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Salazar LJ, Hegde D, Srinivasan K, Heylen E, Ekstrand ML. Correlates of disability among primary care patients with common mental disorders and chronic medical conditions- a cross-sectional study from rural South India. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02727-w. [PMID: 39044019 DOI: 10.1007/s00127-024-02727-w] [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] [Received: 12/07/2023] [Accepted: 07/05/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE We examined the correlates of disability among people with non-communicable diseases (NCDs) and comorbid common mental disorders (CMDs) from rural India. METHODS The sample comprised 2,486 participants enrolled in a cluster randomized trial (cRCT), Healthier OPtions through Empowerment (HOPE). Participants were 30 years or older, with a diagnosis of major depressive disorder, dysthymia, generalized anxiety disorder, and/or panic disorder on the MINI-International Neuropsychiatric Interview, with hypertension, diabetes, dsylipidemia and/ or ischemic heart disease. Disability was measured with the 12-item version of WHODAS 2.0. The severity of depression and anxiety was measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. Multiple linear regression analyses were used to examine associations. RESULTS The mean age was 59 ± 10.0 years, three quarters (1864) of the participants were female, and 64.0% were married. More than half of the participants had no formal education (57.9%). Most of the participants had two or more chronic medical conditions (73.0%). The mean disability score was 24.3. The mean depression score was 8.5, and the mean anxiety score was 6.7. Higher levels of disability were reported by participants ≥ 60 years of age, those with moderate and severe depression, and moderate anxiety. Among female participants, being unmarried was associated with greater disability. Male participants without formal education reported greater levels of disability. CONCLUSION Higher severity of CMDs is significantly associated with higher levels of disability. For women, being unmarried and for men having no formal education was associated with higher levels of disability. TRIAL REGISTRATION ClinicalTrials.gov NCT02310932 [URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ] registered on December 8, 2014, and Clinical Trials Registry India CTRI/2018/04/013001, registered on April 4, 2018. Retrospectively registered.
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Affiliation(s)
- Luke Joshua Salazar
- Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Divya Hegde
- Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St. John's Research Institute, Sarjapur Road, Bengaluru, Karnataka, 560034, India
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, 94158, USA
| | - Maria L Ekstrand
- Division of Mental Health and Neurosciences, St. John's Research Institute, Sarjapur Road, Bengaluru, Karnataka, 560034, India.
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, 94158, USA.
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Thekkumkara S, Rawat VS, Jagannathan A, Muliyala KP. Vocational rehabilitation in persons with mental illness in India: A scoping review. Int J Soc Psychiatry 2024; 70:13-22. [PMID: 37387462 DOI: 10.1177/00207640231183920] [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: 07/01/2023]
Abstract
BACKGROUND Employment has a therapeutic impact, enhances community integration and improves the quality of life of persons with mental illness (PwMI). Vocational rehabilitation (VR) models must be sensitive to existing needs and resources. Several VR models have been tested in high income countries. Mapping different VR models in India would help both practitioners and policymakers. AIM The study aimed to comprehensively review VR models tested among PwMI in India. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. We included interventional studies, case studies and grey literature carried out for the VR of PwMI in India. The search was done in PubMed, PsychInfo, worldwide science and Web of Science. Google Scholar was used to supplement the search. A Boolean search using MeSH terms was carried out for the period January 2000 to December 2022. RESULTS A total of twelve studies (one feasibility study, four case studies, four institute-based intervention studies and two studies reporting NGOs' role) were included in the final synthesis. The studies included in the review were either quasi-experimental studies or case based. Types of VR included supported employment or place and train or train and place models, case management and prevocational skills training. CONCLUSION Limited studies exist on VR in PwMI from India. Most studies assessed a restricted set of outcomes. The experiences of NGOs should be published so that practical challenges can be understood. There is a need for public-private partnerships in designing and testing services and should involve all the stakeholders.
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Affiliation(s)
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, India
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Daniel M, Kallakuri S, Gronholm PC, Wahid SS, Kohrt B, Thornicroft G, Maulik PK. Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India. Front Psychiatry 2024; 15:1337662. [PMID: 38356906 PMCID: PMC10864454 DOI: 10.3389/fpsyt.2024.1337662] [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] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background The International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership is a multi-country international research program in seven sites across five low- and middle-income countries (LMICs) in Africa and Asia to develop, contextually adapt mental health stigma reduction interventions and pilot these among a variety of target populations. The aim of this paper is to report on the process of culturally adapting these interventions in India using an established framework. Methods As part of this larger program, we have contextualized and implemented these interventions from March 2022 to August 2023 in a site in north India. The Ecological Validity Model (EVM) was used to guide the adaptation and contextualization process comprising eight dimensions. Findings Six dimensions of the Ecological Validity Model were adapted, namely language, persons, metaphors, content, methods, and context; and two dimensions, namely concepts and goals, were retained. Conclusion Stigma reduction strategies with varied target groups, based on culturally appropriate adaptations, are more likely to be acceptable to the stakeholders involved in the intervention, and to be effective in terms of the program impact.
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Affiliation(s)
- Mercian Daniel
- Research Department, George Institute for Global Health, New Delhi, India
| | - Sudha Kallakuri
- Research Department, George Institute for Global Health, New Delhi, India
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Syed Shabab Wahid
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Pallab K. Maulik
- Research Department, George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Department of Public Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Mudiyanselage KWW, De Santis KK, Jörg F, Saleem M, Stewart R, Zeeb H, Busse H. The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries - a systematic review. BMC Public Health 2024; 24:77. [PMID: 38172713 PMCID: PMC10763181 DOI: 10.1186/s12889-023-17417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Combining non-specialists and digital technologies in mental health interventions could decrease the mental healthcare gap in resource scarce countries. This systematic review examined different combinations of non-specialists and digital technologies in mental health interventions and their effectiveness in reducing the mental healthcare gap in low-and middle-income countries. METHODS Literature searches were conducted in four databases (September 2023), three trial registries (January-February 2022), and using forward and backward citation searches (May-June 2022). The review included primary studies on mental health interventions combining non-specialists and digital technologies in low-and middle-income countries. The outcomes were: (1) the mental health of intervention receivers and (2) the competencies of non-specialists to deliver mental health interventions. Data were expressed as standardised effect sizes (Cohen's d) and narratively synthesised. Risk of bias assessment was conducted using the Cochrane risk-of-bias tools for individual and cluster randomised and non-randomised controlled trials. RESULTS Of the 28 included studies (n = 32 interventions), digital technology was mainly used in non-specialist primary-delivery treatment models for common mental disorders or subthreshold symptoms. The competencies of non-specialists were improved with digital training (d ≤ 0.8 in 4/7 outcomes, n = 4 studies, 398 participants). The mental health of receivers improved through non-specialist-delivered interventions, in which digital technologies were used to support the delivery of the intervention (d > 0.8 in 24/40 outcomes, n = 11, 2469) or to supervise the non-specialists' work (d = 0.2-0.8 in 10/17 outcomes, n = 3, 3096). Additionally, the mental health of service receivers improved through digitally delivered mental health services with non-specialist involvement (d = 0.2-0.8 in 12/27 outcomes, n = 8, 2335). However, the overall certainty of the evidence was poor. CONCLUSION Incorporating digital technologies into non-specialist mental health interventions tended to enhance non-specialists' competencies and knowledge in intervention delivery, and had a positive influence on the severity of mental health problems, mental healthcare utilization, and psychosocial functioning outcomes of service recipients, primarily within primary-deliverer care models. More robust evidence is needed to compare the magnitude of effectiveness and identify the clinical relevance of specific digital functions. Future studies should also explore long-term and potential adverse effects and interventions targeting men and marginalised communities.
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Affiliation(s)
- Kalpani Wijekoon Wijekoon Mudiyanselage
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany.
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Frederike Jörg
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
| | - Maham Saleem
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Roy Stewart
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hajo Zeeb
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
| | - Heide Busse
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
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Singh V, Sutar RF, Gupta S, Pakhare AP, Kokane AM, Aravind BA, Gururaj G, Varghese M, Benegal V, Rao GN. A study of disability and socio-economic impact of mental morbidities from the state of Madhya Pradesh, India. Indian J Psychiatry 2023; 65:1297-1306. [PMID: 38298882 PMCID: PMC10826863 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_841_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/22/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background Disability associated with mental illness has a disproportionate impact on the work, social, and family responsibilities of an individual toward society. The evidence for disability in mental illnesses would help the clinician, caregivers, policymakers, and various stakeholders to come up with sustainable solutions not only to help fill the existing gaps in care but also to develop new avenues as per the specific needs of the population of Madhya Pradesh (MP). Aim To estimate the burden of disability related to mental illnesses in the state of MP. Materials and Methods A multi-site cross-sectional study was conducted in 2015-16 as part of National Mental Health Survey among adults above 18 years of age. Samples were selected using multi-stage, stratified, random cluster sampling based on probability proportionate to size. Six tehsils with one urban metro out of four districts from a total of 50 districts were selected in the state of MP. The Sheehan Disability Scale and socio-economic impact of illness (from selected questions from WHO-Disability Assessment Schedule-2.0) were used to assess mental morbidity and the subjective reporting of disability. Results The weighted prevalence of disability (n = 1011) was found as 10.2%, 13.1%, and 13.9%, respectively, in work/school, social life, and family/home domains. The weighted prevalence of moderate to extreme disability in the same domains was, respectively, 5.1%, 6.7%, and 7.3%. The presence of common mental disorders (CMDs) increases the odds of self-reported disability in work [odds ratio (OR) 2.48, 95% CI 1.35 to 4.59], social life (OR 2.74, 95% CI 1.50 to 5.07), and family domains (OR 3.03, 95% CI1.62 to 5.74). When combined with common mental disorders, tobacco use disorder further escalates the odds of self-reported disability in all three domains [OR 7.10, confidence interval (CI) 3.15 to 16.37; 4.93, CI 2.19 to 11.28; and 7.10, CI 2.78 to 19.25]. Currently, non-working persons had a higher disability in social life and family life domains (P = 0.003 and P = 0.021), respectively. Conclusion We report a substantial magnitude of disability in social, work, and family life domains. Participants having CMDs, female gender, and those non-working had more disabilities and would require targeted interventions.
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Affiliation(s)
- Vijender Singh
- Department of Psychiatry, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Roshan F. Sutar
- Department of Psychiatry, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Suruchi Gupta
- Department of Community and Family Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Abhijit P. Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Arun M. Kokane
- Department of Community and Family Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - B. A. Aravind
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, WHO Collaborative Centre for Injury Prevention and Safety Promotion, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Ji Y, Xiang X. The Reciprocal Relationship of Physical Capacity and Mental Health: A Random Intercept Cross-Lagged Panel Model Analysis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:924-941. [PMID: 37006136 DOI: 10.1080/01634372.2023.2197017] [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: 10/05/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
This study investigates the mutual influence of mental health and physical capacity in older adults, considering potential gender differences. Data from 7,504 Medicare beneficiaries aged 65+ from the NHATS 2011-2015 surveys were analyzed using a random intercept cross-lagged panel model in Mplus. Results revealed moderate within-person effects of physical capacity on mental health (βt12 = -.19, βt23 = -.32, βt34 = -.42, βt45 = -.40), while the reverse relationship showed smaller effects (βt12 = -.02, βt23 = -.03, βt34 = -.03, βt45 = -.02). Gender differences emerged, with the influence of mental health on physical capacity being significant in men but not women. Additionally, correlations between changes in physical capacity and mental health were stronger for men. Lastly, lagged effects of physical capacity on mental health were notably stronger than the reverse. The findings suggest that enhancing physical capacity may alleviate depression and anxiety symptoms in older adults, particularly men.
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Affiliation(s)
- Yuanyuan Ji
- School of Public Administration, Hohai University, Nanjing, China
- School of Management, Nanjing Audit University Jinshen College, Nanjing, China
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Park S, Cubillos L, Martinez-Camblor P, Bartels SM, Torrey WC, John DT, Cepeda M, Bell K, Castro S, Suárez-Obando F, Uribe-Restrepo JM, Gómez-Restrepo C, Marsch LA. Integrating Depression and Alcohol Use Care Into Primary Care in Low- and Middle-Income Countries: A Meta-Analysis. Psychiatr Serv 2023; 74:950-962. [PMID: 36852551 DOI: 10.1176/appi.ps.20220267] [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] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The study updates a previous systematic review summarizing research on care integration in LMICs. METHODS Following PRISMA guidelines, the authors included studies from the previous review and studies published from 2017 to 2020 that included adults with alcohol use disorder or depression. Studies were evaluated for type of integration model with the typology developed previously. A meta-analysis using a random-effects model to assess effectiveness of integrated interventions was conducted. Meta-regression analyses to examine the impact of study characteristics on depression and alcohol use disorder outcomes were conducted. RESULTS In total, 49 new articles were identified, and 74 articles from the previous and current studies met inclusion criteria for the meta-analysis. Overall random effect sizes were 0.28 (95% CI=0.22-0.35) and 0.17 (95% CI=0.11-0.24) for studies targeting care integration for depression or for alcohol use disorder, respectively, into primary care in LMICs. High heterogeneity within and among studies was observed. No significant association was found between country income level and depression and alcohol use outcomes. However, differences in effect sizes between types of integration model were statistically significant (p<0.001). CONCLUSIONS Integration of mental health care into primary health care in LMICs was found to improve depression and alcohol use disorder outcomes. This evidence should be considered when designing interventions to improve mental health screening and treatment in LMICs.
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Affiliation(s)
- Sena Park
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez-Camblor
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sophia M Bartels
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - William C Torrey
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Deepak T John
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
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Odero SA, Mwangi P, Odhiambo R, Mumbua Nzioka B, Shumba C, Ndirangu-Mugo E, Abubakar A. Psychometric evaluation of PHQ-9 and GAD-7 among community health volunteers and nurses/midwives in Kenya following a nation-wide telephonic survey. Front Psychiatry 2023; 14:1123839. [PMID: 37324823 PMCID: PMC10264862 DOI: 10.3389/fpsyt.2023.1123839] [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] [Received: 12/15/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya. Methods Between June and November 2021, a national survey on mental well-being and resilience among nurses/midwives and CHVs was conducted via telephone interviews. The survey had a total sample size of 1907 nurses/midwives and 2027 CHVs. Cronbach's alpha and MacDonalds' omega were used to evaluate the scale's internal consistency. Confirmatory Factor Analysis (CFA) was used to test the one-factor structure of the scales. Multi-group CFA was applied to evaluate the generalizability of the scales across the Swahili and English versions, and among male and female health workers. The Spearman correlation was used to assess the tools' divergent and convergent validity. Results The internal consistency of PHQ-9 and GAD-7 was good, with alpha and omega values above 0.7 across study samples. CFA results indicated a one-factor structure of the PHQ-9 and GAD-7 for both nurses/midwives and CHVs. Multi-group CFA showed that both scales were unidimensional across both language and sex. The PHQ-9 and GAD-7 were significantly negatively correlated with resilience and work engagement, supporting divergent validity. The PHQ-9 and GAD-7 were also significantly positively correlated with resilience and work engagement, supporting divergent validity. Conclusion The PHQ-9 and GAD-7 are unidimensional, reliable, and valid tools for screening depression and anxiety among nurses/midwives and CHVs. The tools can be administered in a similar population or study setting using either Swahili or English.
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Affiliation(s)
| | - Paul Mwangi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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9
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Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review. Glob Ment Health (Camb) 2023; 10:e11. [PMID: 37854388 PMCID: PMC10579696 DOI: 10.1017/gmh.2022.60] [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] [Received: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 03/19/2023] Open
Abstract
Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication; standardized protocols for evidence-based treatments; systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings.
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Affiliation(s)
- Jessica Whitfield
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Bradford Felker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Jewell
- University of Washington Health Sciences Library, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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10
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Maddock A, Ean N, Campbell A, Davidson G. Mental health service accessibility, development and research priority setting in Cambodia - a post-conflict nation. BMC Health Serv Res 2023; 23:183. [PMID: 36810110 PMCID: PMC9945704 DOI: 10.1186/s12913-023-09187-z] [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: 01/20/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The limited health and social care infrastructure that existed in the 1970s in Cambodia was destroyed due to the Khmer Rouge. Mental Health service infrastructures have developed in Cambodia in the last twenty five years, however, they have been shaped significantly by very limited funding being made available for human resources, support services and research. The lack of research on Cambodia's mental health systems and services is a significant barrier to the development of evidence-based mental health policies and practice. In order to address this barrier, effective research and development strategies are needed in Cambodia, which are based on locally well-informed research priorities. There are many possibilities for mental health research in LMIC countries such as Cambodia, therefore focused research priorities in these areas are needed to guide future research investment. This paper is the result of the development of international collaborative workshops, which focused on service mapping and research priority setting in the field of mental health in Cambodia. METHODS A nominal group technique was used to gather ideas and insights from a range of key mental health service stakeholders in Cambodia. RESULTS The key issues in service provisions for people with mental health issues and disorders, the interventions and programmes of support available, and currently needed, were identified. This paper also identifies five key mental health research priority areas which could form the basis for effective mental health research and development strategies in Cambodia. CONCLUSION There is a clear need for the Cambodian government to devise a clear policy framework for health research. This framework could focus on the five research domains identified in this paper and could be incorporated within its National Health Strategic plans. The implementation of this approach would likely lead to the development of an evidence base which would allow the development of effective and sustainable strategies for mental health problem prevention and intervention. This would also contribute to promote the Cambodian government's capacity to take the deliberate, concrete, and targeted steps necessary to address the complex mental health needs of its population.
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Affiliation(s)
- Alan Maddock
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Nil Ean
- School of Psychology, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Anne Campbell
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK.
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11
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Nirisha PL, Malathesh BC, Kulal N, Harshithaa NR, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Parthasarathy R, Manjappa AA, Thirthalli J, Chand PK, Arora S, Math SB. Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training. Community Ment Health J 2023; 59:175-184. [PMID: 35779139 PMCID: PMC10290774 DOI: 10.1007/s10597-022-00996-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.
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Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Barikar C Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | - Nithesh Kulal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nisha R Harshithaa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - N Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Adarsha Alur Manjappa
- DMHP Psychiatrist, Department of Health and Family Welfare, Government of Karnataka Office of the District Health Officer, Ramanagara District, Ramanagara, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Bond L, Simmons E, Sabbath EL. Measurement and assessment of fidelity and competence in nonspecialist-delivered, evidence-based behavioral and mental health interventions: A systematic review. SSM Popul Health 2022; 19:101249. [PMID: 36246092 PMCID: PMC9563630 DOI: 10.1016/j.ssmph.2022.101249] [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] [Received: 06/21/2022] [Revised: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022] Open
Abstract
Nonspecialists have increasingly been used to deliver evidence-based, mental health and behavioral interventions in lower resource settings where there is a dearth of specialized providers and a corresponding gap in service delivery. Recent literature acknowledges that nonspecialist-delivered interventions are shown to be effective. However, few studies report on the fidelity (the degree to which an intervention was implemented as intended) and/or competence (general skills of nonspecialists), key concepts that measure quality of evidence-based intervention delivery. This study seeks to understand how both fidelity and competence have been assessed in nonspecialist-delivered, evidence-based interventions with an intended social or psychological behavior-change outcome. Our search results originally yielded 2317 studies, and ultimately, 16 were included in our final analysis. Generally, results from a narrative synthesis indicated that tools used in the studies demonstrated sufficient inter-rater reliability and intra-class correlation components. Included studies used and described a range of fidelity and competence tools. However, the ENhancing Assessment of Common Therapeutic factors tool was the most commonly used tool that measures competence of nonspecialists, and has been adapted to several other settings. The roles of supervisors in mentoring, monitoring, and supervising nonspecialists emerged as a key ingredient for ensuring fidelity. Most studies assessing fidelity were limited by small sample sizes due to low numbers of nonspecialists implementing interventions, however, more advanced statistical methods may not be needed and may actually impede community-based organizations from assessing fidelity data. Our results suggest interventions can share resources, tools, and compare findings regardless with proper supervision. While the two terms "fidelity" and "competence" are often used interchangeably, their differences are noteworthy. Ultimately, both competency and fidelity are critical for delivering evidence-based interventions, and nonspecialists are most effective when they can be evaluated and mentored on both throughout the course of the intervention.
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13
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Chen S, Conwell Y, Xue J, Li L, Zhao T, Tang W, Bogner H, Dong H. Effectiveness of integrated care for older adults with depression and hypertension in rural China: A cluster randomized controlled trial. PLoS Med 2022; 19:e1004019. [PMID: 36279299 PMCID: PMC9639850 DOI: 10.1371/journal.pmed.1004019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/07/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Effectiveness of integrated care management for common, comorbid physical and mental disorders has been insufficiently examined in low- and middle-income countries (LMICs). We tested hypotheses that older adults treated in rural Chinese primary care clinics with integrated care management of comorbid depression and hypertension (HTN) would show greater improvements in depression symptom severity and HTN control than those who received usual care. METHODS AND FINDINGS The study, registered with ClinicalTrials.gov as Identifier NCT01938963, was a cluster randomized controlled trial with 12-month follow-up conducted from January 1, 2014 through September 30, 2018, with analyses conducted in 2020 to 2021. Participants were residents of 218 rural villages located in 10 randomly selected townships of Zhejiang Province, China. Each village hosts 1 primary care clinic that serves all residents. Ten townships, each containing approximately 20 villages, were randomly selected to deliver either the Chinese Older Adult Collaborations in Health (COACH) intervention or enhanced care-as-usual (eCAU) to eligible village clinic patients. The COACH intervention consisted of algorithm-driven treatment of depression and HTN by village primary care doctors supported by village lay workers with telephone consultation from centrally located psychiatrists. Participants included clinic patients aged ≥60 years with a diagnosis of HTN and clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10). Of 2,899 eligible village residents, 2,365 (82%) agreed to participate. They had a mean age of 74.5 years, 67% were women, 55% had no schooling, 59% were married, and 20% lived alone. Observers, older adult participants, and their primary care providers (PCPs) were blinded to study hypotheses but not to group assignment. Primary outcomes were change in depression symptom severity as measured by the Hamilton Depression Rating Scale (HDRS) total score and the proportion with controlled HTN, defined as systolic blood pressure (BP) <130 mm Hg or diastolic BP <80 for participants with diabetes mellitus, coronary heart disease, or renal disease, and systolic BP <140 or diastolic BP <90 for all others. Analyses were conducted using generalized linear mixed effect models with intention to treat. Sixty-seven of 1,133 participants assigned to eCAU and 85 of 1,232 COACH participants were lost to follow-up over 12 months. Thirty-six participants died of natural causes, 22 in the COACH arm and 14 receiving eCAU. Forty COACH participants discontinued antidepressant medication due to side effects. Compared with participants who received eCAU, COACH participants showed greater reduction in depressive symptoms (Cohen's d [±SD] = -1.43 [-1.71, -1.15]; p < 0.001) and greater likelihood of achieving HTN control (odds ratio [OR] [95% CI] = 18.24 [8.40, 39.63]; p < 0.001). Limitations of the study include the inability to mask research assessors and participants to which condition a village was assigned, and lack of information about participants' adherence to recommendations for lifestyle and medication management of HTN and depression. Generalizability of the model to other regions of China or other LMICs may be limited. CONCLUSIONS The COACH model of integrated care management resulted in greater improvement in both depression symptom severity and HTN control among older adult residents of rural Chinese villages who had both conditions than did eCAU. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01938963 https://clinicaltrials.gov/ct2/show/NCT01938963.
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Affiliation(s)
- Shulin Chen
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester, Rochester, New York, United States of America
- * E-mail:
| | - Jiang Xue
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Lydia Li
- School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Tingjie Zhao
- Department of Biostatistics and Data Science, Tulane University, New Orleans, Louisiana, United States of America
| | - Wan Tang
- Department of Biostatistics and Data Science, Tulane University, New Orleans, Louisiana, United States of America
| | - Hillary Bogner
- Department of Family Medicine, University of Pennsylvania, Philadelphia, Philadelphia, United States of America
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University, Hangzhou, China
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Yatirajula SK, Kallakuri S, Paslawar S, Mukherjee A, Bhattacharya A, Chatterjee S, Sagar R, Kumar A, Lempp H, Raman U, Singh R, Essue B, Billot L, Peiris D, Norton R, Thornicroft G, Maulik PK. An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums: protocol for the ARTEMIS project. Trials 2022; 23:612. [PMID: 35906663 PMCID: PMC9336093 DOI: 10.1186/s13063-022-06539-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. METHODS The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived-a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. DISCUSSION The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. TRIAL STATUS Protocol version - V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) TRIAL REGISTRATION: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries ( https://www.who.int/clinical-trials-registry-platform/network/primary-registries ) Reference No. CTRI/2022/02/040307 . Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.
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Affiliation(s)
| | | | | | | | | | | | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar
- Dr.A.V. Baliga Memorial Trust, New Delhi, India
| | - Heidi Lempp
- Department of Inflammation Biology, Centre for Rheumatic Diseases, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Usha Raman
- University of Hyderabad, Hyderabad, India
| | | | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laurent Billot
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Robyn Norton
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Imperial College, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- University of New South Wales, Sydney, Australia.
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Gladstone TRG, Ugueto AM, Muleta M, Meshesha TM, Ambaafris GG, Patwa MC, Zhong C, Buchholz KR. Development and Pilot Test of a Group Cognitive Behavioral Intervention for Women Recovering From Fistula Repair Surgery in Ethiopia. Front Public Health 2022; 10:862351. [PMID: 35734763 PMCID: PMC9207711 DOI: 10.3389/fpubh.2022.862351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Obstetric fistula is a serious complication that affects thousands of women in low-income countries. Women who suffer from obstetric fistulae are at risk of developing mental health problems, but to date most interventions have focused on repairing the physical consequences of fistulae through surgery. The goal of the current study is to develop an evidence-based intervention targeting symptoms of depression, anxiety, and trauma in women recovering from fistula repair surgery. First, hospital staff and patients awaiting surgery at a fistula hospital in Ethiopia participated in qualitative interviews to provide information on the mental health needs of women with fistulae, how the hospital tends to these women's psychological needs, and the training needs of staff members. Data from these interviews were used to develop the COFFEE intervention (CBT with Obstetric Fistula for Education and Empowerment). COFFEE is a modular, group intervention that teaches psycho-education, behavioral activation, relaxation, problem solving, cognitive restructuring, and includes a trauma narrative. Patients then participated in an open trial of the COFFEE intervention at the University of Gondar Hospital. Five separate groups were conducted with 24 women who were enrolled post-fistula repair surgery. Women completed pre-treatment self-report questionnaires, participated in group sessions conducted by nurses (with 8 sessions delivered across 10–14 days), and were assessed post-treatment and at 3-month follow-up. Results indicate a significant reduction on depression and anxiety symptoms scores across the three time points [F(2, 40) = 68.45, p < 0.001 partial η2 = 0.774]. Additionally, there was a significant decrease in traumatic stress scores from baseline to post-treatment [F(1.10, 21.98) = 100.51, p < 0.001 partial η2 = 0.834]. Feedback forms completed by nurses and patients suggest the intervention was well-received. Results of this open-trial suggest the COFFEE intervention is feasible, acceptable, and clinically beneficial to treat symptoms of depression, anxiety, and traumatic stress in women post-fistula repair surgery in a hospital setting.
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Affiliation(s)
- Tracy R. G. Gladstone
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
- *Correspondence: Tracy R. G. Gladstone
| | - Ana M. Ugueto
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Tsega M. Meshesha
- MIT Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Genet G. Ambaafris
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mariya C. Patwa
- School of Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Cordelia Zhong
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
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Thekkumkara SN, Jagannathan A, Muliyala KP, Murthy P. Development and validation of a peer support programme for the prisoners with mental and substance use disorders in India. Indian J Psychiatry 2022; 64:316-321. [PMID: 35859557 PMCID: PMC9290426 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_416_21] [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: 05/20/2021] [Revised: 01/06/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of mental health problems and substance use disorders is high in prisons. There is a need to develop effective and sustainable models in prison to address their mental health demands. AIM The study aimed to develop and validate a peer support programme (PSP) for prisoners with common mental and substance use disorders (SUD). METHOD The PSP was developed by reviewing the literature and expert interviews and validated by seven experts. RESULT The expert interview brought out a total of 10 themes. The final components included in the content of the peer support interventions were information about mental health issues, identification of the cases, basic counseling skills, psycho-education, early warning signs and symptoms, managing substance use by motivational interviewing, and suicidal gatekeeping. CONCLUSION This study describes the development of a comprehensive PSP, and it needs to be tested to examine its feasibility and effectiveness in addressing mental health problems in prison settings.
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Affiliation(s)
| | - Aarti Jagannathan
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | | | - Pratima Murthy
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Koly KN, Christopher E, Ahmed S, Baskin C, Saba J, Islam MS, Tariq MR, Alam SF, Sultana MS, Mushtaq M, Ahmed HU. Mental health training needs of physicians in Bangladesh: Views from stakeholders. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Occupational stressors in healthcare workers in France. Rev Epidemiol Sante Publique 2022; 70:59-65. [PMID: 35337699 DOI: 10.1016/j.respe.2022.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/03/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To describe psychosocial constraints and mental health of hospital workers, and to identify the psychosocial constraints significantly associated with mental health difficulties, especially in two groups: caregivers and other hospital workers. METHOD Data about working conditions and health status collected by the Evrest National observatory in 2018-2019 during occupational health consultation were used. Psychosocial constraints and mental health among caregivers, other hospital workers and non-hospital workers were described. RESULTS There were 1251 hospital workers (843 caregivers, 408 other hospital workers) and 25 129 other workers. Intensity and working time (time pressure, extra working time, missing or shortening a meal), and ethical dilemmas (not having the means to ensure high-quality work, too rapidly handling a procedure that would require more painstaking care) were significantly more reported by the caregivers than by the other hospital workers (50.8% vs 44.2%, 43.4% vs 32.5%, 47.2% vs 17.2%, 21.4% vs 16.4% and 41.5% vs 29.0% respectively). Prevalence of psychological distress was not significantly higher for caregivers (12.3%) than for other hospital workers (12.4%) but was significantly higher than for other workers (7.3%). For caregivers, factors significantly associated with psychological distress were time pressure (Odds Ratio adjusted on sociodemographic factors (OR) = 2.33 CI95% [1.35-4.04]), "difficulties to reconcile private life and work life" (OR = 2.95 [1.54-5.69]), "work not recognized in the professional setting" (OR = 1.89 [1.08-3.31]) and "fear of losing one's job" (OR = 2.98 [1.53-5.8]). For other hospital workers, they were "difficulties to reconcile private life and work life (OR = 2.76 [1.04-7.30]), "insufficient possibilities of mutual aid" (OR = 2.85 [1.24-6.53] and "not having the means to ensure high-quality work" (OR = 3.42 [1.62-7.21]). CONCLUSION Factors significantly associated with psychological distress were not the same for caregivers and other hospital workers, nor were they the most frequently reported. Detailed description of the constraints according to group of workers could help to develop a high-priority preventive program regarding psychosocial risk factors.
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Mabunda D, Oliveira D, Sidat M, Cavalcanti MT, Cumbe V, Mandlate F, Wainberg M, Cournos F, de Jesus Mari J. Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation. Int J Ment Health Syst 2022; 16:14. [PMID: 35168650 PMCID: PMC8845308 DOI: 10.1186/s13033-022-00526-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. AIMS This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. METHODS We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Expert consultation was performed according to Arksey & O'Malley framework and cultural adaptation analysis was performed according to Bernal framework. RESULTS Out of 14,549 retrieved records, we identified ten peer-reviewed articles conducted in Zimbabwe, Uganda, South Africa and Zambia describing four distinct interventions. Six were randomized controlled trials; none addressed implementation outcomes. Group-based interpersonal therapy (n = 5), trauma-focused cognitive behaviour therapy (n = 1), problem solving therapy (n = 3) and narrative exposure therapy (n = 1) emerged as psychological interventions delivered by LHW for people with depression, anxiety, trauma and suicidal behavior. Psychological interventions delivered by LHW in Africa were all culturally adapted to meet the competence of LHW. All the interventions were associated with symptom improvement, but the quality of this evidence varied widely with study design. CONCLUSION Task-shifting psychological interventions delivered by LHW after appropriate cultural adaptation show promise for addressing unmet mental health care needs in Africa. More effectiveness and implementation evidence is needed, especially with regard to psychological interventions delivered by LHW for adolescence, older people and those with severe mental disorders and suicidal behaviors.
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Affiliation(s)
- Dirceu Mabunda
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique.
| | - Déborah Oliveira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | | | - Vasco Cumbe
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Flávio Mandlate
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Milton Wainberg
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, USA
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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Garg A, Agrawal R, Velleman R, Rane A, Costa S, Gupta D, Dsouza E, Jambhale A, Sabnis A, Fernandes G, Bhatia U, Nadkarni A. Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study. Glob Ment Health (Camb) 2022; 9:26-36. [PMID: 36618733 PMCID: PMC9806979 DOI: 10.1017/gmh.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
Background Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. Methods Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. Results The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92-39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61-25.57, p = 0.008)]. Conclusion Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings.
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Affiliation(s)
| | - Ravindra Agrawal
- Sangath, Porvorim, Goa, India
- Antarman Centre for Psychosocial Wellbeing, Panjim, Goa, India
- Manipal Hospital, Panaji, Goa, India
| | | | - Anil Rane
- Institute of Psychiatry & Human Behaviour, Bambolim, Goa, India
| | - Sheina Costa
- Sangath, Porvorim, Goa, India
- Manovikas English Medium School, Margao, Goa, India
| | - Devika Gupta
- Sangath, Porvorim, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
| | | | | | - Akshada Sabnis
- Institute of Psychiatry & Human Behaviour, Bambolim, Goa, India
| | | | - Urvita Bhatia
- Sangath, Porvorim, Goa, India
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Headington Rd, Headington, Oxford OX3 0BP, UK
| | - Abhijit Nadkarni
- Sangath, Porvorim, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
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21
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Le PD, Eschliman EL, Grivel MM, Tang J, Cho YG, Yang X, Tay C, Li T, Bass J, Yang LH. Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks. Implement Sci 2022; 17:4. [PMID: 35022081 PMCID: PMC8756725 DOI: 10.1186/s13012-021-01179-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/05/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Task-sharing is a promising strategy to expand mental healthcare in low-resource settings, especially in low- and middle-income countries (LMICs). Research on how to best implement task-sharing mental health interventions, however, is hampered by an incomplete understanding of the barriers and facilitators to their implementation. This review aims to systematically identify implementation barriers and facilitators in evidence-based task-sharing mental health interventions using an implementation science lens, organizing factors across a novel, integrated implementation science framework. METHODS PubMed, PsychINFO, CINAHL, and Embase were used to identify English-language, peer-reviewed studies using search terms for three categories: "mental health," "task-sharing," and "LMIC." Articles were included if they: focused on mental disorders as the main outcome(s); included a task-sharing intervention using or based on an evidence-based practice; were implemented in an LMIC setting; and included assessment or data-supported analysis of barriers and facilitators. An initial conceptual model and coding framework derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework was developed and iteratively refined to create an integrated conceptual framework, the Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH), which specifies 37 constructs across eight domains: (I) client characteristics, (II) provider characteristics, (III) family and community factors, (IV) organizational characteristics, (V) societal factors, (VI) mental health system factors, (VII) intervention characteristics, and (VIII) stigma. RESULTS Of the 26,935 articles screened (title and abstract), 192 articles underwent full-text review, yielding 37 articles representing 28 unique intervention studies that met the inclusion criteria. The most prevalent facilitators occur in domains that are more amenable to adaptation (i.e., the intervention and provider characteristics domains), while salient barriers occur in domains that are more challenging to modulate or intervene on-these include constructs in the client characteristics as well as the broader societal and structural levels of influence (i.e., the organizational, mental health system domains). Other notable trends include constructs in the family and community domains occurring as barriers and as facilitators roughly equally, and stigma constructs acting exclusively as barriers. CONCLUSIONS Using the BeFITS-MH model we developed based on implementation science frameworks, this systematic review provides a comprehensive identification and organization of barriers and facilitators to evidence-based task-sharing mental health interventions in LMICs. These findings have important implications for ongoing and future implementation of this critically needed intervention strategy, including the promise of leveraging task-sharing intervention characteristics as sites of continued innovation, the importance of but relative lack of engagement with constructs in macro-level domains (e.g., organizational characteristics, stigma), and the need for more delineation of strategies for task-sharing mental health interventions that researchers and implementers can employ to enhance implementation in and across levels. TRIAL REGISTRATION PROSPERO CRD42020161357.
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Affiliation(s)
- PhuongThao D. Le
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA
| | - Evan L. Eschliman
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205 USA
| | - Margaux M. Grivel
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA
| | - Jeffrey Tang
- grid.137628.90000 0004 1936 8753Department of Psychology, New York University Graduate School of Arts and Science, One-Half Fifth Avenue, New York, NY 10003 USA
| | - Young G. Cho
- grid.21729.3f0000000419368729New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., New York, NY 10032 USA
| | - Xinyu Yang
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032 USA
| | - Charisse Tay
- grid.21729.3f0000000419368729Columbia University Teachers College, 525 West 120th Street, New York, NY 10027 USA
| | - Tingyu Li
- grid.21729.3f0000000419368729Columbia University Teachers College, 525 West 120th Street, New York, NY 10027 USA
| | - Judith Bass
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Lawrence H. Yang
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA ,grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032 USA
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22
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Smith SL, Nyirandagijimana B, Hakizimana J, Levy RP, Bienvenu R, Uwamwezi A, Hakizimfura O, Uwimana E, Kundu P, Mpanumusingo E, Nshimyiryo A, Rusangwa C, Kateera F, Mukasakindi H, Raviola G. Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design. BMJ Open 2021; 11:e054630. [PMID: 34862298 PMCID: PMC8647529 DOI: 10.1136/bmjopen-2021-054630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda. METHODS AND ANALYSIS We will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews. ETHICS AND DISSEMINATION This evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.
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Affiliation(s)
- Stephanie L Smith
- Partners In Health, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Roger P Levy
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | - Giuseppe Raviola
- Partners In Health, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Prevalence and correlates of total sleep time among the older adults during COVID-19 pandemic in Bangladesh. SLEEP EPIDEMIOLOGY 2021; 1:100008. [PMID: 35673624 PMCID: PMC8489283 DOI: 10.1016/j.sleepe.2021.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/19/2021] [Accepted: 09/08/2021] [Indexed: 01/05/2023]
Abstract
Purpose The present study was aimed to identify inappropriate sleep duration and its correlates among the Bangladeshi older adults during the COVID-19 pandemic. Material and methods This cross-sectional study was carried out among 1030 older adults aged 60 years and above in Bangladesh. Information was collected through telephone interviews using a pretested semi-structures questionnaire installed in SurveyCTO mobile app. Sleep duration was defined as total sleep time (TST) in last 24 h including day and nighttime sleep. TST was further categorized into shorter (<7 h), recommended (7-8 h), and longer sleep (>8 h) according to 2015 National Sleep Foundation guideline. The multinomial logistic regression model identified the factors associated with sleep duration. Results Mean TST was 7.9 h (SD=1.62). Of the total participants, 28.2% had longer and 17.8% shorter sleep duration. In the regression model, participants' age of ≥80 years (OR: 3.36, 1.46-7.73), monthly family income of <5,000 Bangladeshi Taka (OR: 3.50, 1.79-6.82), difficulty in getting medicine during COVID-19 (OR: 1.72, 1.05-2.82), lack of communication during the pandemic (OR: 2.20, 1.43-3.40) and receiving COVID-19 related information from friends/family/neighbours (OR: 1.83, 1.11-3.01) were significantly associated with shorter TST. On the other hand, monthly family income of < 5,000 Bangladeshi Taka (OR: 2.00, 1.13-3.53), difficulty in getting medicine during COVID-19 pandemic (OR: 2.01, 1.33-3.03) and receiving COVID-19 related information from radio/TV (OR: 2.09, 1.22-3.59) were associated with longer TST. Conclusions The study findings suggest implementing sleep management program for older adults in Bangladesh, particularly during emergencies like COVID-19.
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Adefolarin AO, Gershim A, Sola AO, Oye G. The effect of training and supervision on primary health care workers' competence to deliver maternal depression inclusive health education in Ibadan, Nigeria: a quasi-experimental study. BMC Health Serv Res 2021; 21:1286. [PMID: 34847938 PMCID: PMC8630868 DOI: 10.1186/s12913-021-07208-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background Health workers lack the competence to address maternal depression in the routine health education in Nigeria. Hence, awareness among maternal-child health clients is low. We assessed the effect of training and supervision on knowledge, skills, and self-efficacy of primary healthcare workers in delivering health talks and the clients’ knowledge on maternal depression. Methods A quasi-experimental study design was adopted. Five Local Government Area (LGAs) in the Ibadan metropolis were grouped according to geographical proximity and randomly assigned to experimental (Group A = two LGAs) and control (Group B = three LGAs) with 12 primary health centres in each group. All primary health care workers recruited in group A received a one-day training on maternal depression. Good Knowledge Gain (GKG), Good Skill Gain (GSG) and Self-Efficacy (SEG) were assessed in both groups. 1-week post-training, the knowledge of all the PHCs’ attendees in the two groups was assessed. Two weeks post- training, a half of experimental group’s PHCs received supportive supervision and a clinic-based health education delivery skill assessment was conducted. The knowledge of clients and their health seeking were also assessed. Fisher’s exact test, independent t test and Poisson regression were used to analyze differences in percentages and mean/ factors associated with GKG, GSG and SE, using SPSS 25. Results Training improved gains in the experimental versus controls as follows: GKG (84.3% vs. 15.7%), GSG (90.7% vs 9.3%) and SEG (100% vs 0%). Training contributed to the good gain in knowledge (RR = 6.03; 95%CI =2.44–16.46; p < 0.01); skill (RR = 1.88; CI = 1.53–2.33; p < 0.01).) and self-efficacy (RR = 2.74; CI = 2.07–2.73; p < 0.01). Clients in the experimental group had higher knowledge gain score than in the control (7.10 ± 2.4 versus − 0.45 ± 2.37); p < 0.01). The rater supervisor observed better motivation in the supervised group than the not supervised. Forty clients sought help in the intervention group while none in the control group. Thirty-five clients sought help in the supervised group while only five did in the not supervised. Conclusions Training followed by supervision improved the competence of health workers to transfer knowledge to clients. This intervention is recommended for primary healthcare settings to improve uptake of maternal mental health services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07208-3.
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Affiliation(s)
- Adeyinka Olufolake Adefolarin
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Health Promotion and Education, Faculty Public Health, University of Ibadan, Ibadan, Nigeria.
| | - Asiki Gershim
- African Population and Health Research Center, Nairobi, Kenya.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Arulogun Oyedunni Sola
- Department of Health Promotion and Education, Faculty Public Health, University of Ibadan, Ibadan, Nigeria.,Centre for Entrepreneurship and Innovation, University of Ibadan, Ibadan, Nigeria
| | - Gureje Oye
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.,WHO Collaborating Centre, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
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Rivero-Santana A, Perestelo-Perez L, Alvarez-Perez Y, Ramos-Garcia V, Duarte-Diaz A, Linertova R, Garcia-Perez L, Serrano-Aguilar P. Stepped care for the treatment of depression: a systematic review and meta-analysis. J Affect Disord 2021; 294:391-409. [PMID: 34315101 DOI: 10.1016/j.jad.2021.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/17/2021] [Accepted: 07/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Stepped Care Model (SCM) proposes a sequential approach in the treatment of depression, applying interventions of increasing intensity according to the level of severity of the individual. METHODS A systematic review was carried out until January 2020 in eight electronic databases. We included randomized (RCT) and non-randomized controlled trials comparing the SCM to usual non-sequential care. RESULTS Eighteen RCT with patients with confirmed or probable depression diagnosis were included. Meta-analyses yielded high heterogeneity, and subgroup analyses showed significant effects of the SCM only in studies with baseline moderately severe symptoms on average, compared to samples with mild/moderate depression. In the former subgroup, effects at 3-6 and 9-12 months were small for symptoms' reduction (g = -0.33, 95%CI: -0.55, -0.17 and -0.34, 95%CI: -0.53, -0.16) and moderate-to-strong in response and remission (Risk Ratios between 1.70-1.90). Overall, a significant benefit on quality of life was also observed (6 months: g = 0.31, 95%CI: 0.12, 0.49; 12 months: g = 0.18, 95%CI: 0.06, 0.31). More patients in the SCM groups were prescribed antidepressants at 6 months (RR = 1.31, 95%CI: 1.09, 1.57; I² = 87%). LIMITATIONS The search does not guarantee the identification of all the relevant literature. Most included studies show uncertain or high risk of bias. CONCLUSIONS The SCM seems to outperform usual care in populations with at least moderately severe symptoms on average. Results show high heterogeneity and future research should explore its sources.
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Affiliation(s)
- Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation, Tenerife, Spain (FIISC), Spain; Health Services Research on Chronic Patients Network (REDISSEC). Tenerife, Spain
| | - Lilisbeth Perestelo-Perez
- Health Services Research on Chronic Patients Network (REDISSEC). Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain..
| | | | - Vanesa Ramos-Garcia
- Canary Islands Health Research Institute Foundation, Tenerife, Spain (FIISC), Spain
| | - Andrea Duarte-Diaz
- Canary Islands Health Research Institute Foundation, Tenerife, Spain (FIISC), Spain
| | - Renata Linertova
- Canary Islands Health Research Institute Foundation, Tenerife, Spain (FIISC), Spain; Health Services Research on Chronic Patients Network (REDISSEC). Tenerife, Spain
| | - Lidia Garcia-Perez
- Canary Islands Health Research Institute Foundation, Tenerife, Spain (FIISC), Spain; Health Services Research on Chronic Patients Network (REDISSEC). Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Health Services Research on Chronic Patients Network (REDISSEC). Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
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Barnett ML, Luis Sanchez BE, Green Rosas Y, Broder-Fingert S. Future Directions in Lay Health Worker Involvement in Children's Mental Health Services in the U.S. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:966-978. [PMID: 34554014 PMCID: PMC8633058 DOI: 10.1080/15374416.2021.1969655] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidence-based practices for historically marginalized communities within the U.S.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, University of California Santa Barbara
| | | | | | - Sarabeth Broder-Fingert
- Department of Pediatrics, University of Massachusetts Medical School
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School
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Koly KN, Baskin C, Khanam I, Rao M, Rasheed S, Law GR, Sarker F, Gnani S. Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review. Front Psychiatry 2021; 12:741328. [PMID: 34707524 PMCID: PMC8542900 DOI: 10.3389/fpsyt.2021.741328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: To bridge significant mental health treatment gaps, it is essential that the healthcare workforce is able to detect and manage mental health conditions. We aim to synthesise evidence of effective educational and training interventions aimed at healthcare workers to increase their ability to detect and manage mental health conditions in South and South-East Asia. Methods: Systematic review of six electronic academic databases from January 2000 to August 2020 was performed. All primary research studies were eligible if conducted among healthcare workers in South and South-East Asia and reported education and training interventions to improve detection and management of mental health conditions. Quality of studies were assessed using Modified Cochrane Collaboration, ROBINS-I, and Mixed Methods Appraisal Tools and data synthesised by narrative synthesis. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A review protocol was registered with the PROSPERO database (CRD42020203955). Findings: We included 48 of 3,654 screened articles. Thirty-six reported improvements in knowledge and skills in the detection and management of mental health conditions. Training was predominantly delivered to community and primary care health workers to identify and manage common mental health disorders. Commonly used training included the World Health Organization's mhGAP guidelines (n = 9) and Cognitive Behavioural Therapy (n = 8) and were successfully tailored and delivered to healthcare workers. Digitally delivered training was found to be acceptable and effective. Only one study analysed cost effectiveness. Few targeted severe mental illnesses and upskilling mental health specialists or offered long-term follow-up or supervision. We found 21 studies were appraised as low/moderate and 19 as high/critical risk of bias. Interpretation: In low resource country settings, upskilling and capacity building of primary care and community healthcare workers can lead to better detection and management of people with mental health disorders and help reduce the treatment gap. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020203955.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ivylata Khanam
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Sabrina Rasheed
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Graham R. Law
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Farhana Sarker
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Kormendi NM, Brown AD. Asian American mental health during COVID-19: A call for task-sharing interventions. SSM - MENTAL HEALTH 2021; 1:100006. [PMID: 34494013 PMCID: PMC8413682 DOI: 10.1016/j.ssmmh.2021.100006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 12/05/2022] Open
Abstract
In the age of COVID-19, the Asian American community is facing a number of unique risks and barriers to mental health care. Mounting challenges—including language barriers, unemployment, racialized trauma, and anti-Asian violence—threaten the health and wellness of these communities. Yet, structural obstacles prevent Asian Americans from accessing care within the professionalized behavioral health workforce. Leveraging the resources of Asian American peer networks, collectives, and community-based organizations through a task-sharing program presents an attractive alternative for mental health care provision. Investing in task-sharing approaches to care would both address access barriers and build capacity within the Asian American community.
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Affiliation(s)
- Nicole Misun Kormendi
- Apicha Community Health Center, 400 Broadway, New York, NY, USA, 10013.,Vassar College, 124 Raymond Ave, Poughkeepsie, NY, USA, 12604
| | - Adam D Brown
- Department of Psychology, New School for Social Research, 80 5th Avenue, 601, New York, NY, USA, 10011.,Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY, USA, 10016
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Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. GLOBAL HEALTH JOURNAL 2021. [DOI: 10.1016/j.glohj.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koly KN, Baskin C, Lata I, Rao M, Rasheed S, Law G, Gnani S. Educational and training interventions aimed at healthcare workers in the detection and management of people with mental health conditions in South and Southeast Asia: systematic review protocol. BMJ Open 2021; 11:e045615. [PMID: 34215602 PMCID: PMC8256758 DOI: 10.1136/bmjopen-2020-045615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The mental health burden and treatment gap in South and Southeast Asia is high and significant. Capacity building of healthcare workers is essential to support programmes related to the detection and management of patients with mental health conditions. We aim to conduct a systematic review to summarise the research on educational, training and capacity-building interventions aimed at the healthcare workforce in detection and management of mental health conditions in South and Southeast Asia. OBJECTIVE To synthesise evidence on (1) the types of educational and training interventions that have been used to improve the knowledge, skills and attitudes of healthcare workers in South and Southeast Asian countries in the detection and management of mental health conditions; (2) the effectiveness, including cost-effectiveness of the interventions; and (3) the enabling factors and barriers that influence the effectiveness of these interventions. METHODS AND ANALYSIS This review will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We will search six electronic databases: MEDLINE, EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Global Health for empirical studies published from 1 January 2000 to 31 August 2020. Search results from each database will be combined and uploaded in Covidence library. Title, abstract and full-text screening, and data extraction of each included study will be performed by two independent reviewers. Disagreements between reviewers will be resolved by a third reviewer and study team. Quality of included studies will be assessed by the modified Cochrane Collaboration tool and ROBINS-I tool. Data will be synthesised and if a meta-analysis is not appropriate, a stepwise thematic analysis will be performed. ETHICS AND DISSEMINATION Ethics approval is not required for this study. Findings will be disseminated through peer-reviewed publications, fact sheets, multimedia press briefings, conferences, seminars and symposia. PROSPERO REGISTRATION NUMBER CRD42020203955.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ivy Lata
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sabrina Rasheed
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Graham Law
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Son J, Shin J. Bimodal effects of sunlight on major depressive disorder. Compr Psychiatry 2021; 108:152232. [PMID: 33905989 DOI: 10.1016/j.comppsych.2021.152232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Seasonal patterns in the effect of sunlight on depression, where depression decreases when sunlight increases, have been observed in previous studies. In this study, we demonstrate a bimodal effect of sunlight on depression - short-term increases in sunlight increase depression and long-term increases in sunlight decrease depression. The analysis showed that the significant effect of sunlight is temporary and appears only when seasonal changes are severe within a given year. METHODS We analyzed approximately 530,000 cases where patients visited hospital for depression in Korea from January 1 to December 31, 2016. We measured the daily average amount of sunlight and daily sunlight for the 30 days previous to the day of measurement using data from 96 weather stations. To analyze the effect of sunlight, several climatic variables and local dummies were added to the negative binomial model, and the period in which the effect of sunlight was significant was derived as a term of the interaction between the month variable and sunlight. RESULTS When the average effects of climatic factors such as temperature, precipitation, and humidity were removed, the number of cases of depression increased when the daily average amount of sunlight increased [IRR = 1.024 (95% CI: 1.009 to 1.039)]; this effect was significant only in January and May. The number of cases of depression decreased with higher daily average sunlight for the previous 30 days increasing [IRR = 0.917 (95% CI: 0.892 to 0.944)], and this effect was significant only in January, March, and May. CONCLUSIONS The effect of sunlight on depression appears in both the short and long terms, but the effect is significant only for limited periods. The data examined in this study supports a pattern where short-term daily sunlight increases depression and daily sunlight for the previous 30 days decreases depression.
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Affiliation(s)
- Jungmin Son
- College of Economics and Management, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea.
| | - Jinhee Shin
- College of Economics and Management, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea.
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Mistry SK, Harris-Roxas B, Yadav UN, Shabnam S, Rawal LB, Harris MF. Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries. Front Public Health 2021; 9:666753. [PMID: 34239854 PMCID: PMC8258154 DOI: 10.3389/fpubh.2021.666753] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.
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Affiliation(s)
- Sabuj Kanti Mistry
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Ben Harris-Roxas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Sadia Shabnam
- Health Nutrition and Population Program, BRAC, Dhaka, Bangladesh
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Rockhampton, QLD, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
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Maddock A, Blair C, Ean N, Best P. Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review. Int J Ment Health Syst 2021; 15:56. [PMID: 34090491 PMCID: PMC8178881 DOI: 10.1186/s13033-021-00482-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mental health issues and disorders are major public health challenges, particularly in low- and middle-income countries in Southeast Asia, where chronic shortages in mental health services and human resources exist. The development of effective and accessible mental health systems in Southeast Asia will require evidence based psychological and social interventions. This systematic review provides a narrative synthesis of the evidence on the effectiveness of such interventions for mental health issues and disorders in Southeast Asia. METHODS A comprehensive literature search of 7 electronic databases (PsycINFO, Medline (Ovid), Cochrane library, EMBASE, SCOPUS, APA PsycArticles, and Social Care Online) was undertaken. RESULTS Thirty two studies employing RCT designs to evaluate the effectiveness of a range of psychological and social mental health interventions on a number of different mental health outcomes were included in this review. The disparate intervention programmes reviewed were categorised as: lay delivered, yoga, aerobic and/or meditation based, cognitive behavioural therapy oriented, eye movement desensitization and reprocessing based (EMDR), health worker delivered, and hybrid programmes. The majority of the studies included in this review were of low to moderate quality due to the variability in the quality of the study design. The highest quality, and most promising evidence came from the evaluations of lay delivered interventions. This evidence demonstrates the feasibility and potential sustainability of implementing such interventions in resource constrained contexts. CONCLUSIONS The review findings indicate that a disparate array of mental health interventions can be implemented effectively in a range of Southeast Asian mental health and health settings. There is a clear need for significantly more research however, through higher quality and larger scale RCTs before it will be known more definitively, if these interventions are effective, and for whom they are most effective in different Southeast Asian contexts.
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Affiliation(s)
- Alan Maddock
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Northern Ireland, Belfast, UK.
| | - Carolyn Blair
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Northern Ireland, Belfast, UK
| | - Nil Ean
- Department of Psychology, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Paul Best
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Northern Ireland, Belfast, UK
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Connolly SM, Vanchu-Orosco M, Warner J, Seidi PA, Edwards J, Boath E, Irgens AC. Mental health interventions by lay counsellors: a systematic review and meta-analysis. Bull World Health Organ 2021; 99:572-582. [PMID: 34354312 PMCID: PMC8319860 DOI: 10.2471/blt.20.269050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries. Methods We searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model. Findings We identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges' g for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was -0.616 (95% confidence interval: -0.866 to -0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results. Conclusion The use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.
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Affiliation(s)
- Suzanne M Connolly
- 70 Payne Place, Suite 6, Sedona, AZ 86446, United States of America (USA)
| | | | - Jan Warner
- Department of Social Work Services, Veterans Affairs Medical Center, Cleveland, USA
| | | | - Jenny Edwards
- School of Leadership Studies, Fielding Graduate University, Santa Barbara, USA
| | - Elisabeth Boath
- Department of Social Work and Social Welfare, Staffordshire University, Stoke-on-Trent, England
| | - A C Irgens
- Department of Psychiatry, Sørlandet Hospital, Arendal, Norway
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Pillai A, Keyes KM, Susser E. Antidepressant prescriptions and adherence in primary care in India: Insights from a cluster randomized control trial. PLoS One 2021; 16:e0248641. [PMID: 33739982 PMCID: PMC7978355 DOI: 10.1371/journal.pone.0248641] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The World Health Organization recommends that treatment of depression in low and middle-income countries with a scarcity of psychiatrists could be done in primary care and should include prescription of antidepressant medications for moderate and severe depression. Little is known, however, about the actual practices of antidepressant prescription by primary care physicians in low and middle-income countries, nor about adherence by people receiving such prescriptions. In a large study of primary care clinics in Goa, India, we examined the relationship of actual to recommended prescribing practices for depression, among all patients who screened positive for common mental disorder. We also examined other patient and clinic characteristics associated with antidepressant prescription, and self-reported adherence over a one-month period. METHODS Patients attending 24 primary care clinics were screened for common mental disorders. Those who screened positive were eligible to enroll in a trial to assess the effectiveness of a collaborative stepped care (CSC) intervention for mental disorders. Physicians in the 12 intervention and 12 control clinics (usual care) were free to prescribe antidepressants and follow-up interviews were conducted at 2, 6 and 12 months. Screening results were shared with the physician, but they were blinded to the diagnosis generated later using a standardized diagnostic interview administered by a health counsellor. We categorized these later diagnoses as "moderate/severe depression", "mild depression or non-depression diagnosis", and "no diagnosis". We used a two-level hierarchical logistic regression model to examine diagnostic and other factors associated with antidepressant prescription and one-month adherence. RESULTS Overall, about 47% of screened positive patients (n = 1320) received an antidepressant prescription: 60% of those with moderate/severe depression, 48% of those with mild depression or non-depression diagnosis, and 31% with no diagnosis. Women (OR 1.29; 95%CI 1.04-1.60) and older adults (OR 1.80; 95%CI 1.32-2.47) were more likely to receive an antidepressant prescription. While the overall rate of antidepressant prescription was similar in clinics with and without CSC, patients without any diagnosis were more likely to receive a prescription (OR 2.20 95% CI 1.03-4.70) in the usual care clinics. About 47% of patients adhered to antidepressant treatment for one month or more and adherence was significantly better among older adults (OR 3.92; 95% CI 1.70-8.93) and those who received antidepressant as part of the CSC treatment model (OR 6.10 95% CI 3.67-10.14) compared with those attending the usual care clinic. CONCLUSION Antidepressants were widely prescribed following screening in primary care, but prescription patterns were in poor accord with WHO recommendations. The data suggest under-prescription for people with moderate/severe depression; over-prescription for people with mild depression or non-depression diagnoses; and over-prescription for people with no disorders. For all diagnoses adherence was low, especially in usual care clinics. To address these concerns, there is an urgent need to study and develop strategies in primary care practices to limit unnecessary antidepressant prescriptions, target prescription for those patients who clearly benefit, and to improve adherence to antidepressant treatment. ClinicalTrials.gov Identifier: NCT00446407.
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Affiliation(s)
- Aravind Pillai
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Ezra Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
- New York State Psychiatric Institute, New York, New York, United States of America
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Daniel M, Maulik PK, Kallakuri S, Kaur A, Devarapalli S, Mukherjee A, Bhattacharya A, Billot L, Thornicroft G, Praveen D, Raman U, Sagar R, Kant S, Essue B, Chatterjee S, Saxena S, Patel A, Peiris D. An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme. Trials 2021; 22:179. [PMID: 33653406 PMCID: PMC7923507 DOI: 10.1186/s13063-021-05136-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. METHODS We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived-a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation. EXPECTED OUTCOMES The primary study outcome is the difference in mean behaviour scores at 12 months in the combined 'high-risk' and 'non-high-risk' cohort and the mean difference in PHQ-9 scores at 12 months in the 'high-risk' cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations. SIGNIFICANCE The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings. TRIAL REGISTRATION Clinical Trial Registry India CTRI/2018/08/015355 . Registered on 16 August 2018.
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Affiliation(s)
- Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- University of New South Wales, Sydney, Australia.
- Prasanna School of Public Health, Manipal, India.
- The George Institute for Global Health, Oxford, UK.
| | | | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | | | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Devarsetty Praveen
- University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal, India
- The George Institute for Global Health, Hyderabad, India
| | - Usha Raman
- University of Hyderabad, Hyderabad, India
| | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- All India Institute of Medical Sciences, New Delhi, India
| | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Susmita Chatterjee
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal, India
| | | | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Asher L, Birhane R, Teferra S, Milkias B, Worku B, Habtamu A, Kohrt BA, Hanlon C. "Like a doctor, like a brother": Achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia. PLoS One 2021; 16:e0246158. [PMID: 33630893 PMCID: PMC7906313 DOI: 10.1371/journal.pone.0246158] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are gaps in our understanding of how non-specialists, such as lay health workers, can achieve core competencies to deliver psychosocial interventions in low- and middle-income countries. METHODS We conducted a 12-month mixed-methods study alongside the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) pilot study. We rated a total of 30 role-plays and 55 clinical encounters of ten community-based rehabilitation (CBR) lay workers using an Ethiopian adaptation of the ENhancing Assessment of Common Therapeutic factors (ENACT) structured observational rating scale. To explore factors influencing competence, six focus group discussions and four in-depth interviews were conducted with 11 CBR workers and two supervisors at three time-points. We conducted a thematic analysis and triangulated the qualitative and quantitative data. RESULTS There were improvements in CBR worker competence throughout the training and 12-month pilot study. Therapeutic alliance competencies (e.g., empathy) saw the earliest improvements. Competencies in personal factors (e.g., substance use) and external factors (e.g., assessing social networks) were initially rated lower, but scores improved during the pilot. Problem-solving and giving advice competencies saw the least improvements overall. Multimodal training, including role-plays, field work and group discussions, contributed to early development of competence. Initial stigma towards CBR participants was reduced through contact. Over time CBR workers occupied dual roles of expert and close friend for the people with schizophrenia in the programme. Competence was sustained through peer supervision, which also supported wellbeing. More intensive specialist supervision was needed. CONCLUSION It is possible to equip lay health workers with the core competencies to deliver a psychosocial intervention for people with schizophrenia in a low-income setting. A prolonged period of work experience is needed to develop advanced skills such as problem-solving. A structured intervention with clear protocols, combined with peer supervision to support wellbeing, is recommended for good quality intervention delivery. Repeated ENACT assessments can feasibly and successfully be used to identify areas needing improvement and to guide on-going training and supervision.
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Affiliation(s)
- Laura Asher
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rahel Birhane
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barkot Milkias
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Benyam Worku
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alehegn Habtamu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington DC, United States of America
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Psychology and Neuroscience, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Centre for Global Mental Health, London, United Kingdom
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Cubillos L, Bartels SM, Torrey WC, Naslund J, Uribe-Restrepo JM, Gaviola C, Díaz SC, John DT, Williams MJ, Cepeda M, Gómez-Restrepo C, Marsch LA. The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review. BJPsych Bull 2021; 45:40-52. [PMID: 32321610 PMCID: PMC8058938 DOI: 10.1192/bjb.2020.35] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. RESULTS Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. CLINICAL IMPLICATIONS Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
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Affiliation(s)
- Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Sophia M. Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - William C. Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
| | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, USA
| | | | - Chelsea Gaviola
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - Sergio Castro Díaz
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Deepak T. John
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - Makeda J. Williams
- Center for Global Mental Health Research, National Institute of Mental Health, USA
| | - Magda Cepeda
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Carlos Gómez-Restrepo
- Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Colombia
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
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Aydin Guclu O, Karadag M, Akkoyunlu ME, Acican T, Sertogullarindan B, Kirbas G, Selimoglu Sen H, Lakadamyali H, Intepe YS, Arslan S, Firat Gursoy S, Kaya A. Association between burnout, anxiety and insomnia in healthcare workers: a cross-sectional study. PSYCHOL HEALTH MED 2021; 27:1117-1130. [PMID: 33486992 DOI: 10.1080/13548506.2021.1874434] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
All healthcare workers (HCWs) encounter stress during in their working lives, and are constantly exposed to adverse conditions. The present study evaluates the relationship between burnout syndrome, anxiety levels and insomnia severity among healthcare workers, who mostly work in shifts. The Maslach Burnout Inventory, the Insomnia Severity Index and the Beck Anxiety Inventory were used to measure burnout, insomnia severity and anxiety status, respectively. This cross sectional study included a total of 1,011 HCWs and 679 (67.2%) of the study respondents were women. The respondents were aged 20-72, with a mean age of 35.67 ± 8.61 years. Fifty-eight percent (n = 589) of the participants were rotating shift workers. Working on-call led to a significant difference in all burnout parameters (for each, <0.001). Age and on-call duty were seen to lead to a significant difference in the severity of insomnia (p = 0.028, p < 0.001, respectively). The total ISI score was found to be statistically significant positively correlated with the MBI subscales and the total BAI score (for each, <0.001). An increased awareness of the impact of sleep deprivation, burnout and anxiety among HCWs and meaningful interventions promoting change within the healthcare system are needed.
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Affiliation(s)
- Ozge Aydin Guclu
- Boyabat 75th Year State Hospital, Department of Pulmonary Diseases, Sinop, Turkey.,, Bursa Uludag University Faculty of Medicine, Department of Pulmonary Disease, Bursa, Turkey
| | - Mehmet Karadag
- , Bursa Uludag University Faculty of Medicine, Department of Pulmonary Disease, Bursa, Turkey
| | | | - Turan Acican
- Ankara University Faculty of Medicine, Department of Pulmonary Diseases, Ankara, Turkey
| | | | - Gokhan Kirbas
- Dicle University Faculty of Medicine, Department of Pulmonary Diseases, Diyarbakir, Turkey
| | - Hatice Selimoglu Sen
- Dicle University Faculty of Medicine, Department of Pulmonary Diseases, Diyarbakir, Turkey
| | - Huseyin Lakadamyali
- Alanya Alaaddin Keykubat University Faculty of Medicine, Department of Pulmonary Diseases, Alanya, Turkey
| | - Yavuz Selim Intepe
- Bozok University Faculty of Medicine, Department of Pulmonary Diseases, Yozgat, Turkey
| | - Sertac Arslan
- Hitit University Faculty of Medicine, Department of Pulmonary Diseases, Corum, Turkey
| | - Sibel Firat Gursoy
- Nilufer District Health Directorate, Licensed Clinical Psychologist, Bursa, Turkey
| | - Akin Kaya
- Ankara University Faculty of Medicine, Department of Pulmonary Diseases, Ankara, Turkey
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Anik E, West RM, Cardno AG, Mir G. Culturally adapted psychotherapies for depressed adults: A systematic review and meta-analysis. J Affect Disord 2021; 278:296-310. [PMID: 32979561 DOI: 10.1016/j.jad.2020.09.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is current debate about the effectiveness and generalizability of evidence-based psychological therapies in treatment of depression for diverse ethno-cultural groups. This has led to increasing interest in culturally adapted psychotherapies (CAPs). METHODS Studies on CAPs for face-to-face treatment of depressed adults were identified using nine electronic database searches. Data on the process of adaptation was analysed using thematic analysis and treatment efficacy was assessed through meta-analysis of Randomized Controlled Trials. RESULTS Fifteen studies were included in the review, of which eight were included in a meta-analysis. Cognitive Behavioural Therapy and Behavioural Activation were commonly selected approaches for CAPs, mainly based on their strong evidence base for effectiveness. Twelve studies reported the adaptation process that follows all or some phases recommended by the Medical Research Council Framework for developing complex interventions. A meta-analysis of 16 RCTs, which included eight studies from the current review and eight studies from an earlier review (Chowdhary et al. (2014), demonstrated a statistically significant benefit in favour of CAPs, reducing symptom burden [standardized mean difference -0.63, 95% confidence interval -0.87 to -0.39]. Subgroup analysis showed a larger effect when the intervention was for the majority ethnic group in a population, rather than a minority group. LIMITATIONS Some studies did not report all relevant information, and in the subgroup analysis only three studies were of minority groups. CONCLUSIONS CAPs were confirmed to be more efficacious than control treatments. This supports the continued development and evaluation of culturally adapted psychotherapies for depression.
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Affiliation(s)
- Evrim Anik
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK.
| | - Robert M West
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Alastair G Cardno
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Ghazala Mir
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, UK
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Bunn M, Gonzalez N, Falek I, Weine S, Acri M. Supporting and Sustaining Nonspecialists to Deliver Mental Health Interventions in Low- and Middle-Income Countries: An Umbrella Review. INTERVENTION 2021. [DOI: 10.4103/intv.intv_47_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thekkumkara SN, Jagannathan A, Jadhav P, Durgoji SK, Muliyala KP, Angothu H, Reddi VSK. 'Family centric rehabilitation' for persons with mental illness in India: Conceptual framework using evidence-based case studies'. Asian J Psychiatr 2020; 54:102344. [PMID: 32758925 DOI: 10.1016/j.ajp.2020.102344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE OF THE STUDY In India, people live in a collective society wherein family members are the primary caregivers for the person suffering from mental illness (PMI). Psychiatric rehabilitative models are individual-centric, focusing on individual level skills (emotional, social, self-management and vocational) and development to enhance successful community reintegration. If the entire family is considered to be a unit for rehabilitation, i.e. family centric rehabilitation, the possibility of empowering the family to function effectively is higher despite the illness. The objective of the case study is to conceptualize the framework 'Family centric Rehabilitation'. METHODS Case study design. RESULTS Family centric rehabilitation can be conceptualized as 'a process that facilitates families, dysfunctional due to PMI, to reach their optimal level of independent functioning by harnessing resources available within the community'. Family centric rehabilitation focuses on enhancing global functioning of the "family unit", in essence all members, rather than just the PMI. Strategies deployed include concurrently addressing and minimizing anticipated challenges across domains including medical, psychosocial, vocational as well as economic, thereby aiding in recovery of the family unit as a whole. CONCLUSIONS Family centric rehabilitation is an important culture specific concept that aims to provide optimal level of functioning of all family members and can contribute to the family achieving self-sustenance, a sense of autonomy and empowerment.
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Affiliation(s)
- Sreekanth Nair Thekkumkara
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Aarti Jagannathan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, NIMHANS, Bengaluru, 560029, India.
| | - Prabhu Jadhav
- Department of Psychiatry, NIMHANS, Bengaluru, 560029, India.
| | | | - Krishna Prasad Muliyala
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Hareesh Angothu
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Venkata Senthil Kumar Reddi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
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Rodriguez-Villa E, Naslund J, Keshavan M, Patel V, Torous J. Making mental health more accessible in light of COVID-19: Scalable digital health with digital navigators in low and middle-income countries. Asian J Psychiatr 2020; 54:102433. [PMID: 33271713 DOI: 10.1016/j.ajp.2020.102433] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Abstract
The rapid spread of COVID-19 and the devastating consequences to economies and healthcare systems around the world has highlighted the exigent need for accessible mental health support. Increasing use of mobile devices in Lower Middle-Income Countries (LMIC) such as India offers novel opportunity to expand treatment options and reach underserved populations. Prior efforts have utilized technology to redistribute or supplement clinical care but measurable outcomes of this research are limited. In this paper, we explain the structural barriers that prevent access to care and build on prior research to demonstrate how technology can be utilized to offer treatment if it is aided by education and technical support.
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Affiliation(s)
- Elena Rodriguez-Villa
- Division of Digital Psychiatry at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - John Naslund
- Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Matcheri Keshavan
- Division of Digital Psychiatry at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Vikram Patel
- Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Govindan R, Rangaswamy T, John S, Kandasamy S. Methodology for Development of a Community Level Intervention Module for Physical Illness in Persons with Mental Illness (CLIPMI). Indian J Psychol Med 2020; 42:S94-S98. [PMID: 33487810 PMCID: PMC7802035 DOI: 10.1177/0253717620973381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Medical illnesses seen in persons with psychiatric disorders are important but often ignored causes of increased morbidity and mortality. Hence, a community level intervention program addressing the issue is proposed. MATERIALS AND METHODS Patients with severe mental illnesses will be identified by a door-to-door survey and assessed for comorbid physical illnesses like anemia, hypertension, diabetes, and so on. They will then be randomized into two groups. The treatment as usual (TAU) group will not receive intervention from the trained community level workers, while the Intervention group will receive it. RESULTS The two groups will be compared for the prevalence and severity of comorbid physical illnesses. The expected outcome is compared to the TAU group, the intervention group will have a greater reduction in the morbidity due to physical illnesses and improved mental health. CONCLUSION If successful, the module can be incorporated into the community level mental health delivery system of the District Mental Health Program (DMHP).
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Affiliation(s)
| | | | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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45
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Creed TA. Training Aboriginal Practitioners in Cognitive Behavioural Therapy. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Torrey A Creed
- Aaron T. Beck Psychopathology Research Center, Department of Psychiatry, University of Pennsylvania,
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Marastuti A, Subandi MA, Retnowati S, Marchira CR, Yuen CM, Good BJ, Good MJD. Development and Evaluation of a Mental Health Training Program for Community Health Workers in Indonesia. Community Ment Health J 2020; 56:1248-1254. [PMID: 32062716 DOI: 10.1007/s10597-020-00579-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Abstract
The treatment gap in mental health care in Indonesia is a critical issue due in large measure to the dearth of professional mental health staff. In response to this need, our team designed a mental health training program for existing community health workers. The training program was offered to 65 participants at 2 (two) community primary care center (Puskesmas); we evaluated the training program with quantitative and qualitative methods. We assessed the gains in knowledge using a 20-question knowledge assessment test. In addition, in Puskesmas 1, the test was repeated as a follow-up test 4 months after the training. Statistical analysis showed that the differences between pre-test and post-test scores were significant in both Puskesmas 1 (p = 0.004) and Puskesmas 2 (p < 0.001). This study concluded that the model of integrative training appears effective for preparing Indonesian CHWs to recognize and respond to needs for mental health care.
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Affiliation(s)
- Ariana Marastuti
- Fakultas Psikologi, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281
| | - M A Subandi
- Fakultas Psikologi, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281.
| | - Sofia Retnowati
- Fakultas Psikologi, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281
| | - Carla R Marchira
- Fakultas Kedokteran, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Byron J Good
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Mary-Jo D Good
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
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Luitel NP, Breuer E, Adhikari A, Kohrt BA, Lund C, Komproe IH, Jordans MJD. Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study. BJPsych Open 2020; 6:e77. [PMID: 32718381 PMCID: PMC7443901 DOI: 10.1192/bjo.2020.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal. AIMS To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP. METHOD A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers. RESULTS The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma. Involvement of Ministry of Health, procurement of new psychotropic medicines through PRIME, motivation of health workers and the development of a new supervision system were key facilitating factors. CONCLUSIONS Effective implementation of mental health services in primary care settings require interventions to increase demand for services and to ensure there is clinical supervision for health workers, private rooms for consultations, a separate cadre of psychosocial workers and a regular supply of psychotropic medicines.
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Affiliation(s)
| | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Department of Medicine and Public Health, University of Newcastle, Australia
| | - Anup Adhikari
- Transcultural Psychosocial Organization (TPO), Nepal
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, USA; and Transcultural Psychosocial Organization (TPO), Nepal
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ivan H Komproe
- Faculty of Social and Behavioural Sciences, Utrecht University; and Research and Development Department, HealthNet TPO, Amsterdam, the Netherlands
| | - Mark J D Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Faculty of Social and Behavioural Sciences, Department of Anthropology, University of Amsterdam, the Netherlands; and Transcultural Psychosocial Organization (TPO), Nepal
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Abstract
Systems are investing in workers who come from the communities they serve to meet patient needs that extend well beyond clinic walls.
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Affiliation(s)
- Rob Waters
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/. Rob Waters is an independent writer in Oakland, California, who writes about health and science and has contributed to Kaiser Health News, STAT, Mother Jones, and Psychotherapy Networker, among other publications
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Pedersen GA, Lakshmin P, Schafer A, Watts S, Carswell K, Willhoite A, Ottman K, van 't Hof E, Kohrt BA. Common factors in psychological treatments delivered by non-specialists in low- and middle-income countries: Manual review of competencies. ACTA ACUST UNITED AC 2020; 30:165-186. [PMID: 34308387 DOI: 10.1016/j.jbct.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Delivery of psychological and psychosocial treatments by non-specialists in low-and middle-income countries (LMIC) is a growing strategy to address the global mental health treatment gap. However, little is known about which competencies are essential for non-specialists to effectively deliver treatment. Psychotherapy research in high-income countries suggests that effective treatment requires competency in common factors. Therefore, our objective was to identify how common factors are described in evidence-supported non-specialist interventions in LMICs. To meet this objective, we identified and coded common factors by reviewing 16 evidence-supported manuals for psychological treatments delivered by non-specialists in LMICs. World Health Organization (WHO) manuals and other non-proprietary manuals, with positive randomized control outcomes, were included in the review. Fifteen common factors were identified and described in most manuals: 'promoting hope and realistic expectancy of change' and 'confidentiality' were described in 15 manuals (94%), followed by 'giving praise' and 'psychoeducation' (88% of manuals), and 'rapport building' (81% of manuals). Descriptions of common factors were similar across manuals, suggesting that training and competency evaluation approaches can be harmonized across interventions. Compiling these descriptions from the manuals can inform foundational training in common factors for diverse cadres of non-specialists around the world.
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Affiliation(s)
- Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C. 20037, USA
| | - Pooja Lakshmin
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C. 20037, USA
| | - Alison Schafer
- World Health Organization, Department of Mental Health and Substance Use, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Sarah Watts
- World Health Organization, Department of Mental Health and Substance Use, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Kenneth Carswell
- World Health Organization, Department of Mental Health and Substance Use, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ann Willhoite
- United States Agency for International Development, DCHA/DRG, Empowerment & Inclusion Division, Washington, D.C., USA.,Child Protection in Emergencies, Child Protection, Programme Division, UNICEF Headquarters, 3 UN Plaza, 10017 New York, NY, USA
| | - Katherine Ottman
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C. 20037, USA
| | - Edith van 't Hof
- World Health Organization, Department of Mental Health and Substance Use, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600, Washington, D.C. 20037, USA
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Aggarwal S, Patton G, Bahl D, Shah N, Berk M, Patel V. Explanatory style in youth self-harm: an Indian qualitative study to inform intervention design. EVIDENCE-BASED MENTAL HEALTH 2020; 23:100-106. [PMID: 32651178 DOI: 10.1136/ebmental-2020-300159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are very few studies that have examined the effectiveness of psychological interventions (PIs) that have been developed and tested in high-income countries to reduce self-harm in low and middle-income countries. OBJECTIVE To evaluate the perspectives and explanatory styles of youth with self-harm and their caregivers to inform the design of an evidence based PI in a non-Western cultural setting. An additional objective was to suggest ways of integrating local practices and traditions to enhance its acceptability. METHODS We conducted 15 in-depth qualitative interviews with youth with self-harm and four interviews with the caregivers in the psychiatry department of a tertiary hospital located in Mumbai, India. Data were analysed using phenomenological thematic analysis. FINDINGS Five themes were uncovered: (i) contextual factors related to self-harm including interpersonal factors, intrapersonal factors and socio-cultural factors; (ii) formulation and current feelings about the attempt (iii) family members and friends as the perceived supports and deterrents for future self-harm attempts; (iv) treatment related experiences with counselling, in-patient and outpatient treatment and barriers to treatment; and (v) coping strategies. Recommendations for key areas of adaptation include therapist adaptation, content adaptation to accommodate for cultural considerations and broader social context. Gender based socio-cultural norms, beliefs and stigma attached to self-harm need to be specifically addressed in South Asian setting. Interpersonal conflicts are the most common triggers. CONCLUSION AND CLINICAL IMPLICATIONS To our knowledge this is the first study in the South Asian context evaluating explanatory styles of youth with self-harm and their caregivers to inform the design of an intervention to ensure its cultural congruence. Cultural adaptation of an evidence based PI results in competent delivery and ensures best results in diverse ethno-cultural populations.
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Affiliation(s)
- Shilpa Aggarwal
- Department of Mental Health and Non-Communicable Diseases, Public Health Foundation of India, New Delhi, Delhi, India
| | - George Patton
- Department of Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Deepika Bahl
- Department of Mental Health and Non-Communicable Diseases, Public Health Foundation of India, New Delhi, Delhi, India
| | - Nilesh Shah
- Department of Psychiatry, Sion Hospital, Mumbai, Maharashtra, India
| | - Michael Berk
- Department of Psychiatry, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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