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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Erlangsen A, Khan M, Su W, Alateeq K, Charfi F, Madsen T, Qin P, Morthorst BR, Thomsen M, Malik A, Bandara P, Fleischmann A, Saeed K. Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region. Arch Suicide Res 2023:1-19. [PMID: 37837375 DOI: 10.1080/13811118.2023.2262532] [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: 10/16/2023]
Abstract
OBJECTIVE An estimated 41,000 lives are lost to suicide each year in World Health Organization Eastern Mediterranean Region Office (WHO EMRO) countries. The objective of this study was to conduct a situation analysis for suicide and self-harm in the WHO EMRO region. METHODS Data on suicide were obtained from the WHO Global Health Estimates for the years 2000-2019. Information on risk groups efforts to prevent self-harm and suicide in the EMRO region were retrieved through scientific studies, grey literature, and public websites. RESULTS During 2000-2019, the age-standardized suicide rate was 6.7 per 100,000 inhabitants, albeit there are concerns regarding data quality. Self-harm and suicide remain criminal acts in more than half of the countries. Few countries have a national plan for prevention of suicide. Toxic agents, such as pesticides and black henna, are easily available and frequently used for suicide in some areas, as are firearms and self-immolation. Successful prevention measures include means restriction and psychosocial interventions after self-harm. CONCLUSION Many WHO EMRO countries remain underserved in terms of mental health care. Decriminalization of suicide and means restriction might be further promoted. Online-based tools for mental health literacy and psychosocial therapy are other options to explore.
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Gómez-Restrepo C, Sarmiento-Suárez MJ, Alba-Saavedra M, Calvo-Valderrama MG, Rincón-Rodríguez CJ, Bird VJ, Priebe S, van Loggerenberg F. Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post-Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial. JMIR Form Res 2023; 7:e46757. [PMID: 37792465 PMCID: PMC10585436 DOI: 10.2196/46757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post-armed conflict areas, to reduce the burden of mental disorders in this population. OBJECTIVE This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. METHODS We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. RESULTS The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. CONCLUSIONS Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/40286.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Epidemiologia Clínica y Bioestadistica, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | | | - Carlos Javier Rincón-Rodríguez
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, United Kingdom
| | - Francois van Loggerenberg
- Unit for Social and Community Psychiatry, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Alvi MH, Ashraf T, Naz F, Sardar A, Ullah A, Patel A, Kiran T, Gumber A, Husain N. Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990-2019. BJPsych Bull 2023:1-8. [PMID: 37772484 DOI: 10.1192/bjb.2023.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
AIMS AND METHOD We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990-2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15-49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan. RESULTS DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25-4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73-5.29) versus males 2.37% (95% CI 1.62-3.25). CLINICAL IMPLICATIONS A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.
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Affiliation(s)
| | - Tehmina Ashraf
- Pakistan Institute of Living and Learning, Rawalpindi, Pakistan
| | - Farah Naz
- Pakistan Institute of Living and Learning, Rawalpindi, Pakistan
| | - Asif Sardar
- Pakistan Institute of Living and Learning, Rawalpindi, Pakistan
| | | | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Rawalpindi, Pakistan
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Nakamura-Thomas H, Sano N, Maciver D. Factors influencing junior high school students' perceptions of attending school in Japan. Child Adolesc Psychiatry Ment Health 2023; 17:86. [PMID: 37403148 DOI: 10.1186/s13034-023-00631-w] [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: 11/21/2022] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND School attendance is a crucial determinant of academic success. Our previous research has identified factors that influence elementary school students' perceptions of attending school, but whether these factors apply to older students remains unclear. We investigated the extent to which the factors identified in the previous research apply to junior high school students and their attitudes toward attending school. METHODS We hypothesized that students' "perceptions of attending school" was directly influenced by their perceptions of "relationships with friends and teachers," "current circumstances," "subjective health status," and "having people to share experiences and thoughts with." We developed an original questionnaire with 19 items and analyzed data collected from 6245 junior high school students in Japan, using a structural equation model. RESULTS The final model demonstrated a good fit. Students' "positive perceptions of attending school" was directly and positively influenced by their "positive perceptions of relationships with friends and teachers" and directly and negatively influenced by their "perceptions of poorer subjective health status". Other latent variables directly and positively influenced the perceptions of attending school, but not strongly. Students' perceptions of "relationships with friends and teachers," "current circumstances," and "having people to share experiences and thoughts with" correlated positively with each other. These three latent variables also correlated negatively with "poorer subjective health status." CONCLUSIONS The role of positive relationships with friends and teachers in shaping students' perceptions of school attendance, coupled with the negative impact of poorer subjective health status, underscores the need for educators to adopt approaches that specifically address these areas. It is crucial to provide support to students in cultivating positive relationships, fostering positive perceptions of school, and offering resources to those who are encountering mental or physical health challenges. Implementing the evidence-based questionnaire developed in this study is recommended to enhance student support and well-being.
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Affiliation(s)
- Hiromi Nakamura-Thomas
- Graduate School of Health, Medicine and Welfare, School of Health, Medicine and Welfare, Saitama Prefectural University, 820 San-No-Miya, Koshigaya City, Saitama, Japan.
| | - Nobuyuki Sano
- Department of Occupational Therapy, Faculty of Medical Sciences, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-Ku, Fukuoka City, , Fukuoka, Japan
| | - Donald Maciver
- School of Health Sciences, Division of Occupation Therapy and Art Therapies, Queen Margaret University, Queen Margaret University Way, Musselburgh, EH21 6UU, UK
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Fekih-Romdhane F, Smaoui O, Jahrami H, Cheour M. Attitudes and beliefs of Tunisian High-School teachers about schizophrenia: The impact of vignette gender. Int J Soc Psychiatry 2022; 68:1737-1747. [PMID: 34903062 DOI: 10.1177/00207640211057726] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Teachers have a crucial active role in provision of mental health services to students and fighting against mental health stigma in schools, hence their attitudes and beliefs toward mental illness should be assessed. METHOD We carried-out a cross-sectional study with a non-probabilistic sample of 304 higher secondary school teachers. We used a structured questionnaire in which a vignette describing an individual with schizophrenia was presented, and was followed by a series of stigma-related questions. RESULTS A substantial proportion of teachers endorsed stressful life events (79.6%) as a cause of schizophrenia, elicited feelings of discomfort (41.4%) and incomprehension (41.1%) with the person displaying symptoms of schizophrenia, and agreed that the person's condition will deteriorate even more (45.4%). Teachers perceived that the person described in the vignette is dependent on others, lacks will, is different from others and is unpredictable in 65.1%, 59.2%, 55.6%, and 49.7% of cases, respectively. In addition, 38.5% and 34.2% of teachers recommended turning to traditional healers and to a Sheikh or an imam of a mosque, respectively. Regarding gender effects, females with schizophrenia were regarded as more likely to be unable to make her own decisions and to be dependent on others than males, and were less likely to be recommended for seeking help from a family physician or to consult a psychiatric hospital than males. CONCLUSION In the light of our findings, raising awareness of teachers of the impact of mental health issues on students should be prioritized in high schools in Tunisia.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.,Department of Psychiatry "Ibn Omrane," The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Manouba, Tunisia
| | - Olfa Smaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Haitham Jahrami
- Ministry of Health, Manama, Kingdom of Bahrain.,College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.,Department of Psychiatry "Ibn Omrane," The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Manouba, Tunisia
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Gómez-Restrepo C, Sarmiento-Suárez MJ, Alba-Saavedra M, Bird VJ, Priebe S, van Loggerenberg F. Adapting DIALOG+ in a School Setting—A Tool to Support Well-being and Resilience in Adolescents Living in Postconflict Areas During the COVID-19 Pandemic: Protocol for a Cluster Randomized Exploratory Study. JMIR Res Protoc 2022; 11:e40286. [DOI: 10.2196/40286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Background
Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population.
Objective
Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders’ (teachers’ and students’) perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being.
Methods
We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents’ data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability.
Results
Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022.
Conclusions
This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access.
Trial Registration
ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374
International Registered Report Identifier (IRRID)
DERR1-10.2196/40286
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Latifeh Y, Jaredh MW, Nasri L, Shriedy D, Al-Mahdi A, Murtada MW. Knowledge, stigma, and beliefs toward mental illnesses among schoolteachers in Damascus. Int J Soc Psychiatry 2022; 68:1054-1062. [PMID: 33969746 PMCID: PMC9310142 DOI: 10.1177/00207640211015701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Teachers have an important role in promoting the mental wellbeing of their students, hence their knowledge and attitudes toward mental health disorders should be assessed. A very few studies regarding this topic were conducted in Syria, but due to the recent events which have had occurred the country, it is essential to deal with students who suffer from mental illnesses professionally especially that such disorders may be stigmatized by the society. AIMS This paper aims to investigate knowledge, beliefs, and attitudes toward mental disorders in a sample of Syrian schoolteachers. METHOD A cross-sectional study using self-administered questionnaire was conducted in Damascus and Refdimashq, involving 400 teachers from 16 schools. RESULTS The results showed that the prevalence of stigmatizing positions toward psychiatric illnesses was low among teachers. The contributors did not state a correlation between spiritual beliefs and psychological disorders. It was also found that teachers were neutral in their knowledge about mental illnesses and psychiatric treatment or interventions along with their mental health resources. However, 42.5% of the participants use the internet for such purposes. CONCLUSION In general, teachers of Damascus and its Refdimashq had a reasonable degree of awareness about mental disorders and treatments. Furthermore, neither stigma nor the relation between religious thoughts and mental disorders had been ascertained.
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Affiliation(s)
- Youssef Latifeh
- Syrian Private University, Syria.,Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Mhd Wael Jaredh
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Lulia Nasri
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Duaa Shriedy
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Ayat Al-Mahdi
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Mhd Wasim Murtada
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
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Imran N, Rahman A, Chaudhry N, Asif A. Effectiveness of a school-based mental health intervention for school teachers in urban Pakistan: a randomized controlled trial. Child Adolesc Psychiatry Ment Health 2022; 16:33. [PMID: 35505362 PMCID: PMC9066809 DOI: 10.1186/s13034-022-00470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools have a major role in promoting children's physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers' knowledge and beliefs about psychological problems influence the way they deal with their students' mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization's Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore. METHODS Teachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention. RESULTS Compared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher's self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months. CONCLUSION This study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools. TRAIL REGISTRATION ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register. CLINICALTRIALS gov .
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Affiliation(s)
- Nazish Imran
- Department of Child and Family Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | - Atif Rahman
- grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Nakhshab Chaudhry
- grid.414714.30000 0004 0371 6979Department of Basic Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Aftab Asif
- grid.412129.d0000 0004 0608 7688Department of Psychiatry Behavioural Sciences, King Edward Medical University, Lahore, Pakistan
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Al Omari O, Khalaf A, Al Hashmi I, Al Qadire M, Abu Shindi Y, Al Sabei S, Matani N, Jesudoss D. A comparison of knowledge and attitude toward mental illness among secondary school students and teachers. BMC Psychol 2022; 10:109. [PMID: 35488319 PMCID: PMC9052537 DOI: 10.1186/s40359-022-00820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Aim The current study aimed to assess and compare the level of knowledge and attitude towards mental illness between secondary school students and their teachers in Oman. Methods An online survey was carried out to collect data from 400 students and 411 teachers about their knowledge and attitudes toward people with mental illness. Two independent case studies about depression and schizophrenia were also tested. Results Students have a poor knowledge of mental illness compared with their teachers, as more than half scored less than 60% compared with 16.5% of the teachers. More than two-thirds of the students (80%) and teachers (76.4%) have a low or minor positive attitude toward people with mental illness. The study identified significant differences in knowledge in favour of teachers, although the opposite was found regarding attitudes. Conclusions Since students spend a significant amount of time in school, bridging the gap between teachers' and students’ knowledge and attitudes toward mental illness is an essential part in enhancing the knowledge and attitudes of the students. In addition, knowledgeable teachers with positive attitude can assist in early identification of mental illnesses and help students when needed. In turn, students who possess knowledge and positive attitude toward mental illness can share their concerns with their teachers. In the presence of such accepting and cooperative environment, the stigma can be decreased and early detection of mental illness and help-seeking behaviour can be promoted.
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Affiliation(s)
- Omar Al Omari
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Atika Khalaf
- College of Nursing, Sultan Qaboos University, Muscat, Oman. .,Faculty of Health Science, Kristianstad University, 291 88, Kristianstad, Sweden.
| | - Iman Al Hashmi
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, Muscat, Oman.,Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | | | | | - Nasir Matani
- College of Nursing, Sultan Qaboos University, Muscat, Oman
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11
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Alonge O, Chiumento A, Hamoda HM, Gaber E, Huma ZE, Abbasinejad M, Hosny W, Shakiba A, Minhas A, Saeed K, Wissow L, Rahman A. Identifying pathways for large-scale implementation of a school-based mental health programme in the Eastern Mediterranean Region: a theory-driven approach. Health Policy Plan 2020; 35:ii112-ii123. [PMID: 33156933 PMCID: PMC7646738 DOI: 10.1093/heapol/czaa124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.
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Affiliation(s)
- Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8140, Baltimore, MD 21205, USA
| | - Anna Chiumento
- Department of Psychological Sciences, Institute of Population Health Sciences, The University of Liverpool, Block B, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Hesham M Hamoda
- Department of Psychiatry, Boston Children’s Hospital 300 Longwood Avenue, Boston, MA 02115, USA
| | - Eman Gaber
- General Secretariat of Mental Health and Addiction Treatment, Ministry of Health, Al-Inshaa WA Al-Munirah, El-Sayeda Zainab, Cairo Governorate, Egypt
| | - Zill-e- Huma
- Human Development Research Foundation, House 06, Street 55, F-7/4, Islamabad, Pakistan
| | - Maryam Abbasinejad
- Department for Mental Health and Substance Abuse, Ministry of Health and Medical Education, Shahrak-e-Gharb, Eivanak Blvd, Islamic Republic of Iran
| | - Walaa Hosny
- General Secretariat of Mental Health and Addiction Treatment, Ministry of Health, Al-Inshaa WA Al-Munirah, El-Sayeda Zainab, Cairo Governorate, Egypt
| | - Alia Shakiba
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ayesha Minhas
- Institute of Psychiatry, Benazir Bhutto Hospital, Benazir Bhutto Road, Chah Sultan, Rawalpindi, Punjab 46000, Pakistan
| | - Khalid Saeed
- Department of Non-communicable Diseases and Mental Health, World Health Organization, Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Street, Nasr City, Cairo 11371, Egypt
| | - Lawrence Wissow
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of Washington, 1959 NE Pacific Street, Seattle WA 98195, USA
| | - Atif Rahman
- Department of Psychological Sciences, Institute of Population Health Sciences, The University of Liverpool, Block B, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK
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12
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Ahmad N, Hussain S, Shaheen N. Internal Displacement: Relationship of mental health and education of children in Swat, Pakistan. Pak J Med Sci 2020; 36:909-913. [PMID: 32704262 PMCID: PMC7372669 DOI: 10.12669/pjms.36.5.1847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Internal displacement causes mental health problems and effect education of school going children. This study intended to find the relationship between mental health problems and education of children displaced during violence in Swat Pakistan. Methods: This is quantitative co-relational study conducted in Swat, Pakistan during October 2017 to June 2018. The population of the study constitutes all the students of 25 high schools destroyed during violence. Child PTSD symptom scale, Siddiqui-Shah Depression Scale and Beck Anxiety Inventory were used to collect data from the sample (712) students. Results: High level of PTSD, depression and anxiety were found in female students and those who were not attending schools during displacement. PTSD and depression have negatively affected academic achievements of female students and those students who were out of schools irrespective of their gender. Conclusion: The study concludes that internal displacement causes mental health problems in children which can be minimize through education to a great extent.
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Affiliation(s)
- Nasir Ahmad
- Dr. Nasir Ahmad, Centre for Education and Staff Training
| | - Sajjad Hussain
- Dr. Sajjad Hussain, Centre for Education and Staff Training
| | - Nasir Shaheen
- Dr. Nasir Shaheen, Centre for Commerce and Management Sciences
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13
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Assessment of Knowledge, Readiness and Barriers, Female Secondary School Teachers and Staff Regarding Adolescent Mental Health in Riyadh, Saudi Arabia. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Khalil A, Gondal F, Imran N, Azeem MW. Self-Stigmatization in children receiving mental health treatment in Lahore, Pakistan. Asian J Psychiatr 2020; 47:101839. [PMID: 31665697 DOI: 10.1016/j.ajp.2019.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/23/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Self-stigma has a negative impact on the lives of children with mental health illnesses. It is a massive obstacle in the way of seeking professional help and poses a challenge to clinician's efforts to timely intervene and provide treatment. AIM The aim of our study was to measure the stigma associated with mental illness in children with a variety of psychiatric diagnoses. METHODS Following Institutional Review Board approval, an interviewer-based questionnaire was administered to children (aged 8-12 years), receiving treatment in Child Psychiatry Department at a tertiary care hospital in Lahore. The questionnaire comprised of Demographic Information Form and Paediatric Self-Stigmatization Scale (PaedS). In addition, parent / caregiver also completed a modified sub scale of the PaedS measuring the children's rejection by others due to their mental health difficulties. RESULTS 110 children with various psychiatric problems, were interviewed with a mean age of 10 years + 1.7. Widespread presence of self-stigmatization was found in these children with particularly high scores for the scales of Societal Devaluation (2.6 + 0.54), Secrecy (2.85 + 0.59) and Self stigma (2.7 + 0.70). Almost two third of parents also answered in affirmative to statements about their children rejection by others due to their mental health difficulties. Children with emotional/ behavioral difficulties had statistically significant scores on secrecy and personal rejection subscales (P value<.05). CONCLUSIONS Significant self-stigmatization amongst the children diagnosed with mental health illnesses in Lahore, Pakistan emphasize negative societal attitudes, which need to be addressed effectively in a timely manner.
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Affiliation(s)
- Amna Khalil
- Department of Child and Family Psychiatry, King Edward Medical University, Lahore, Pakistan.
| | - Fazila Gondal
- Department of Child and Family Psychiatry, King Edward Medical University, Lahore, Pakistan.
| | - Nazish Imran
- Child & Family Psychiatry Department, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | - Muhammad Waqar Azeem
- Department of Psychiatry, Sidra Medicine, Professor of Psychiatry, Weill Cornell Medicine, Cornell University, Doha, Qatar.
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15
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Gallego J, Cangas AJ, Aguilar JM, Trigueros R, Navarro N, Galván B, Smyshnov K, Gregg M. Education Students' Stigma Toward Mental Health Problems: A Cross-Cultural Comparison. Front Psychiatry 2020; 11:587321. [PMID: 33250795 PMCID: PMC7676434 DOI: 10.3389/fpsyt.2020.587321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
One of the main obstacles to integrating individuals with severe mental disorders into society today is the stigma directed at them. Although breakthroughs in treatment have been made in recent years, many professionals continue to admit that they do not possess enough training to combat this problem. Considering this situation, the present study analyzes the existing stigma among University Education students in three countries with different education systems and cultures, namely Spain, Russia, and Canada. A total of 1,542 students from these three countries participated in the study. ANOVA, MANOVA, and Multigroup Confirmatory Factor Analysis were applied in the data analysis. The results showed that the highest rates of stigma were in Spain and the lowest were in Canada, while Russia displayed intermediate values. This work addresses the relevance of these results, the influence that cultural difference may have on education policies, and the need to implement anti-stigma programs in countries like Spain, which has a relatively high level of social stigma and where these programs are practically not applied at all.
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Affiliation(s)
- José Gallego
- Department of Education, Health Research Centre, University of Almería, Almería, Spain
| | - Adolfo J Cangas
- Department of Psychology, Health Research Centre, University of Almería, Almería, Spain
| | - José M Aguilar
- Department of Psychology, Health Research Centre, University of Almería, Almería, Spain
| | - Rubén Trigueros
- Department of Psychology, Health Research Centre, University of Almería, Almería, Spain
| | - Noelia Navarro
- Department of Psychology, Health Research Centre, University of Almería, Almería, Spain
| | - Blanca Galván
- Department of Psychology, Health Research Centre, University of Almería, Almería, Spain
| | - Konstantin Smyshnov
- Faculty of Physical Culture, North-Caucasian Federal University, Stavropol, Russia
| | - Melanie Gregg
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB, Canada
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16
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Mirza Z, Rahman A. Mental health care in Pakistan boosted by the highest office. Lancet 2019; 394:2239-2240. [PMID: 31868627 DOI: 10.1016/s0140-6736(19)32979-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/08/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Zafar Mirza
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Atif Rahman
- Department of Psychological Sciences, University of Liverpool, Liverpool L69 3BX, UK.
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