth adjustment. This study explored the diffusion of an evidence-based mental health intervention-the Youth Readiness Intervention (YRI)-among peer networks of Sierra Leonean youth (aged 18-30) who participated in a trial of the intervention as integrated into youth entrepreneurship programs. METHODS Trained research assistants recruited index participants who had completed the YRI integrated within entrepreneurship training (N = 165) and control index participants (N = 165). Index participants nominated three of their closest peers. Nominated peers were recruited and enrolled in the current study (N = 289). A sub-sample of index participants and peers participated in dyadic interviews (N = 11) and focus group discussions (N = 16). Multivariate regression analysis compared YRI knowledge levels among YRI participants' peers relative to control participants' peers. RESULTS Qualitative findings supported the diffusion of several YRI skills and components across peer networks (i.e., progressive muscle relaxation and diaphragmatic breathing). Quantitative findings indicated that YRI knowledge was significantly higher for YRI participants' peers (β = 0.02, p < 0.00) compared to control participants' peers. CONCLUSION Findings suggest that diffusion of evidence-based intervention components can occur naturally among peers in post-conflict LMIC settings. Developing tools to promote the diffusion of the most transferrable EBI components across peer networks could help maximize the benefits of mental health interventions for youth adjustment and resilience in post-conflict settings.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02906, USA
| | - Laura Bond
- School of Social Work, Boston College, Chestnut Hill, MA 02496, USA
| | - Morgan Hoffman
- School of Social Work, Boston College, Chestnut Hill, MA 02496, USA
| | - Praveen Kumar
- School of Social Work, Boston College, Chestnut Hill, MA 02496, USA
| | - Carolyn Schafer
- Institute for Public Health and Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Isha W. Metzger
- College of Arts and Sciences, Georgia State University, Atlanta, GA 30302, USA
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Aréchiga A, Freeman K, Tan A, Lou J, Lister Z, Buckles B, Montgomery S. Building resilience and improving wellbeing in Sierra Leone using the community resiliency model post Ebola. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2023. [DOI: 10.1080/00207411.2023.2166312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Adam Aréchiga
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - Kimberly Freeman
- Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, California, USA
| | - Alison Tan
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - John Lou
- Department of Counseling and Family Sciences, Loma Linda University, Loma Linda, California, USA
| | - Zephon Lister
- Department of Counseling and Family Sciences, Loma Linda University, Loma Linda, California, USA
| | - Beverly Buckles
- Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, California, USA
| | - Susanne Montgomery
- Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, California, USA
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James PB, Osborne A, Bah AJ, Margao EK, Conteh-Barrat M. Sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia: a secondary analysis of the 2017 Global school-based student health surveys. Contracept Reprod Med 2022; 7:27. [PMID: 36566228 DOI: 10.1186/s40834-022-00193-w] [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: 08/08/2022] [Accepted: 10/18/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sierra Leone and Liberia have experienced civil wars and, recently, Ebola outbreaks that led to profound economic hardship, psychopathologies and family disruptions. These factors are associated with sexual risk behaviours among youths. However, there is very little information on sexual risk behaviour among Sierra Leonean and Liberian school-going adolescents. The present study assessed the prevalence and determinants of sexual risk behaviours among school-going adolescents (10-19 years) in Sierra Leone and Liberia. METHOD: We used publicly available nationally representative cross-sectional datasets of the 2017 Sierra Leone and Liberia Global school health survey. The sample consisted of 2798 and 2744 school-going adolescents from Sierra Leone and Liberia, respectively. Complex sample descriptive and regression analysis was used to analyse our data. RESULTS The majority of adolescents in the two countries were involved in multiple sexual risk behaviour (80.2%), with a higher prevalence observed in Sierra Leone (85.2%) than in Liberia (75.3%). Liberian adolescents showed lesser odds of indulging in multiple sexual risk behaviours than their Sierra Leonean counterparts (AOR = 0.572; 95%CI: 0.345-0.946). Male, compared to females, were more likely to engage in multiple sexual risk behaviour (AOR = 2.310;95%CI:1.543-3.458), with a similar pattern observed in both countries. Alcohol use was associated with multiple sexual risk behaviour (AOR = 3.064; 95%CI: 2.137-4.392). Also, in Sierra Leone and Liberia, adolescents with one and two or more forms of psychological distress were more likely to have ever had sex than those who did not show any form of psychological distress. Missing class/school was associated with multiple sexual risk behaviour (AOR = 1.655; 95%CI:1.133-2.418). Peer support was only found to be a protective factor against no condom use among Liberian adolescents (AOR = 0.608; 95%CI: 0.435-0.850). Less parental support was only associated with ever had sex among adolescents in Sierra Leone (AOR = 2.027; 95%CI: 1.322-3.107) but not in Liberia (AOR = 1.034; 95%CI: 0.650-1.644). CONCLUSION Our study found a high sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia. Our finding highlights the need to strengthen sexual and reproductive health education in schools and communities that incorporate mental health promotion activities tailored to this group.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala Campus, Njala, Sierra Leone
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Emmanuel Kamanda Margao
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Lew B, Lester D, Kõlves K, Yip PSF, Chen YY, Chen WS, Hasan MT, Koenig HG, Wang ZZ, Fariduddin MN, Zeyrek-Rios EY, Chan CMH, Mustapha F, Fitriana M, Dolo H, Gönültaş BM, Dadfar M, Davoudi M, Abdel-Khalek AM, Chan LF, Siau CS, Ibrahim N. An analysis of age-standardized suicide rates in Muslim-majority countries in 2000-2019. BMC Public Health 2022; 22:882. [PMID: 35509027 PMCID: PMC9066769 DOI: 10.1186/s12889-022-13101-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study examines the 20-year trend of suicide in 46 Muslim-majority countries throughout the world and compares their suicide rates and trends with the global average. Ecological-level associations between the proportion of the Muslim population, the age-standardized suicide rates, male-to-female suicide rate ratio, and the Human Development Index (HDI) in 2019 were examined. METHODS Age-standardized suicide rates were extracted from the WHO Global Health Estimates database for the period between 2000 and 2019. The rates in each country were compared with the age-standardized global average during the past 20 years. The countries were further grouped according to their regions/sub-regions to calculate the regional and sub-regional weighted age-standardized suicide rates involving Muslim-majority countries. Correlation analyses were conducted between the proportion of Muslims, age-standardized suicide rate, male: female suicide rate ratio, and the HDI in all countries. Joinpoint regression was used to analyze the age-standardized suicide rates in 2000-2019. RESULTS The 46 countries retained for analysis included an estimated 1.39 billion Muslims from a total worldwide Muslim population of 1.57 billion. Of these countries, eleven (23.9%) had an age-standardized suicide rate above the global average in 2019. In terms of regional/sub-regional suicide rates, Muslim-majority countries in the Sub-Saharan region recorded the highest weighted average age-standardized suicide rate of 10.02/100,000 population, and Southeastern Asia recorded the lowest rate (2.58/100,000 population). There were significant correlations between the Muslim population proportion and male-to-female rate ratios (r=-0.324, p=0.028), HDI index and age-standardized suicide rates (r=-0.506, p<0.001), and HDI index and male-to-female rate ratios (r=0.503, p<0.001) in 2019. Joinpoint analysis revealed that seven Muslim-majority countries (15.2%) recorded an increase in the average annual percentage change regarding age-standardized suicide rates during 2000-2019. CONCLUSIONS Most Muslim-majority countries had lower age-standardized suicide rates than the global average, which might reflect religious belief and practice or due to Muslim laws in their judicial and social structure which may lead to underreporting. This finding needs further in-depth country and region-specific study with regard to its implication for public policy.
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Affiliation(s)
- Bob Lew
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - David Lester
- Stockton University, Galloway, New Jersey, United States
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland, Australia
| | - Paul S F Yip
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
| | - Won Sun Chen
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - M Tasdik Hasan
- Jeeon Bangladesh Ltd., Dhaka, Bangladesh.,Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Harold G Koenig
- Duke University Medical Center, Durham, NC, USA.,King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zhi Zhong Wang
- Department of Epidemiology and Statistics, School of Public Health at Guangdong Medical University, Dongguan, Guangdong, China
| | - Muhamad Nur Fariduddin
- Faculty of Education, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | | | - Caryn Mei Hsien Chan
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Feisul Mustapha
- Non-Communicable Diseases Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Mimi Fitriana
- Department of Psychology, International University of Malaya-Wales, Kuala Lumpur, Malaysia.,Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Housseini Dolo
- Filariasis Unit, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali
| | - Burak M Gönültaş
- Social Work Department., Faculty of Letters, Sivas Cumhuriyet University, Sivas, Turkey
| | - Mahboubeh Dadfar
- Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Davoudi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmed M Abdel-Khalek
- Department of Psychology, Faculty of Arts, Alexandria University, Alexandria, Egypt
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Norhayati Ibrahim
- Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Institute of Islam Hadhari, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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