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Mirti AF, Kane JC, Watt KG, Desmond C, Gruver RS, Munsami A, Myeza NP, Norwitz GA, Davidson LL. Does perceived caregiver HIV stigma and depression increase adolescent neuro-behavioral difficulties? A mediation analysis in the Asenze Cohort. RESEARCH SQUARE 2024:rs.3.rs-4543382. [PMID: 39070660 PMCID: PMC11276019 DOI: 10.21203/rs.3.rs-4543382/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: 07/30/2024]
Abstract
People living with HIV (PLWH) often experience HIV related stigma that is, in turn, associated with several negative health outcomes including depression, harmful drinking, and intimate partner violence. Despite knowledge of these proximal impacts of HIV stigma on PLWH, less is known about the impact that Caregivers living with HIV's perception of stigma has on the health and behavior of adolescents in their care. Utilizing data from adolescents and their primary caregivers from the population-based Asenze cohort study in KwaZulu-Natal, South Africa, we conducted a path analysis to determine if caregiver depression [operationalized as mental health functioning] is a mediator of the hypothesized association between caregiver HIV stigma and adolescent neurodevelopmental behavior including internalizing and externalizing behaviors. Results suggest good model fit and a statistically significant relationship between caregiver HIV stigma and caregiver mental health functioning. However, neither the direct nor indirect (including potential mediator caregiver mental health functioning) effect of HIV stigma on adolescent behavioral difficulties was statistically significant. This paper builds on previous research demonstrating the relationship between HIV stigma and depression, highlighting the need for continued study of underlying mechanisms that impact the stigma and health of PLWH and others important to them such as their children.
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Affiliation(s)
- Amaleah F. Mirti
- Department of Sociomedical Sciences, Columbia University, New York City, USA
| | - Jeremy C. Kane
- Department of Epidemiology, Columbia University, New York City, USA
| | - Kathryn G. Watt
- Centre for Rural Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Chris Desmond
- Centre for Rural Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel S. Gruver
- Department of Epidemiology, Columbia University, New York City, USA
| | - Adele Munsami
- Centre for Rural Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nonhlanhla P. Myeza
- Centre for Rural Health, School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
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Njuguna IN, King'e M, Moraa H, Kumar M, Benki-Nugent S, Wagner AD, McGrath CJ, Dorsey S, Ndegwa S, Onyango A, Wamalwa D, John-Stewart G. Cohort profile: longitudinal and population comparison of children who are HIV-exposed uninfected and children who are HIV unexposed in Kenya (HOPE study). BMJ Open 2024; 14:e081975. [PMID: 38844397 PMCID: PMC11163661 DOI: 10.1136/bmjopen-2023-081975] [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: 11/10/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
PURPOSE Globally, the number of children/adolescents exposed to HIV but uninfected (HIV-exposed uninfected, HEU) is growing. The HEU outcomes: population-evaluation and screening strategies study was designed to provide population-level evidence of the impact of HIV and recent antiretroviral therapy regimen exposure on neurodevelopmental, hearing and mental health outcomes from infancy to adolescence. PARTICIPANTS The study includes a prospective mother-infant cohort and cross-sectional child/youth-caregiver cohorts conducted in Kenya.Between 2021 and 2022, the study enrolled 2000 mother-infant pairs (1000 HEU and 1000 HIV-unexposed uninfected (HUU)) for longitudinal follow-up. Infants were eligible if they were aged 4-10 weeks and healthy. Mothers were eligible if their HIV status was known and were ≥18 years. Study visits are 6 monthly until the child reaches age 3 years.Cross-sectional cohorts spanning ages 3-18 years started enrolment in 2022. Target enrolment is 4400 children/youth (4000 HEU and 400 HUU). Children and youth are eligible if they are HIV negative, maternal HIV status and timing of diagnosis is known, and caregivers are ≥18 years.Data on infant/child/youth growth, neurodevelopment, mental health, morbidity and hearing are collected at enrolment using standardised tools. Dry blood spots samples are collected for telomere length assessment at baseline and yearly for the longitudinal cohort. Growth z-scores, neurodevelopmental scores, telomere length and prevalence of developmental and hearing problems will be compared between HEU/HUU populations. FINDINGS TO DATE Full cohort enrolment for the longitudinal cohort is complete and participants are in follow-up. At 1 year of age, comparing HEU to HUU neurodevelopment using the Malawi developmental assessment tool, we found that HEU infants had higher language scores and comparable scores in fine motor, gross motor and social scores. The cross-sectional cohort has enrolled over 2000 participants and recruitment is ongoing. FUTURE PLANS Longitudinal cohort follow-up and enrolment to the cross-sectional study will be completed in June 2024.
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Affiliation(s)
- Irene N Njuguna
- Department of Medical Research, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Maureen King'e
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Helen Moraa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Manasi Kumar
- Grossman School of Medicine, New York University, New York City, New York, USA
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Sarah Benki-Nugent
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anjuli Dawn Wagner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Shannon Dorsey
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Serah Ndegwa
- Departnment of Surgery, University of Nairobi, Nairobi, Kenya
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Deaprtment of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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AlSamhori JF, Toubasi AA, Jaber DZ, Ghanem HH, Thainat BI, AlSamhori AF, Kalbouneh H. Jordanian parental perception of screen time and its association with psychological distress: A cross-sectional design. Pediatr Neonatol 2024:S1875-9572(24)00052-4. [PMID: 38677918 DOI: 10.1016/j.pedneo.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The excessive use of electronic devices among children is a global concern because of its negative impact on behavior. This cross-sectional study aimed to assess parents' awareness of their children's electronic device use and their perspective on how screen time affects behavior for 4-10-year-olds in Jordan. METHODS A cross-sectional study was conducted to assess parents' awareness of their children's electronic device usage. The study included 807 mothers and fathers from Jordan with at least one child aged 4 to 10. The data collection instrument consisted of a self-administered survey with 43 questions, including sociodemographic characteristics and the Strength and Difficulties Questionnaire. Descriptive analysis, categorical Chi-square test, Independent t-test, and Mann-Whitney U test were used for statistical analysis. The study followed ethical standards and principles. RESULTS A survey of 807 parents in Jordan found that gaming and videos were the most common content watched by children, and 61.3% used devices alone. Only 37.1% of parents believed that device use could improve their children's psychological growth, while 72.7% and 65.9% believed it could impact negatively their children's mental and psychological growth, respectively. The Strengths and Difficulties Questionnaire showed that 51.4% of children were normal, while 25.3% were borderline and 23.3% were abnormal. CONCLUSION Children in the study used electronic devices excessively and this was linked to severe behavioral problems. Parents should follow AAP guidelines and spend more time with their children through non-electronic activities to improve their behavior.
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Affiliation(s)
| | | | - Dunia Z Jaber
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | | | | | | | - Heba Kalbouneh
- Department of Anatomy, Faculty of Medicine, University of Jordan, Amman, Jordan
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Dielemans A, Mahat P, Dunn JA, Balcke E, Kumar Jha R, Ghimire S, Gaire H, Honikman S. Prevalence of maternal depression and anxiety symptoms and associations with child mental health outcomes in rural Nepal. Trop Med Int Health 2024; 29:128-136. [PMID: 38126274 DOI: 10.1111/tmi.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well-understood in rural, community-based settings in low- and middle-income countries (LMIC). METHODS A sample of 347 women with children under 5 years was recruited in September 2019 for a cross-sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. RESULTS In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1-3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02-5.84). In contrast, there was no association between maternal anxiety and child outcomes. CONCLUSIONS Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low-resourced and community-based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post-infancy, emphasising the importance of improving maternal mental health in the early years of a child's life.
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Affiliation(s)
| | - Pashupati Mahat
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Julia Alexandra Dunn
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Emily Balcke
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Rajesh Kumar Jha
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Smriti Ghimire
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Himal Gaire
- Centre for Mental Health and Counselling Nepal, Kathmandu, Nepal
| | - Simone Honikman
- Perinatal Mental Health Project, Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Kaseka PU, Zgambo M, Mbakaya BC, Lazarus M, Nkhata O, Kalembo FW. Emotional and behavioural difficulties among children and adolescents attending "ART teen clubs" in Mzuzu City in northern Malawi: a cross-sectional study. BMC Pediatr 2024; 24:41. [PMID: 38218758 PMCID: PMC10787500 DOI: 10.1186/s12887-023-04504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND While triple anti-retroviral therapy (ART) has improved HIV-infected children surviving into adolescence and adulthood, these children remain vulnerable to HIV-related psychological disturbance due to both the direct HIV infection effects on the brain and indirect effects related to coping with a range of medical, psychological and social stresses associated with HIV, which makes it vital to identify their mental health needs. This study assessed the emotional and behavioural challenges of HIV perinatally infected children and adolescents with a completed disclosure process attending "ART teen club" in Malawi. METHODS A cross-sectional descriptive study design was conducted to obtain quantitative descriptive descriptions of emotional and behavioural challenges among HIV-infected children and adolescents between 10 and 22 years of age. They were interviewed on their family socio-demographic characteristics, clinical characteristics as well as emotional, conduct, hyperactivity, peer and prosocial problems using the Chichewa version of the Strengths and Difficulties Questionnaire. Data were analyzed using descriptive analysis and logistic regression. RESULTS Based on the four-band categorization of the SDQ, higher scores for total difficulties score were observed in 72.9% of the children. According to the subscales of the SDQ, results show that children had higher scores in peer problems (62.8%), emotional (68.2%), conduct (68.6%) and prosocial (57.8%) subscales while lower scores were identified in the hyperactivity (16.6%) subscale. Results show that within each level, males are having lower frequencies as compared to females. Results from multivariate binary logistic regression indicate that those with a single parent or not as well as the WHO HIV clinical stage had an impact on the mental health status of the children. Children who do not have a single parent (AOR 3.404; 95% CI:1.563-7.416, p = 0.002) had 3.404 odds of having abnormal mental health status unlike those children with a single parent and children who were in WHO HIV clinical stage 2 (AOR 2.536; 95% CI:1.005-6.395, p = 0.049) or 3 and 4 (AOR 8.459; 95% CI:1.5.820-10.544, p < 0.001) had more odds of having the mental disorder as compared with those children in WHO HIV clinical stage 1. CONCLUSION The findings of this research underscore the multifaceted nature of mental well-being among children and adolescents living with HIV. Elevated scores in total difficulties, emotional, conduct, and peer problems signify areas of concern, while disparities in hyperactivity and prosocial behavior highlight the nuanced nature of their behavioral challenges. Recognizing the inadequacy of a one-size-fits-all approach, the research emphasizes the necessity of a comprehensive strategy, incorporating factors like religious background, family structure, and clinical HIV stage. Furthermore, the role of "ART teen clubs" in this context is pivotal. Beyond addressing identified risk factors, these clubs must actively foster resilience. Creating an inclusive environment, tapping into individual strengths, and nurturing a sense of community are vital components. By adopting such a holistic approach, Teen support clubs can significantly contribute to the overall mental well-being of adolescents living with HIV, enabling them to navigate challenges effectively and thrive amidst their circumstances.
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Affiliation(s)
- Paul Uchizi Kaseka
- Paediatric Department, Mzuzu Central Hospital, Private Bag 209, Mzuzu, Malawi.
| | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Balwani Chingatichifwe Mbakaya
- Public Health, University of Livingstonia, Mzuzu, Malawi
- Nursing and Midwifery Department, Mzuzu University, Mzuzu, Malawi
| | - Mathews Lazarus
- Basic Department, Kamuzu University for Health Sciences, Lilongwe, Malawi
| | - Obed Nkhata
- Investigations Department, Nurses and Midwives Council of Malawi, Mzuzu, Malawi
| | - Fatch W Kalembo
- School of Nursing, Curtin University, Bentley, Western Australia
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Sutherland SC, Shannon HS, Ayuku D, Streiner DL, Saarela O, Atwoli L, Hogan J, Braitstein P. Resilience and associated factors in orphaned and separated adolescents in Kenya: Understanding the relationship with care environment and HIV risks. Glob Public Health 2024; 19:2271970. [PMID: 38252788 PMCID: PMC10832302 DOI: 10.1080/17441692.2023.2271970] [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: 10/06/2022] [Accepted: 10/12/2023] [Indexed: 01/24/2024]
Abstract
Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one's material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10-26 living in Charitable Children's Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7-36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors.
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Affiliation(s)
- Sarah C. Sutherland
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Harry S. Shannon
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Science, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Canada
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th, L8N 3K7, Hamilton, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8, Toronto, Canada
| | - Olli Saarela
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
- Brain and Mind Institute and the Department of Medicine, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Joseph Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, Eldoret, Kenya
- Department of Biostatistics, Brown University, 121 S Main St, Providence, RI 02912, Rhode Island, United States of America
| | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, Eldoret, Kenya
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
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Asare K, Ntlantsana V, Ranjit K, Tomita A, Paruk S. Relationship between physical activity and behaviour challenges of adolescents in South Africa. S Afr J Psychiatr 2023; 29:2124. [PMID: 38223307 PMCID: PMC10784231 DOI: 10.4102/sajpsychiatry.v29i0.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/24/2023] [Indexed: 01/16/2024] Open
Abstract
Background Four out of five adolescents worldwide are physically inactive based on recommended standards. Aim We determined whether physical activity is associated with lower behavioural challenges in adolescents to promote buy-in from stakeholders. Setting KwaZulu-Natal province, South Africa, from January 2020 to March 2020. Methods A cross-sectional study was conducted among 187 adolescent learners (12-18 years) from three government schools in KwaZulu-Natal Province, South Africa, from January to March 2020. We fitted linear regression models between the Strengths and Difficulties Questionnaire scores (total, internalising, externalising, and prosocial) and hours of physical activity exposure, adjusting for demographic covariates, and depression history. Results The median age was 14.4 years (interquartile range = 1.36) and 75.9% of the participants were females. Overall average and weekday physical activity were each associated with lower total and externalising but higher pro-social scores. Depression was associated with higher inactivity scores (total, internalising and externalising). Conclusions The article shows that physical activity can reduce the behavioural and emotional problems in adolescents. Contribution Physical activity is critical for a healthy adolescent hood and needs to be actively included in childhood development.
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Affiliation(s)
- Kwabena Asare
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Vuyokazi Ntlantsana
- Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Karina Ranjit
- Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Doerr CM, Hoeffler A, Goessmann K, Olorunlambe W, Hecker T. Sexual violence affects adolescents' health and prosocial behaviour beyond other violence exposure. Eur J Psychotraumatol 2023; 14:2263319. [PMID: 37843878 PMCID: PMC10580796 DOI: 10.1080/20008066.2023.2263319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/22/2023] [Indexed: 10/17/2023] Open
Abstract
Background: Sexual violence is a public health issue among adolescents globally but remains understudied in Sub-Saharan Africa.Objective: The present study focused on the association of cumulative exposure to different types of sexual violence with mental and physical health problems and prosocial behaviour.Method: We conducted a survey with a regionally representative sample of both in-school and out-of-school adolescents, aged 13-17 years, living in south-western Nigeria. Self-reported exposure to sexual violence, behavioural problems, physical complaints, and prosocial behaviour were assessed.Results: About three quarters of the participants reported the experience of sexual violence (74.6%). Multiple regression models revealed that the more types of sexual violence an individual reported, the more mental and physical health problems, and the fewer prosocial behaviours they reported when controlling for other forms of violence exposure. Latent class analysis revealed three severity classes of sexual violence. Symptoms of mental and physical health indicators were significantly higher as exposure increased by group whereas prosocial behaviours were non-significantly fewer in the opposite direction.Conclusion: This study revealed a consistent and unique relation between sexual violence exposure and negative health outcomes among adolescents. Further research on sexual violence in Sub-Saharan Africa and its associations is needed.
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Affiliation(s)
- Carla Maria Doerr
- Department of Psychology & Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Bielefeld, Germany
| | - Anke Hoeffler
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Kate Goessmann
- Department of Psychology & Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Bielefeld, Germany
| | - Wasiu Olorunlambe
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Tobias Hecker
- Department of Psychology & Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Bielefeld, Germany
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Surendran G, Sarkar S, Kandasamy P, Rehman T, Eliyas S, Sakthivel M. Effect of life skills education on socio-emotional functioning of adolescents in urban Puducherry, India: A mixed-methods study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:250. [PMID: 37727404 PMCID: PMC10506769 DOI: 10.4103/jehp.jehp_434_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/19/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND We wanted to assess the effect of life skills education (LSE) and regular curriculum on the self-esteem, self-efficacy, adjustment, and psychosocial functioning of students from co-educational government schools, compared to those receiving only the regular curriculum. The secondary objectives were to study the feasibility of such sessions and identify the factors affecting the effectiveness of the sessions. MATERIALS AND METHODS We conducted a mixed-methods study in government schools of urban Puducherry, India in 2018-2019. The quantitative component was a cluster-randomized trial with activity-based learning methods delivered over 10 sessions in the intervention arm (IA). Differences in outcome variables (self-esteem, self-efficacy, adjustment, psychosocial behavior) between baseline and after intervention in each of the groups were calculated, and the difference-in-differences (DID) technique was applied to account for any natural change in scores over time. Qualitative data were collected through focused group discussions (FGDs) among students and teachers. Analysis was founded on a positivist paradigm with inducto-deductive methodology. RESULTS The mean (SD) age of 258 participants was 13 (1) years in both arms. The mean (SD) difference between baseline and end-line for IA and control arm (CA) was 0.3 (4.4) and - 0.1 (4.0), for self-esteem (P = 0.38), 0.03 (6.0) and - 1.1 (6.1) for self-efficacy (P = 0.12), and - 0.04 (3.5) and - 0.05 (4.3) for adjustment (P = 0.73), respectively. Similarly, the median (interquartile range [IQR]) difference in the conduct problems scale of the Strengths and Difficulties Questionnaire was - 1 (-2, 1) and 0 (-1, 1) (P < 0.01). Five FGDs revealed multiple positive effects on anger management, conduct, self-awareness, and responsible behavior. All 10 teachers viewed life skills education (LSE) positively. CONCLUSIONS LSE positively affects adolescents' socio-emotional functioning, but more extended periods of exposure are needed to demonstrate discernible change. The feasibility of implementation depends on the syllabus and based on health policies.
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Affiliation(s)
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | | | - Tanveer Rehman
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Salin Eliyas
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
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Lenhart J, Richter T, Appel M, Mar RA. Adolescent leisure reading and its longitudinal association with prosocial behavior and social adjustment. Sci Rep 2023; 13:9695. [PMID: 37322024 PMCID: PMC10272230 DOI: 10.1038/s41598-023-35346-7] [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: 03/28/2021] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Reading is a popular leisure activity for children, teenagers, and adults. Several theories agree that reading might improve social cognition, but the empirical evidence remains tentative, with research on adolescents especially lacking. We employed a very large, and nationally representative, longitudinal dataset from the National Educational Panel Study (NEPS) in Germany to examine this hypothesis. Specifically, we tested whether reading prospectively predicted future self-reported prosocial behavior and social adjustment in adolescents, controlling for a number of covariates. Two-way cross-lagged panel analyses probed the longitudinal relationship between leisure reading and these social outcomes from Grade 6 to Grade 9. In addition, we examined the effect of cumulative reading experience across Grades 5-8 on future social outcomes, using structural equation modeling. We also explored the unique contributions of cumulative reading experience in different literary genres (classic literature, popular literature, nonfiction, comic books). Cumulative reading in general did not predict future prosocial behavior and social adjustment. However, cumulative reading of modern classic literature was positively associated with later prosocial behavior and social adjustment. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 08 November 2021. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/KSWY7 .
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Affiliation(s)
- Jan Lenhart
- Department of Psychology, University of Bamberg, Bamberg, Germany.
| | - Tobias Richter
- Department of Psychology IV, University of Würzburg, Würzburg, Germany
| | - Markus Appel
- Department of Human-Computer-Media, University of Würzburg, Würzburg, Germany
| | - Raymond A Mar
- Department of Psychology IV, University of Würzburg, Würzburg, Germany
- Department of Psychology, York University, Toronto, Canada
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Doyle AM, Bandason T, Dauya E, McHugh G, Grundy C, Simms V, Chibanda D, Ferrand R. Common mental health and emotional and behavioural disorders among adolescents and young adults in Harare and Mashonaland East, Zimbabwe: a population-based prevalence study. BMJ Open 2023; 13:e065276. [PMID: 36918245 PMCID: PMC10016291 DOI: 10.1136/bmjopen-2022-065276] [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: 06/05/2022] [Accepted: 12/21/2022] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of common mental health disorders (CMDs) and emotional and behavioural disorders among young people and to explore the correlates of CMDs risk. SETTING Five urban and periurban communities in Harare and Mashonaland East, Zimbabwe DESIGN: Population-based cross-sectional study PARTICIPANTS: Young people aged 13-24 years living in households in the study areas. OUTCOME MEASURES The primary outcome was the proportion of participants screening positive for probable CMDs defined as a Shona Symptoms Questionnaire (SSQ) score ≥8. Secondary outcomes were emotional and behavioural disorders measured using the Strength and Difficulties Questionnaire (SDQ), and adjusted ORs for factors associated with CMD. RESULTS Out of 634 young people, 37.4% (95% CI 33.0% to 42.0%) screened positive for probable CMDs, 9.8% (95% CI 7.5% to 12.7%) reported perceptual symptoms and 11.2% (95% CI 9.0% to 13.8%) reported suicidal ideation. Using UK norms to define normal, borderline and abnormal scores for each of the SDQ domains, a high proportion (15.8%) of Zimbabwean young people had abnormal scores for emotional symptoms and a low proportion had abnormal scores for hyperactivity/inattention scores (2.8%) and prosocial scores (7.1%). We created local cut-offs for the emotional symptoms, hyperactivity/attention and prosocial SDQ domains. The odds of probable CMDs increased with each year of age (OR 1.09, p<0.001) and was higher among those who were out of school and not working compared with those in school or working (adj. OR 1.67 (1.07, 2.62), p=0.04). One in five participants (22.1%) were referred immediately for further clinical assessment but uptake of referral services was low. CONCLUSIONS We observed a high prevalence of symptoms of CMDs among general population urban and peri-urban young people especially among those with no employment. There is a need for more accessible and acceptable youth-friendly mental health services.
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Affiliation(s)
- Aoife Margaret Doyle
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
| | - T Bandason
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
| | - E Dauya
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chris Grundy
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
| | - D Chibanda
- Department of Psychiatry, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida Ferrand
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Nagenda MC, Crowley T. Contextual Factors Influencing Self-Management of Adolescents and Youth Living with HIV: A Cross-Sectional Survey in Lesotho. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:238. [PMID: 36612559 PMCID: PMC9819797 DOI: 10.3390/ijerph20010238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Background: HIV treatment outcomes of adolescents and youth living with HIV (AYLWH) are lagging. One way to improve outcomes is through supporting AYLWH to acquire self-management skills. Although self-management is associated with improved health outcomes, condition-specific, individual/family, and social/environmental contextual factors influence self-management. We aimed to describe factors influencing the self-management of AYLWH in Lesotho. Methods: A cross-sectional survey design was used. AYLWH (n = 183) aged 15−24 were conveniently sampled from two HIV treatment sites in Lesotho. Participants completed self-report questionnaires in English or Sesotho. Results: Participants (89.1% female) had high HIV self-management scores (mean 92.7%, SD 5.3%) that corresponded with treatment outcomes (98.9% adherent and 100% viral load < 1000 copies/mL). This might be attributed to condition-specific factors, including once-daily doses (100%) and longer duration of treatment (81.4% on ART for more than 10 years). Participants were older (median age 22), and the majority (61.7%) had stable living conditions. Individual strengths were associated with higher self-management scores (p < 0.01) and mental health problems with lower self-management scores (p < 0.05). Most (97.9%) were satisfied with their health care services. Conclusions: Uncomplicated treatment regimens, longer duration of treatment, stable living conditions, individual strengths, good mental health, and satisfaction with healthcare services have a positive influence on self-management.
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Affiliation(s)
- Mapaseka Chabalala Nagenda
- Department of Nursing, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7535, South Africa
| | - Talitha Crowley
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
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Bezborodovs Ņ, Kočāne A, Rancāns E, Villeruša A. Clinical Utility of the Parent-Report Version of the Strengths and Difficulties Questionnaire (SDQ) in Latvian Child and Adolescent Psychiatry Practice. Medicina (B Aires) 2022; 58:medicina58111599. [PMID: 36363556 PMCID: PMC9694199 DOI: 10.3390/medicina58111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Objectives: Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing professionals to triage the patient flow in a limited resource setting and help in clinical decision making. Our study aimed to examine whether the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, can reliably detect children and adolescents with different mental disorders in a clinical population sample. Materials and Methods: a total of 363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed. Results: The subscales of the parent-report SDQ showed a significant correlation with the corresponding clinical diagnoses. The sensitivity of the SDQ ranged 65–78%, and the specificity was 57–78%. The discriminative ability of the SDQ, as measured by the diagnostic odds ratio, did not quite reach the level of clinical utility in specialised psychiatric settings. Conclusions: We suggest the SDQ be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.
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Affiliation(s)
- Ņikita Bezborodovs
- Department of Psychiatry and Narcology, Rīga Stradiņš University, LV-1007 Riga, Latvia
- Child Psychiatry Clinic, Children’s Clinical University Hospital, LV-1004 Riga, Latvia
- Correspondence: ; Tel.: +371-28343256
| | - Arta Kočāne
- Child Psychiatry Clinic, Children’s Clinical University Hospital, LV-1004 Riga, Latvia
| | - Elmārs Rancāns
- Department of Psychiatry and Narcology, Rīga Stradiņš University, LV-1007 Riga, Latvia
| | - Anita Villeruša
- Department of Public Health and Epidemiology, Rīga Stradiņš University, LV-1007 Riga, Latvia
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Augsburg B, Attanasio OP, Dreibelbis R, Nketiah-Amponsah E, Phimister A, Wolf S, Krutikova S. Lively Minds: improving health and development through play-a randomised controlled trial evaluation of a comprehensive ECCE programme at scale in Ghana. BMJ Open 2022; 12:e061571. [PMID: 36229147 PMCID: PMC9562311 DOI: 10.1136/bmjopen-2022-061571] [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: 11/04/2022] Open
Abstract
INTRODUCTION Many children in developing countries grow up in environments that lack stimulation, leading to deficiencies in early years of development. Several efficacy trials of early childhood care and education (ECCE) programmes have demonstrated potential to improve child development; evidence on whether these effects can be sustained once programmes are scaled is much more mixed. This study evaluates whether an ECCE programme shown to be effective in an efficacy trial maintains effectiveness when taken to scale by the Government of Ghana (GoG). The findings will provide critical evidence to the GoG on effectiveness of a programme it is investing in, as well as a blueprint for design and scale-up of ECCE programmes in other developing countries, which are expanding their investment in ECCE programmes. METHODS AND ANALYSIS This study is a cluster randomised controlled trial, in which the order that districts receive the programme is randomised. A minimum sample of 3240 children and 360 schools will be recruited across 72 district school cohort pairs. The primary outcomes are (1) child cognitive and socioemotional development measured using the International Development and Early Learning Assessment tool, the Strengths and Difficulties Questionnaire, and tasks from the Harvard Laboratory for Development Studies; (2) child health (measured using height/weight for age, height-for-weight Z scores). Secondary outcomes include (1) maternal mental health, (using Kessler-10 and Warwick Edinburgh Mental Wellbeing Scale) and knowledge of ECCE practices; (2) teacher knowledge, motivation and teaching quality (measured with classroom observation); (3) parental investment (using the Family Care Index and Home Observation Measurement of the Environment and the Child-Parent Relationship Scale); (4) water, sanitation, and hygiene (WASH) practices; (5) acute malnutrition (using mid-upper arm circumference). We will estimate unadjusted and adjusted intent-to-treat effects. ETHICS AND DISSEMINATION Study protocols have been approved by ethics boards at the University College London (21361/001), Yale University (2000031549) and Ghanaian Health Service Ethics Review Committee (028/09/21). Results will be made available to participating communities, funders, the wider public and other researchers through peer-reviewed journals, conference presentations, social and print media and various community/stakeholder engagement activities. TRIAL REGISTRATION NUMBER ISRCTN15360698, AEARCTR-0008500.
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Affiliation(s)
| | | | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Sharon Wolf
- Graduate School of Education, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kansiime C, Hytti L, Nelson KA, Torondel B, Francis SC, Tanton C, Greco G, Belfield S, Nakalema S, Matovu F, Ssemata AS, Alezuyo C, Neema S, Jerrim J, Bonell C, Seeley J, Weiss HA. Menstrual health interventions, schooling, and mental health problems among Ugandan students (MENISCUS): study protocol for a school-based cluster-randomised trial. Trials 2022; 23:759. [PMID: 36071530 PMCID: PMC9449307 DOI: 10.1186/s13063-022-06672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Menstrual health is an increasingly recognised public health issue, defined as complete physical, mental, and social well-being in relation to the menstrual cycle. The MENISCUS trial aims to assess whether a multi-component intervention addressing physical and emotional aspects of menstrual health improves educational attainment, mental health problems, menstrual management, self-efficacy, and quality of life among girls in secondary school in Uganda. METHODS The study is a parallel-arm cluster-randomised controlled trial with 60 schools (clusters) in Wakiso and Kalungu districts, with a mixed-methods process evaluation to assess intervention fidelity and acceptability and economic and policy analyses. The schools will be randomised 1:1 to immediate intervention or to optimised usual care with delayed intervention delivery. The intervention includes creation of a Menstrual Health Action Group at schools and NGO-led training of trainers on puberty education, development of a drama skit, delivery of a menstrual health kit including reusable pads and menstrual cups, access to pain management strategies including analgesics, and basic improvements to school water, sanitation, and hygiene facilities. Baseline data will be collected from secondary 2 students in 2022 (median age ~15.5 years), with endline after 1 year of intervention delivery (~3600 females and a random sample of ~900 males). The primary outcomes assessed in girls are (i) examination performance based on the Mathematics, English, and Biology curriculum taught during the intervention delivery (independently assessed by the Uganda National Examinations Board) and (ii) mental health problems using the Total Difficulties Scale of the Strengths and Difficulties 25-item questionnaire. Secondary outcomes are menstrual knowledge and attitudes in girls and boys and, in girls only, menstrual practices, self-efficacy in managing menstruation, quality of life and happiness, prevalence of urogenital infections, school and class attendance using a self-completed menstrual daily diary, and confidence in maths and science. DISCUSSION The trial is innovative in evaluating a multi-component school-based menstrual health intervention addressing both physical and emotional aspects of menstrual health and using a "training of trainers" model designed to be sustainable within schools. If found to be cost-effective and acceptable, the intervention will have the potential for national and regional scale-up. TRIAL REGISTRATION ISRCTN 45461276 . Registered on 16 September 2021.
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Affiliation(s)
- Catherine Kansiime
- grid.415861.f0000 0004 1790 6116MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Laura Hytti
- grid.8991.90000 0004 0425 469XLSHTM, London, UK
| | | | - Belen Torondel
- grid.8991.90000 0004 0425 469XFaculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | | | | | | | | | | | - Fred Matovu
- grid.11194.3c0000 0004 0620 0548PADRI, Makerere University, Kampala, Uganda
| | - Andrew Sentoogo Ssemata
- grid.415861.f0000 0004 1790 6116MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Connie Alezuyo
- grid.466898.d0000 0004 0648 0949Education Response Plan Secretariat, Ministry of Education and Sports, Kampala, Uganda
| | - Stella Neema
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
| | - John Jerrim
- grid.83440.3b0000000121901201UCL Institute of Education, University College London, London, UK
| | | | - Janet Seeley
- grid.8991.90000 0004 0425 469XLSHTM, London, UK
- Social Science Programme, MRC/UVRI and LSHTM, Entebbe, Uganda
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Lovero KL, Adam SE, Bila CE, Canda ED, Fernandes ME, Rodrigues TIB, Sander MCT, Mellins CA, Duarte CS, Dos Santos PF, Wainberg ML. Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents. BMC Psychiatry 2022; 22:549. [PMID: 35962378 PMCID: PMC9373392 DOI: 10.1186/s12888-022-04189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa. METHODS We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12-19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents. RESULTS Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test-retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test-retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden's index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity. CONCLUSIONS Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W. 168th St. 9th Floor, New York, NY, 10032, USA.
| | | | | | - Elda D Canda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | | | | | - Mariel C Tai Sander
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Claude A Mellins
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- HIV Center for Clinical and Behavioral Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Psychometric properties of the ASEBA Child Behaviour Checklist and Youth Self-Report in sub-Saharan Africa - A systematic review. Acta Neuropsychiatr 2022; 34:167-190. [PMID: 35466902 DOI: 10.1017/neu.2022.5] [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: 01/09/2023]
Abstract
OBJECTIVE Behavioural screening tools may be used to identify at-risk children in resource-limited settings in sub-Saharan Africa. The ASEBA forms (Child Behaviour Checklist and Youth Self-Report) are frequently translated and adapted for use in sub-Saharan African populations, but little is known about their measurement properties in these contexts. METHODS We conducted a systematic review of all published journal articles that used the ASEBA forms with sub-Saharan African samples. We evaluated the reported psychometric properties, as well as the methodological quality of the psychometric evaluations, using COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. RESULTS Fifty-eight studies reported measurement properties of the ASEBA forms. Most studies came from Southern (n = 29, 50%) or East African (n = 25, 43%) countries. Forty-nine studies (84%) used translated versions of the tool, but details regarding the translation process, if available, were often sparse. Most studies (n = 47, 81%) only reported internal consistency (using coefficient alpha) for one or more subscale. The methodological quality of the psychometric evaluations ranged from 'very good' to 'inadequate' across all measurement properties, except for internal consistency. CONCLUSIONS There is limited good quality psychometric evidence available for the ASEBA forms in sub-Saharan Africa. We recommend (i) implementing a standardised procedure for conducting and reporting translation processes and (ii) conducting more comprehensive psychometric evaluations of the translated versions of the tools.
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Hecker T, Kyaruzi E, Borchardt J, Scharpf F. Factors Contributing to Violence Against Children: Insights From a Multi-informant Study Among Family-Triads From Three East-African Refugee Camps. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14507-NP14537. [PMID: 33926287 DOI: 10.1177/08862605211013960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parental violence poses a considerable, yet mitigable risk for the mental health and well-being of refugee children living in resource-poor refugee camps. However, little is known about potential risk factors for parental violence in these settings. Using an ecological systems perspective and a multi-informant approach, we investigated ontogenic (parental childhood experiences of violence), microsystem (parents' and children's psychopathology) and exosystem (families' monthly household income) risk factors for child-directed parental violence in a sample of 226 Burundian families living in refugee camps in Tanzania. Data were collected through individual structured clinical interviews with mothers, fathers, and children. In the child-report path model [χ2 (6) = 7.752, p = .257, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.036 (p = .562)], children's posttraumatic stress disorder (PTSD) symptoms, externalizing symptoms and paternal PTSD symptoms were positively associated with violence by both parents. Maternal psychosocial impairment was positively associated with child-reported paternal violence. In the parent-report path model [χ2 (6) = 7.789, p = .254, CFI = 0.97, RMSEA = 0.036 (p = .535)], children's externalizing problems as well as a lower monthly household income were positively related to maternal violence. Each parent's childhood victimization was positively linked to their use of violence against children. Maternal psychosocial impairment and paternal alcohol abuse were positively associated with paternal violence. Child and paternal psychopathology, maternal psychosocial impairment, parents' childhood victimization, and families' socioeconomic status may be important targets for prevention and intervention approaches aiming to reduce parental violence against refugee children living in camps.
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Affiliation(s)
- Tobias Hecker
- Bielefeld University, Bielefeld, Germany
- University of Zurich, Switzerland
| | - Edna Kyaruzi
- Dar Es Salaam University College of Education, Dar es Salaam, Tanzania
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Sequeira M, Singh S, Fernandes L, Gaikwad L, Gupta D, Chibanda D, Nadkarni A. Adolescent Health Series The status of adolescent mental health research, practice and policy in sub-Saharan Africa: A narrative review. Trop Med Int Health 2022; 27:758-766. [PMID: 35906997 PMCID: PMC9544168 DOI: 10.1111/tmi.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sub‐Saharan Africa (SSA) has the fastest growing adolescent population in the world. In addition to developmental changes, adolescents in SSA face health and socioeconomic challenges that increase their vulnerability to mental ill‐health. This paper is a narrative review of adolescent mental health (AMH) in SSA with a focus on past achievements, current developments, and future directions in the areas of research, practice and policy in the region. We describe the status of AMH in the region, critical factors that negatively impact AMH, and the ways in which research, practice and policy have responded to this need. Depression, anxiety and post‐traumatic stress disorders are the most common mental health problems among adolescents in SSA. Intervention development has largely been focused on HIV/AIDS service delivery in school or community programs by non‐specialist health workers. There is a severe shortage of specialised AMH services, poor integration of services into primary health care, lack of a coordinated inter‐sectoral collaboration, and the absence of clear referral pathways. Policies for the promotion of AMH have been given less attention by policymakers, due to stigma attached to mental health problems, and an insufficient understanding of the link between mental health and social determinants, such as poverty. Given these gaps, traditional healers are the most accessible care available to help‐seeking adolescents. Sustained AMH research with a focus on the socioeconomic benefits of implementing evidence‐based, contextually adapted psychosocial interventions might prove useful in advocating for much needed policies to improve AMH in SSA.
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Affiliation(s)
| | - Soumya Singh
- Addictions Research Group, Sangath, Porvorim, Goa, India
| | | | - Leena Gaikwad
- Addictions Research Group, Sangath, Porvorim, Goa, India
| | - Devika Gupta
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Dixon Chibanda
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Abhijit Nadkarni
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Protective Factors against Self-Harm and Suicidality among Australian Indigenous Adolescents: A Strengths-Based Analysis of the Longitudinal Study of Indigenous Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159131. [PMID: 35897497 PMCID: PMC9330702 DOI: 10.3390/ijerph19159131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022]
Abstract
Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality. Methods: Data came from Footprints in Time—The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents. Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2%). Previous self-harm was reported by 8.2% (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p < 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95% CI 1.31−26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample. Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress.
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Screen Time and Mental Health Among Adolescents: Implications of the Rise in Digital Environment in South Africa. J Nerv Ment Dis 2022; 210:454-461. [PMID: 35394971 DOI: 10.1097/nmd.0000000000001509] [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] [Indexed: 11/27/2022]
Abstract
The rise in use of digital technology among adolescents is unquestionable, with few studies having explored the effect of screen time on mental or behavior challenges in sub-Saharan Africa. We investigated the extent of screen time and its associations with mental/behavior challenges in South Africa. A multisite study was conducted among adolescents aged 15 to 17 years from three government schools in KwaZulu-Natal Province, South Africa. Measures included depressive symptoms (using Patient Health Questionnaire-9), behavioral problems (using Strengths and Difficulties Questionnaire), and screen time (using Children's Leisure Activities Study Survey). The prevalence of severe depressive symptoms, conduct features, and negative prosocial behavior was 11.2% (n = 20), 13.6% (n = 25), and 4.9% (n = 9), respectively. The mean screen time was 2.1 h/d (SD = 2.4) during weekday and 4.7 h/d (SD = 5.5) during weekend. Weekend screen time was significantly associated with a greater likelihood of severe depression and conduct challenges, based on multivariable regression. We also found that greater weekend cell phone use was significantly associated with lower prosocial behavior. No role of weekday screen time was detected in this study. Parents or legal guardians need to be aware of their children's weekend screen time, including cell phones, as access to digital devices becomes more ubiquitous in resource-limited settings.
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22
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Nazareth ML, Kvalsvig JD, Mellins CA, Desmond C, Kauchali S, Davidson LL. Adverse childhood experiences (ACEs) and child behaviour problems in KwaZulu-Natal, South Africa. Child Care Health Dev 2022; 48:494-502. [PMID: 34913192 DOI: 10.1111/cch.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 10/05/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adverse childhood events (ACEs) are associated with negative health effects in adulthood. Despite knowledge of these later impacts, little is known about the earlier effect of ACEs on later child behaviour in low- and middle-income countries (LMIC). METHODS The population-based Asenze cohort study was implemented in a peri-rural area of KwaZulu-Natal, South Africa, comprising five Zulu tribal areas. Two waves of data were examined: family information and ACEs exposure when children were on average 5 years old and child behaviour problems (Strengths and Difficulties Questionnaire [SDQ]) approximately 2 years later (average age 7 years). Logistic regression analysis was used to examine unadjusted and adjusted relationships between cumulative ACEs experienced and the SDQ total scores (dichotomized as top 10% vs. the rest) as well as selected SDQ subscales. RESULTS A significant relationship between increased ACE exposure and SDQ total score was observed. The same relationship was also seen for the SDQ emotional symptoms and conduct problem subscales, but not for hyperactivity. The results of a sensitivity analysis excluding intimate partner violence from the ACEs measure demonstrated similar results. CONCLUSIONS There is an association between exposure to ACEs and later child behaviour problems within this LMIC population demonstrating an early negative impact for ACEs. While previous research has focused on the effects of ACEs on adult health, this study provided evidence for an earlier relationship between ACEs and child behaviour problems that may be a part of the mechanism through which later health effects arise.
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Affiliation(s)
- Meaghan L Nazareth
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jane D Kvalsvig
- School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Chris Desmond
- School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Shuaib Kauchali
- Department of Pediatrics, Nelson Mandela University, Port Elizabeth, South Africa
| | - Leslie L Davidson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York, USA
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23
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Sutherland SC, Shannon HS, Ayuku D, Streiner DL, Saarela O, Atwoli L, Braitstein P. The relationships between resilience, care environment, and social-psychological factors in orphaned and separated adolescents in western Kenya. VULNERABLE CHILDREN AND YOUTH STUDIES 2022; 17:165-179. [PMID: 35874427 PMCID: PMC9302592 DOI: 10.1080/17450128.2022.2067381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
The relationships between care environment, resilience, and social factors in orphaned and separated adolescents and youths (OSAY) in western Kenya are complex and under-studied. This study examines these relationships through the analysis of survey responses from OSAY living in Charitable Children's Institutes (CCI) and family-based care settings (FBS) in Uasin Gishu County, Kenya. The associations between 1) care environment and resilience (measured using the 14-item Resilience Scale); 2) care environment and factors thought to promote resilience (e.g. social, family, and peer support); and 3) resilience and these same resilience-promoting factors, were examined using multivariable linear and logistic regressions. This cross-sectional study included 1202 OSAY (50.4% female) aged 10-26 (mean=16; SD=3.5). The mean resilience score in CCIs was 71 (95%CI=69-73) vs. 64 (95%CI=62-66) in FBS. OSAY in CCIs had higher resilience (β=7.67; 95%CI=5.26-10.09), social support (β=0.26; 95%CI=0.14-0.37), and peer support (β=0.90; 95%CI=0.64-1.17) than those in FBS. OSAY in CCIs were more likely to volunteer than those in FBS (OR=3.72; 95%CI=1.80-7.68), except in the male subgroup. Family (β=0.42; 95%CI=0.24-0.60), social (β=4.19; 95%CI=2.53-5.85), and peer (β=2.13; 95%CI=1.44-2.83) relationships were positively associated with resilience in all analyses. Volunteering was positively associated with resilience (β=5.85; 95%CI=1.51-10.19). The factor most strongly related to resilience in both fully adjusted models was peer support. This study found a strong relationship between care environment and resilience. Care environment and resilience each independently demonstrated strong relationships with peer support, social support, and participating in volunteer activities. Resilience also had a strong relationship with familial support. These data suggest that resilience can be developed through strategic supports to this vulnerable population.
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Affiliation(s)
- Sarah C. Sutherland
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Harry S. Shannon
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Science, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Canada
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5, L8N 3K7, Hamilton, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8 floor, M5T 1R8, Toronto, Canada
| | - Olli Saarela
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
- Brain and Mind Institute and the Department of Medicine, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, Eldoret, Kenya
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
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24
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Aarø LE, Davids EL, Mathews C, Wubs AG, Smith ORF, de Vries PJ. Internalizing problems, externalizing problems, and prosocial behavior - three dimensions of the strengths and difficulties questionnaire (SDQ): A study among South African adolescents. Scand J Psychol 2022; 63:415-425. [PMID: 35388463 DOI: 10.1111/sjop.12815] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the factor structure of the Strengths and Difficulties Questionnaire Self-Report version (SDQ-S), its psychometric properties and measurement invariance by gender and language spoken at home, among secondary school students in Western Cape, South Africa. A sample of 3,542 adolescents in Grade 8 (Mean age = 13.7 years) completed the SDQ-S in a three-language questionnaire (Afrikaans, English and isiXhosa). The data were collected from 42 secondary schools in Cape Town, South Africa. Confirmatory factor analyses with the WLSMV estimator with adjustment for cluster effects (schools) were applied. The SDQ-S was originally developed to cover five domains: four "difficulty" domains (hyperactivity/inattention, emotional, conduct, and peer) and one "strengths" domain (prosocial behavior). When the five factors were tested on the data for the current study, poor fit was obtained. After excluding four items, a three-factor solution with no cross-loadings and no correlated error terms obtained acceptable fit. The results are consistent with previous studies. Strong measurement invariance across genders and language spoken at home was confirmed. In studies of community samples, the use of the SDQ-S scale as an instrument with a three-factor dimension (internalizing, externalizing and prosocial) may be more appropriate than using the original five-factor model.
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Affiliation(s)
- Leif Edvard Aarø
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Eugene L Davids
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Annegreet Gera Wubs
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Petrus J de Vries
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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25
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Nanyunja C, Sadoo S, Mambule I, Mathieson SR, Nyirenda M, Webb EL, Mugalu J, Robertson NJ, Nabawanuka A, Gilbert G, Bwambale J, Martinello K, Bainbridge A, Lubowa S, Srinivasan L, Ssebombo H, Morgan C, Hagmann C, Cowan FM, Le Doare K, Wintermark P, Kawooya M, Boylan GB, Nakimuli A, Tann CJ. Protocol for the Birth Asphyxia in African Newborns (Baby BRAiN) Study: a Neonatal Encephalopathy Feasibility Cohort Study. Gates Open Res 2022; 6:10. [PMID: 35614965 PMCID: PMC9110736 DOI: 10.12688/gatesopenres.13557.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: Neonatal encephalopathy (NE) is a leading cause of child mortality worldwide and contributes substantially to stillbirths and long-term disability. Ninety-nine percent of deaths from NE occur in low-and-middle-income countries (LMICs). Whilst therapeutic hypothermia significantly improves outcomes in high-income countries, its safety and effectiveness in diverse LMIC contexts remains debated. Important differences in the aetiology, nature and timing of neonatal brain injury likely influence the effectiveness of postnatal interventions, including therapeutic hypothermia. METHODS: This is a prospective pilot feasibility cohort study of neonates with NE conducted at Kawempe National Referral Hospital, Kampala, Uganda. Neurological investigations include continuous video electroencephalography (EEG) (days 1-4), serial cranial ultrasound imaging, and neonatal brain Magnetic Resonance Imaging and Spectroscopy (MRI/ MRS) (day 10-14). Neurodevelopmental follow-up will be continued to 18-24 months of age including Prechtl's Assessment of General Movements, Bayley Scales of Infant Development, and a formal scored neurological examination. The primary outcome will be death and moderate-severe neurodevelopmental impairment at 18-24 months. Findings will be used to inform explorative science and larger trials, aiming to develop urgently needed neuroprotective and neurorestorative interventions for NE applicable for use in diverse settings. DISCUSSION: The primary aims of the study are to assess the feasibility of establishing a facility-based cohort of children with NE in Uganda, to enhance our understanding of NE in a low-resource sub-Saharan African setting and provide infrastructure to conduct high-quality research on neuroprotective/ neurorestorative strategies to reduce death and disability from NE. Specific objectives are to establish a NE cohort, in order to 1) investigate the clinical course, aetiology, nature and timing of perinatal brain injury; 2) describe electrographic activity and quantify seizure burden and the relationship with adverse outcomes, and; 3) develop capacity for neonatal brain MRI/S and examine associations with early neurodevelopmental outcomes.
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Affiliation(s)
| | - Samantha Sadoo
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ivan Mambule
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | | | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - J Mugalu
- Kawempe National Referral Hospital, Kampala, UK
| | - Nicola J Robertson
- University College London, London, UK
- University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | | | | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, Australia
| | | | | | - Kirsty Le Doare
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- St George's, University of London, London, UK
| | | | - Michael Kawooya
- Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
| | | | - Annettee Nakimuli
- Kawempe National Referral Hospital, Kampala, UK
- Makarere University, Kampala, Uganda
| | - Cally J Tann
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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26
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Scharpf F, Mkinga G, Masath FB, Hecker T. A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps. Eur Child Adolesc Psychiatry 2021; 30:1651-1662. [PMID: 32959157 PMCID: PMC8505296 DOI: 10.1007/s00787-020-01649-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022]
Abstract
Children and adolescents' mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7-15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children's post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children's vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children's prosocial behavior, just as mothers' social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth's mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.
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Affiliation(s)
- Florian Scharpf
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany.
| | - Getrude Mkinga
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Faustine Bwire Masath
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
- Vivo International, Konstanz, Germany
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
- Department of Psychology, University of Zurich, Zurich, Switzerland
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27
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Loginova SV, Slobodskaya HR. Interactions Between Child Personality and Parenting in Relation to Child Well-Being: Support for Diathesis-Stress and Differential Susceptibility Patterns. Front Psychol 2021; 12:558224. [PMID: 34413805 PMCID: PMC8369233 DOI: 10.3389/fpsyg.2021.558224] [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: 05/01/2020] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
It is well-recognized that the individual characteristics of children moderate the effects of developmental conditions on the well-being of a child. The majority of interactions follow a diathesis-stress pattern; there is also evidence for differential susceptibility and vantage sensitivity models. The present study aimed to examine interactions between parenting and child personality in relation to the well-being of a Russian child and to evaluate the models for moderated relationships. Participants were primary caregivers of 370 children aged 2-7 years. Moderation effects were examined using hierarchical multiple regression and bivariate linear models. In order to differentiate between the models of environmental sensitivity, the analysis of regions of significance was used. Consistent with a diathesis-stress framework, the results revealed that among children low in conscientiousness and high in activity, punitive parenting was a risk factor for externalizing problems; among introverted and fearful children, punitive parenting was a risk factor for internalizing problems. Positive parenting/involvement was a protective factor for internalizing behavior, only for children low in openness. The findings also demonstrate the following evidence for the differential susceptibility model: children low in Beta higher-order personality trait (also known as plasticity or personal growth) showed more total problems when faced with low positive parenting, but fewer problems when experiencing high-quality parenting.
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Affiliation(s)
- Svetlana V. Loginova
- Department of Child Development and Individual Differences, State Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
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28
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Aoki A, Ganchimeg T, Naranbaatar N, Khishigsuren Z, Gundegmaa L, Bat-Erdene S, Munkhbaatar B, Mori R, Kikuchi A, Soya H, Kasai K, Takehara K. Validation of the parent version of the Strengths and Difficulties Questionnaire (SDQ) to screen mental health problems among school-age children in Mongolia. BMC Psychiatry 2021; 21:218. [PMID: 33926396 PMCID: PMC8086060 DOI: 10.1186/s12888-021-03218-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/18/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Child and adolescent mental health problems are urgent health issues in low- and middle-income countries. To promote child and adolescent mental health services, simple validated screening tools are helpful. In Mongolia, the Strengths and Difficulties Questionnaire (SDQ), an internationally used child and adolescent mental health screening tool for children aged 4-17, was translated but not yet validated. To use the questionnaire appropriately, validation is necessary. METHODS Children at 4th year at elementary school (community sample) and children visited psychiatric outpatient service (clinical sample) were recruited and their parental version of the SDQ was compared. The discriminating ability of the parental version of the SDQ was examined using Receiver Operating Characteristics (ROC) analysis on the SDQ total difficulties score. The area under the ROC curve (AUC) was used as a measure. Cut-off score was determined by normative banding that categorizes children with the highest 10% score range as abnormal and the second highest 10% as borderline following the original method; this cut-off score was compared with the cut-off score candidates with good balance between sensitivity and specificity using ROC analysis. RESULTS We included 2301 children in the community sample, and 429 children in the clinical sample. Mean age was 9.7 years (SD 0.4, range 8.3-12.0) among the community sample and 10.4 years (SD 3.8, range 4.0-17.8) among the clinical sample. The mean total difficulties score was 12.9 (SD 4.8) among the community sample and 20.4 (SD 6.2) among the clinical sample. A total of 88.8% of the community sample and 98.8% of the clinical sample answered the SDQ. Using ROC analysis, the AUC was 0.82 (95% confident interval 0.80-0.85), which meant moderate discriminating ability. Using normative banding, the borderline cut-off score was 16/17 and abnormal cut-off score was 19/20. For cut-off scores of 16/17 and 19/20, sensitivity was 71.9 and 53.8% and specificity was 78.5 and 90.5%, respectively. The cut-off score candidates by ROC analysis were 16/17 and 17/18. CONCLUSIONS The parental version of the SDQ had moderate discriminating ability among Mongolian school-age children. For the screening of mental health problems among community children, cut-off score of 16/17 is recommended.
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Affiliation(s)
- Ai Aoki
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo, Bunkyo, 113-8655, Japan. .,Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Tokyo, Setagaya, 157-8535, Japan.
| | - Togoobaatar Ganchimeg
- grid.20515.330000 0001 2369 4728Department of Global Health Nursing, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Nyam Naranbaatar
- grid.444534.6School of Nursing, Mongolian National University of Medical Sciences, Ard Ayush street, Ulaanbaatar -26. P.O.Box – 188, Ulaanbaatar, Mongolia
| | - Zuunnast Khishigsuren
- grid.444534.6Department of Mental Health, School of Medicine, Mongolian National University of Medical Sciences, S.Zorig street, P.O.Box – 48/11, Ulaanbaatar, 14210 Mongolia
| | - Lkagvasuren Gundegmaa
- Mongolian National Institute of Physical Education, P.O. Box-224, Ulaanbaatar-13, Mongolia
| | - Shagdar Bat-Erdene
- Mongolian National Institute of Physical Education, P.O. Box-224, Ulaanbaatar-13, Mongolia
| | - Bolorchimeg Munkhbaatar
- grid.444534.6School of Nursing, Mongolian National University of Medical Sciences, Ard Ayush street, Ulaanbaatar -26. P.O.Box – 188, Ulaanbaatar, Mongolia ,grid.20515.330000 0001 2369 4728Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Rintaro Mori
- grid.258799.80000 0004 0372 2033Graduate School of Medicine, Kyoto University, Yoshida-Konoecho, Sakyoku, Kyoto, Kyoto, 606-8303 Japan
| | - Akihito Kikuchi
- grid.20515.330000 0001 2369 4728Sports Neuroscience Division, ARIHHP, Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Hideaki Soya
- grid.20515.330000 0001 2369 4728Sports Neuroscience Division, ARIHHP, Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8577 Japan ,grid.20515.330000 0001 2369 4728Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8577 Japan
| | - Kiyoto Kasai
- grid.26999.3d0000 0001 2151 536XDepartment of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo, Bunkyo 113-8655 Japan
| | - Kenji Takehara
- grid.63906.3a0000 0004 0377 2305Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Tokyo, Setagaya 157-8535 Japan
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Duke RE, Torty C, Okorie U, Kim MJ, Eneli N, Edadi U, Burton K, Tann C, Bowman R. Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria. BMC Pediatr 2021; 21:165. [PMID: 33832457 PMCID: PMC8028192 DOI: 10.1186/s12887-021-02637-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance. A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included. RESULTS Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6-28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5-5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2-4.3) manual ability classification scale 4-5 (OR 4.7,p = 0.049; CI:1.0-22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0-24.0.) were seen as increasing the likelihood of poor school attendance. CONCLUSION Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance.
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Affiliation(s)
- Roseline E. Duke
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar Children’s Eye Centre, Calabar, Cross River State Nigeria
| | - Chimaeze Torty
- Department of Paediatrics, Neurology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Uche Okorie
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar Children’s Eye Centre, Calabar, Cross River State Nigeria
| | - Min J. Kim
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
| | - Nnena Eneli
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ukam Edadi
- Primary Health Care Development Agency, Calabar, Cross River State Nigeria
| | | | - Cally Tann
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Bowman
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
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Duke RE, Nwachukuw J, Torty C, Okorie U, Kim MJ, Burton K, Gilbert C, Bowman R. Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria. Br J Ophthalmol 2020; 106:427-434. [PMID: 33268343 DOI: 10.1136/bjophthalmol-2020-317768] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria. METHODS A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD). RESULTS 388 children aged 4-15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included. CONCLUSION Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.
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Affiliation(s)
- Roseline Ekanem Duke
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria .,Clinical Research Unit, ITD, International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Justin Nwachukuw
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Chima Torty
- Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Uche Okorie
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Kathryn Burton
- Community Paediatrics, Cambridgeshire Community Services NHS Trust, Saint Ives, Cambridgeshire, UK
| | - Clare Gilbert
- Clinical Research Unit, ITD, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
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Shiau S, Evans H, Strehlau R, Shen Y, Burke M, Liberty A, Coovadia A, Abrams EJ, Yin MT, Violari A, Kuhn L, Arpadi SM. Behavioral Functioning and Quality of Life in South African Children Living with HIV on Antiretroviral Therapy. J Pediatr 2020; 227:308-313.e2. [PMID: 32712285 PMCID: PMC8811608 DOI: 10.1016/j.jpeds.2020.07.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
This study examined behavioral functioning and quality of life in South African children living with perinatally acquired HIV. Compared with controls, children living with perinatally acquired HIV had a higher mean total difficulties score assessed by the Strengths and Difficulties Questionnaire and lower mean quality of life scores assessed by the Pediatric Quality of Life Inventory.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Henry Evans
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yanhan Shen
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J Abrams
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T Yin
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Avy Violari
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Louise Kuhn
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Stephen M Arpadi
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Mohangi Y, Magagula TG, van der Westhuizen D. Adolescent psychiatric outpatients and their caregivers: Comparing the Strengths and Difficulties Questionnaire. S Afr J Psychiatr 2020; 26:1394. [PMID: 33240544 PMCID: PMC7669967 DOI: 10.4102/sajpsychiatry.v26.i0.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/18/2020] [Indexed: 11/28/2022] Open
Abstract
Background The use of the SDQs as a screening tool to monitor new or ongoing problems in adolescent psychiatric outpatients is needed to improve clinical outcomes. Discrepancies between parent and adolescent reports on the Strengths and Difficulties Questionnaire (SDQ), reflects the degree of emotional and behavioural symptoms. This may affect their ability to work together to reach therapeutic goals. Aim The level of SDQ (dis)agreements between adolescent-parental self-reports in adolescent psychiatric outpatients was examined. Setting Weskoppies Child and Adolescent outpatients. Methods This two-group cross-sectional comparative study obtained SDQ responses from 74 psychiatrically diagnosed adolescents and their parents (148 completed SDQ questionnaires). Adolescent outpatients aged between 11 and 18 years following up at the outpatients between July 2017 and November 2017 were included. Adolescent and parent rating scores were compared using a paired sample t-test, and patterns of agreement were measured by using Pearson’s correlation coefficient and Cohen’s kappa. Results Parents reported more difficulties than adolescents, although differences were non-significant (p > 0.58). Caregivers and adolescents agreed on the conduct domain and on emotional symptoms (0.21 ≤ kappa ≤ 0.40, p < 0.05). Caregivers and adolescents agreed on the presentation of internalising and externalising disorders (R = 0.48, p < 0.001). Conclusions The SDQ confirmed fair agreement between parents and adolescents. Parental perceptions of adolescent behavioural difficulties could influence parent– adolescent relations and communication. Using the SDQ as a screening tool in South Africa, requires further validation for it to be integrated as part of a multi-informant best-practice approach.
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Affiliation(s)
- Yashna Mohangi
- School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Psychiatry, Weskoppies Hospital, Pretoria, South Africa
| | - Thulisile G Magagula
- School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Psychiatry, Weskoppies Hospital, Pretoria, South Africa
| | - Deborah van der Westhuizen
- School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Psychiatry, Weskoppies Hospital, Pretoria, South Africa
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Bryant A, Guy J, Holmes J. The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners. Front Psychol 2020; 11:587821. [PMID: 33329246 PMCID: PMC7717974 DOI: 10.3389/fpsyg.2020.587821] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Children and adolescents with developmental problems are at increased risk of experiencing mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is widely used as a screener for detecting mental health difficulties in these populations, but its use thus far has been restricted to groups of children with diagnosed disorders (e.g., ADHD). Transdiagnostic approaches, which focus on symptoms and soften or remove the boundaries between traditional categorical disorders, are increasingly adopted in research and practice. The aim of this study was to assess the potential of the SDQ to detect concurrent mental health problems in a transdiagnostic sample of children. The sample were referred by health and educational professionals for difficulties related to learning (N = 389). Some had one diagnosis, others had multiple, but many had no diagnoses. Parent-rated SDQ scores were significantly positively correlated with parent ratings of mental health difficulties on the Revised Child Anxiety and Depression Scale (RCADS). Ratings on the SDQ Emotion subscale significantly predicted the likelihood of having concurrent clinical anxiety and depression scores. Ratings on the Hyperactivity subscale predicted concurrent anxiety levels. These findings suggest the SDQ could be a valuable screening tool for identifying existing mental health difficulties in children recognized as struggling, as it can be in typically developing children and those with specific diagnoses.
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Affiliation(s)
- Annie Bryant
- Department of Clinical Psychology, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Jacalyn Guy
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Joni Holmes
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Engebretsen IMS, Nalugya JS, Skylstad V, Ndeezi G, Akol A, Babirye JN, Nankabirwa V, Tumwine JK. "I feel good when I drink"-detecting childhood-onset alcohol abuse and dependence in a Ugandan community trial cohort. Child Adolesc Psychiatry Ment Health 2020; 14:42. [PMID: 33110445 PMCID: PMC7585688 DOI: 10.1186/s13034-020-00349-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/15/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alcohol, substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life. This study reports on the existence of childhood alcohol abuse and dependence in a sub-study of a trial cohort in Eastern Uganda. METHODS The project SeeTheChild-Mental Child Health in Uganda (STC) included a sub-study of the Ugandan site of the study PROMISE SB: Saving Brains in Uganda and Burkina Faso. PROMISE SB was a follow-up study of a trial birth cohort (PROMISE EBF) that estimated the effect that peer counselling for exclusive breast-feeding had on the children's cognitive functioning and mental health once they reached 5-8 years of age. The STC sub-study (N = 148) used the diagnostic tool MINI-KID to assess mental health conditions in children who scored medium and high (≥ 14) on the Strengths and Difficulties Questionnaire (SDQ) in the PROMISE SB cohort N = (119/148; 80.4%). Another 29/148 (19.6%) were recruited from the PROMISE SB cohort as a comparator with low SDQ scores (< 14). Additionally, the open-ended questions in the diagnostic history were analysed. The MINI-KID comprised diagnostic questions on alcohol abuse and dependence, and descriptive data from the sub-study are presented in this paper. RESULTS A total of 11/148 (7.4%) children scored positive for alcohol abuse and dependence in this study, 10 of whom had high SDQ scores (≥ 14). The 10 children with SDQ-scores ≥ 14 had a variety of mental health comorbidities of which suicidality 3/10 (30.0%) and separation anxiety disorder 5/10 (50.0%) were the most common. The one child with an SDQ score below 14 did not have any comorbidities. Access to homemade brew, carer's knowledge of the drinking, and difficult household circumstances were issues expressed in the children's diagnostic histories. CONCLUSIONS The discovery of alcohol abuse and dependence among 5-8 year olds in clinical interviews from a community based trial cohort was unexpected, and we recommend continued research and increased awareness of these conditions in this age group.Trial registration Trial registration for PROMISE SB: Saving Brains in Uganda and Burkina Faso: Clinicaltrials.gov (NCT01882335), 20 June 2013. Regrettably, there was a 1 month delay in the registration compared to the commenced re-inclusion in the follow-up study: https://clinicaltrials.gov/ct2/show/NCT01882335?term=saving+brains&draw=2&rank=1.
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Affiliation(s)
- Ingunn Marie Stadskleiv Engebretsen
- grid.7914.b0000 0004 1936 7443Global Mental Health Research Group, Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Joyce S. Nalugya
- grid.11194.3c0000 0004 0620 0548Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vilde Skylstad
- grid.7914.b0000 0004 1936 7443Global Mental Health Research Group, Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- grid.11194.3c0000 0004 0620 0548Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Angela Akol
- grid.7914.b0000 0004 1936 7443Global Mental Health Research Group, Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Juliet N. Babirye
- grid.11194.3c0000 0004 0620 0548School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Nankabirwa
- grid.11194.3c0000 0004 0620 0548School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ,grid.7914.b0000 0004 1936 7443Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - James K. Tumwine
- grid.11194.3c0000 0004 0620 0548Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Davids EL, Adams Tucker L, Wambua GN, Fewster DL, Schlebusch L, Karrim SB, Attia M, Nyoni J, Bayouh FG, Kuteesa H, Brahim T, Hoogenhout M, Moussa Kahloul RB, Jearey-Graham N, Gobie HB, Nalugya JS. Child and adolescent mental health in Africa: A qualitative analysis of the perspectives of emerging mental health clinicians and researchers using an online platform. J Child Adolesc Ment Health 2020; 31:93-107. [PMID: 31570090 DOI: 10.2989/17280583.2019.1659145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Using a social ecological framework, this study aimed to establish emerging mental health clinicians and researchers' perspectives about child and adolescent mental health (CAMH) in Africa. Method: Perspectives of 17 participants from Ethiopia, Kenya, South Africa, Tunisia, Uganda and Zambia, whose professional backgrounds ranged from psychiatry to speech-language therapy, were collected at an African CAMH conference. Data were gathered using open-ended questions, using an online survey. Data were analysed using theoretical thematic analysis. Results: An adapted social ecological framework highlighted: An increased need for commitment from governments to improve CAMH in Africa; and addressing mental health stigma and discrimination through community awareness. The need for specialised CAMH facilities were identified, particularly in the public health sector. The need for multi-sectoral, multi-disciplinary partnerships for advocacy, service delivery, and continuity of care were also identified. Participants emphasised the importance of CAMH awareness, and the role of governments in recognising CAMH needs and using policies to improve CAMH in Africa. Participants were hopeful about the transformation of CAMH on the continent. Conclusion: The participants prioritised government- and community-level awareness to increase the resources and support offered by CAMH services in Africa.
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Affiliation(s)
- Eugene Lee Davids
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town , South Africa ; Cochrane South Africa, South African Medical Research Council, South Africa
| | - Leigh Adams Tucker
- Department of Psychology, University of the Western Cape , Bellville , South Africa
| | | | - Deborah Leigh Fewster
- Occupational Therapy Department, University of KwaZulu-Natal , Durban , South Africa
| | - Liezl Schlebusch
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town , South Africa
| | - Saira Bs Karrim
- Speech-Language Therapy, University of KwaZulu-Natal , Durban , South Africa
| | - Mouna Attia
- Psychiatry Department, University of Monastir , Monastir , Tunisia
| | - Joachim Nyoni
- Ministry of General Education, Directorate of Early Childhood Education , Lusaka , Zambia
| | | | - Hillary Kuteesa
- College of Health Science, Makerere University , Kampala , Uganda
| | - Takoua Brahim
- Psychiatry Department, University Hospital of Monastir , Monastir , Tunisia
| | - Michelle Hoogenhout
- Division of Developmental Paediatrics, University of Cape Town , South Africa ; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | | | - Habte Belete Gobie
- College of Medicine and Health Science, Bahir Dar University , Bahir Dar , Ethiopia
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Kansiime C, Hytti L, Nalugya R, Nakuya K, Namirembe P, Nakalema S, Neema S, Tanton C, Alezuyo C, Namuli Musoke S, Torondel B, Francis SC, Ross DA, Bonell C, Seeley J, Weiss HA. Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study. BMJ Open 2020; 10:e031182. [PMID: 32024786 PMCID: PMC7044877 DOI: 10.1136/bmjopen-2019-031182] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/05/2019] [Accepted: 01/13/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Achieving good menstrual health and hygiene (MHH) is a public health challenge and there is little evidence to inform interventions. The aim of this study was to pilot test an intervention to improve MHH and school attendance in Uganda, in preparation for a future cluster-randomised trial. DESIGN Longitudinal study with pre-post evaluation of a pilot intervention. SETTING Two secondary schools in Entebbe, Uganda. PARTICIPANTS Of the 473 eligible students in secondary 2 (S2) at baseline, 450 (95.1%; 232 girls and 218 boys) consented/assented. 369 students (188 girls; 81.0%; and 181 boys; 83.0%) participated in the endline survey. INTERVENTION The intervention comprised training teachers to improve delivery of government guidelines for puberty education, training in use of a menstrual kit and pain management, a drama skit, provision of analgesics and improvements to school water and sanitation hygiene facilities. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility and acceptability of delivering the intervention. Baseline and endline quantitative surveys were conducted, with qualitative interviews conducted at endline. School attendance was assessed using self-completed daily diaries among a nested cohort of 100 female students. RESULTS There were high levels of uptake of the individual and behavioural intervention components (puberty education, drama skit, menstrual hygiene management (MHM) kit and pain management). The proportion of girls reporting anxiety about next period decreased from 58.6% to 34.4%, and reported use of effective pain management increased from 76.4% to 91.4%. Most girls (81.4%) reported improved school toilet facilities, which improved their comfort managing menstruation. The diary data and qualitative data indicated a potential intervention impact on improving menstrual-related school absenteeism. CONCLUSIONS The pilot study showed that the multicomponent MHM intervention was acceptable and feasible to deliver, and potentially effective in improving menstruation knowledge and management. A cluster-randomised trial is needed to evaluate rigorously the intervention effects on MHM and school attendance. TRIAL REGISTRATION NUMBER NCT04064736; Pre-results.
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Affiliation(s)
- Catherine Kansiime
- Research Unit, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda, Entebbe, Uganda
| | | | - Ruth Nalugya
- Research Unit, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda, Entebbe, Uganda
| | - Kevin Nakuya
- Research Unit, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda, Entebbe, Uganda
| | - Prossy Namirembe
- Research Unit, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda, Entebbe, Uganda
| | | | - Stella Neema
- College of Humanities and Social Science, Makerere University, Kampala, Uganda
| | - Clare Tanton
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Belen Torondel
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David A Ross
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneve, Switzerland
| | - Christopher Bonell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Janet Seeley
- Research Unit, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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The prevalence of mental health problems in sub-Saharan adolescents living with HIV: a systematic review. Glob Ment Health (Camb) 2020; 7:e29. [PMID: 33489245 PMCID: PMC7786273 DOI: 10.1017/gmh.2020.18] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Despite the progress made in HIV treatment and prevention, HIV remains a major cause of adolescent morbidity and mortality in sub-Saharan Africa. As perinatally infected children increasingly survive into adulthood, the quality of life and mental health of this population has increased in importance. This review provides a synthesis of the prevalence of mental health problems in this population and explores associated factors. A systematic database search (Medline, PsycINFO, Scopus) with an additional hand search was conducted. Peer-reviewed studies on adolescents (aged 10-19), published between 2008 and 2019, assessing mental health symptoms or psychiatric disorders, either by standardized questionnaires or by diagnostic interviews, were included. The search identified 1461 articles, of which 301 were eligible for full-text analysis. Fourteen of these, concerning HIV-positive adolescents, met the inclusion criteria and were critically appraised. Mental health problems were highly prevalent among this group, with around 25% scoring positive for any psychiatric disorder and 30-50% showing emotional or behavioral difficulties or significant psychological distress. Associated factors found by regression analysis were older age, not being in school, impaired family functioning, HIV-related stigma and bullying, and poverty. Social support and parental competence were protective factors. Mental health problems among HIV-positive adolescents are highly prevalent and should be addressed as part of regular HIV care.
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Ssenyonga J, Magoba Muwonge C, Hecker T. Prevalence of family violence and mental health and their relation to peer victimization: A representative study of adolescent students in Southwestern Uganda. CHILD ABUSE & NEGLECT 2019; 98:104194. [PMID: 31629222 DOI: 10.1016/j.chiabu.2019.104194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Despite global efforts to end violence against children in all settings, reports reveal that violence against children is still highly prevalent, especially in low-and middle- income countries. Violence in childhood is associated with a host of negative outcomes, and exposure in one setting can easily spill over to other contexts. For instance, exposure to family violence was not only related to mental health problems but also seems to be a risk factor for peer victimization. OBJECTIVES The present study aimed to examine the prevalence of maltreatment within the family and adolescents' mental health problems and their relation to peer victimization. We also aimed to gain new insights into the perceptions of adolescents concerning maltreatment within their families. METHODS Data were collected from April to November 2017 in a representative sample of 702 students from 12 public secondary schools in Southwestern Uganda who responded to self-administered questionnaires. RESULTS Overall, 95% of the students experienced at least one type of family violence in the past month. Students (81.3%) had endorsed some level of acceptance of violent discipline as a valid strategy in response to any misbehavior. Maltreatment within the family was related to peer victimization (β = .47) and this relation was mediated by mental health problems (0.002, 95%-CI: 0.001-0.004). CONCLUSIONS The results indicated a high prevalence of maltreatment within Ugandan families that was associated with peer victimization. This underscores the need to implement interventions aiming to reduce maltreatment and violence in order to protect children from potentially negative consequences.
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Affiliation(s)
- Joseph Ssenyonga
- Department of Psychology, University of Konstanz, 78567 Konstanz, Germany.
| | - Charles Magoba Muwonge
- Department of Educational Foundations and Psychology, Mbarara University of Science and Technology, P.O. Box 1410, Uganda.
| | - Tobias Hecker
- vivo International, 78340 Konstanz, Germany; Department of Psychology, University of Bielefeld, 33501 Bielefeld, Germany.
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Runge RA, Soellner R. Measuring children's emotional and behavioural problems: are SDQ parent reports from native and immigrant parents comparable? Child Adolesc Psychiatry Ment Health 2019; 13:46. [PMID: 31798684 PMCID: PMC6882192 DOI: 10.1186/s13034-019-0306-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/16/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The number of immigrants worldwide is growing and migration might be a risk factor for the mental health of children. A reliable instrument is needed to measure immigrants' childrens mental health. The aim of the study was to test the measurement invariance of the parent version of the Strengths and Difficulties Questionnaire (SDQ) between German native, Turkish origin and Russian origin immigrant parents in Germany. The SDQ is one of the most frequently used screening instruments for mental health disorders in children. METHODS Differential Item Functioning (DIF) was tested in samples matched by socio-economic status, age and gender of the child. A logistic regression/item response theory hybrid method and a multiple indicators- multiple causes model (MIMIC) was used to test for DIF. Multi Group Confirmatory Factor analysis (MGCFA) was used to test for configural invariance. Parent reports of 10610 German native, 534 Russian origin and 668 Turkish origin parents of children aged 3-17 years were analysed. RESULTS DIF items were found in both groups and with both methods. We did not find an adequate fit of the original five factor model of the SDQ for the Turkish origin group, but for the Russian origin group. An analysis of functional equivalence indicated that the SDQ is equally useful for the screening of mental health disorders in all three groups. CONCLUSION Using the SDQ in order to compare the parent reports of native and immigrant parents should be done cautiously. Thus, the use of the SDQ in epidemiological studies and for prevention planning is questionable. However, the SDQ turns out to be a valid instrument for screening purposes in parents of native and immigrant children.
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Affiliation(s)
- Ronja A. Runge
- 0000 0001 0197 8922grid.9463.8Institut für Psychologie, Stiftung Universität Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany
| | - Renate Soellner
- 0000 0001 0197 8922grid.9463.8Institut für Psychologie, Stiftung Universität Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany
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Penboon B, Jampaklay A, Vapattanawong P, Zimmer Z. Migration and absent fathers: Impacts on the mental health of left-behind family members in Thailand. ASIAN AND PACIFIC MIGRATION JOURNAL 2019. [DOI: 10.1177/0117196819876361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper examines whether children and main caregivers of overseas migrant fathers have fewer or more mental health symptoms compared to those of non-migrant fathers. The sample includes 997 households from the 2008 Child Health and Migrant Parents in South-East Asia project. The mental health measurements are the Strengths and Difficulties Questionnaire and the Self-Reporting Questionnaire. Compared to children of non-migrant fathers, those of migrant fathers are more likely to demonstrate conduct problems and hyperactivity/inattention. Factors which appear to impact a caregiver's mental health include the physical health status of children, caregiver's education level and household economic status. To reduce the risk of mental health problems on left-behind children, our findings imply the importance of encouraging and educating left-behind families to monitor the children's psychological well-being, especially those in father-migrant families.
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Springer PE, Slogrove AL, Kidd M, Kalk E, Bettinger JA, Esser MM, Cotton MF, Zunza M, Molteno CD, Kruger M. Neurodevelopmental and behavioural outcomes of HIV-exposed uninfected and HIV-unexposed children at 2-3 years of age in Cape Town, South Africa. AIDS Care 2019; 32:411-419. [PMID: 31280587 DOI: 10.1080/09540121.2019.1637506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Successful vertical HIV transmission prevention programmes (VTP) have resulted in an expanding population of HIV-exposed uninfected (HEU) infants whose growth, health and neurodevelopmental outcomes could have consequences for future resource allocation. We compared neurodevelopmental and behavioural outcomes in a prospective cohort of 2-3 year old HEU and HIV-unexposed uninfected (HU) children.Women living with and without HIV and their infants were enrolled within three days of birth from a low-risk midwife obstetric unit in Cape Town, South Africa during 2012 and 2013, under WHO Option A VTP guidelines. HIV-uninfected children aged 30-42 months were assessed using the Bayley scales of Infant Development-Third edition (BSID) and Strengths and Difficulties questionnaire (SDQ).Thirty-two HEU and 27 HU children (mean birth weight 3048g vs 3096g) were assessed. HEU children performed as well as HU children on BSID cognitive, language and motor domains. Mean scores fell within the low average range. Mothers of HEU children reported fewer conduct problems but stunting was associated with increased total difficulties on the SDQ.HEU and HU children's performance on the BSID was similar. In this low-risk cohort, HIV exposure did not confer additional risk. Stunting was associated with increased behavioural problems irrespective of HIV exposure.
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Affiliation(s)
- P E Springer
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A L Slogrove
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Kidd
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - E Kalk
- Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J A Bettinger
- Vaccine Evaluation Center, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - M M Esser
- Immunology Unit, Medical Microbiology, National Health Laboratory Service Tygerberg, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - M F Cotton
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Family Clinical Research Unit, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - M Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - C D Molteno
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - M Kruger
- Department of Paediatrics and Child Health and Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Chhabra R, Teitelman N, Silver EJ, Raufman J, Bauman LJ. Vulnerability Multiplied: Health Needs Assessment of 13-18-Year-Old Female Orphan and Vulnerable Children in Kenya. WORLD MEDICAL & HEALTH POLICY 2018. [DOI: 10.1002/wmh3.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoosen N, Davids EL, de Vries PJ, Shung-King M. Correction to: The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation. Child Adolesc Psychiatry Ment Health 2018; 12:11. [PMID: 29436523 PMCID: PMC5793386 DOI: 10.1186/s13034-018-0217-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13034-017-0212-1.].
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Affiliation(s)
- Nikhat Hoosen
- 0000 0004 1937 1151grid.7836.aAdolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa ,0000 0004 1937 1151grid.7836.aHealth Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Eugene Lee Davids
- 0000 0004 1937 1151grid.7836.aAdolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Petrus J. de Vries
- 0000 0004 1937 1151grid.7836.aAdolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Maylene Shung-King
- 0000 0004 1937 1151grid.7836.aAdolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa ,0000 0004 1937 1151grid.7836.aHealth Policy and Systems Division, University of Cape Town, Cape Town, South Africa
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