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McBride B, Kane S, O'Neil J, Nguyen LT. The best healthcare (commodity) available (for purchase): provider-induced demand for obstetric ultrasonography among ethnic minority women in rural northern Vietnam. AJOG GLOBAL REPORTS 2024; 4:100375. [PMID: 39148607 PMCID: PMC11325764 DOI: 10.1016/j.xagr.2024.100375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Despite Vietnam's overall progress on maternal health indicators, marginalized ethnic minorities in remote areas face lower access to antenatal care and higher maternal mortality rates relative to the Kinh (majority ethnic group). Last year, we conducted fieldwork for 2 qualitative research projects that aimed to address maternal health inequities among pregnant ethnic minority women in rural Northern Vietnam. Although not the focus of our research, the use of ultrasonography services at for-profit private clinics was ubiquitous in participants' healthcare-seeking accounts. Ultrasound scans from for-profit clinics were a major component of ethnic minority women's antenatal care: many purchased 8 to 10 scans during pregnancy at $6.15 US dollars per scan, despite their limited agricultural income of $120 to $205 per month. Women were unaware of how many scans were recommended and their medically indicated scheduling, but purchased frequent scans to assuage pregnancy anxieties and access what they experienced as the highest-quality antenatal service. In tandem, for-profit ultrasonography providers offered broader opening hours, immediate results, and rich technological scans, which seemed to deliver poor families the most tangible "value" for their hard-earned money. Previous literature documented the concerning overuse of ultrasonography among Kinh women in urban Vietnam: What are the implications of this trend extending to affect rural-dwelling ethnic minority women who face lower education, economic marginalization, and a 4-fold higher maternal mortality rate? Our findings raise concerns related to safety, financial vulnerability and provider-induced demand, and broader health policy questions regarding healthcare commodities in low-resource settings. Critically, there is no evidence of the effect of obstetrical ultrasound on reducing maternal mortality in low- and middle-income countries, and its excess use could burden available resources and detract from evidence-based services. Our findings suggest that health system gaps are driving poor women toward frequent purchases of a single insufficient maternal health commodity: this will not improve their pregnancy outcomes or health equity for marginalized ethnic minorities. We argue that addressing this overuse of ultrasonography due to provider-induced demand requires a multipronged response that meets women's growing expectations. Our findings highlight the need for investment in health education, health promotion, and reliable high-quality public maternal healthcare for ethnic minority communities in Vietnam.
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Affiliation(s)
- Bronwyn McBride
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (McBride and O'Neil)
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia (Kane)
| | - John O'Neil
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (McBride and O'Neil)
| | - Liem T Nguyen
- Institute of Population, Health and Development, Dong Da, Hanoi, Vietnam (Nguyen)
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Nguyen HTH, Hoang PA, Do TKL, Taylor-Robinson AW, Nguyen TTH. Postpartum depression in Vietnam: a scoping review of symptoms, consequences, and management. BMC Womens Health 2023; 23:391. [PMID: 37496038 PMCID: PMC10369808 DOI: 10.1186/s12905-023-02519-5] [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: 11/01/2022] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a major health issue that can affect both mothers and their newborn children. In Vietnam, approximately 20% of mothers suffer from PPD. However, there is a lack of synthesized evidence regarding the case management of PPD in the Vietnamese context. A review of early symptoms, consequences, and management strategies of PPD will help to inform best practices to reduce complications and shorten the recovery time after parturition. METHODS This scoping review aims to analyze and synthesize the findings of studies on PPD examining the symptoms, consequences, and management strategies among Vietnamese women. MEDLINE, CINAHL, PubMed, ScienceDirect, EBSCOHost, Google Scholar, and a networked digital library of projects, theses, and dissertations published between 2010 and 2022 in Vietnam were accessed following search terms including "Vietnam", "depression", "postpartum", "symptom/experience", "consequence", and "management". FINDINGS The most-reported symptoms were sadness, tiredness, the feeling of being ignored, lack of interest in the baby, reduced appetite, and sleep disturbance. The recognized consequences were child stunting and slow growth, without mentioning its long-term effects on mothers. Our findings indicated that PPD in Vietnam has not been sufficiently managed; mothers tend to seek help from 'fortune-tellers' or 'word-of-mouth' practices rather than from evidence-based modern medicine. CONCLUSION This scoping review provides an initial stage of PPD symptoms, consequences, and management along with facilitating an interventional program to support this vulnerable group of women. A large survey of Vietnamese mothers' symptoms, effects, and management strategies is needed.
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Affiliation(s)
- Huyen Thi Hoa Nguyen
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam.
- Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Phuong Anh Hoang
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam
- Faculty of Nursing and Midwifery, Hanoi Medical University, No 1 Ton That Tung, Dong Da, 100000, Hanoi, Vietnam
| | - Thi Kim Ly Do
- University Medical Center Schleswig-Holstein, Lübeck campus, Ratzeburger Allee 96, Lübeck, 23562, Germany
| | - Andrew W Taylor-Robinson
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam
| | - Thi Thanh Huong Nguyen
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam
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Hong SA, Buntup D. Maternal Depression during Pregnancy and Postpartum Period among the Association of Southeast Asian Nations (ASEAN) Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5023. [PMID: 36981932 PMCID: PMC10049420 DOI: 10.3390/ijerph20065023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Identification of mothers with depression is important because untreated perinatal depression can have both short- and long-term consequences for the mother, the child, and the family. This review attempts to identify the prevalence of antenatal and postnatal depression (AD and PD, respectively) of mothers among the ASEAN member countries. A literature review was conducted using PubMed, Scopus, and the Asian Citation Index. The reviews covered publications in peer-reviewed journals written in the English language between January 2010 and December 2020. Of the 280 articles identified, a total of 37 peer-reviewed articles conducted in 8 out of 11 ASEAN member countries were included. The Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument used to identify depression. This study showed the number of studies reporting the prevalence of AD was 18 in five countries. For PD, 24 studies in eight countries were included. The prevalence of AD ranged from 4.9% to 46.8%, and that of PD ranged from 4.4% to 57.7%. This first review among ASEAN countries showed very few studies conducted in lower-middle-income and substantial heterogeneity in prevalence among studies reviewed. Further research should be conducted to estimate the prevalence using a large representative sample with a validated assessment tool among the ASEAN countries.
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Nguyen HTT, Hoang AP, Do LTK, Schiffer S, Nguyen HTH. The Rate and Risk Factors of Postpartum Depression in Vietnam From 2010 to 2020: A Literature Review. Front Psychol 2021; 12:731306. [PMID: 34777111 PMCID: PMC8578872 DOI: 10.3389/fpsyg.2021.731306] [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: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Postpartum depression (PPD) is commonly seen in women after birth and can lead to adverse effects on both the health of mothers and child(ren) development. In Vietnam, there have been a number of studies examining the rate and risk factors of PPD, but none has provided a systematic review. Aim: This current literature review aims to summarize and synthesize the current state of knowledge of studies conducted in Vietnam to provide a comprehensive understanding of the PPD phenomena during the last 10 years. Data Sources: A literature search was conducted relying on the most common online databases—MEDLINE/PubMed, ScienceDirect, and Google Scholar, which included articles if they (i) examined prevalence or risk factors of PPD; (ii) were conducted among Vietnamese participants using either quantitative, qualitative, or mixed-method, and (iii) were published from 2010 to 2020. After the filtering process, 18 articles were eligible to be reviewed. Results: Research studies in Vietnam on PPD are conducted among women at and after 1-month delivery. The rate of PPD reported in Vietnam among mothers at postnatal time points from 1 to 12 months ranged from 8.2 to 48.1%. Risk factors can be clustered into three groups: personal factors, family factors, and environmental factors. Recommendation: Further research studies should focus on examining PPD at an earlier stage within the first month after birth. The investigation of risk factors in a comprehensive manner for Vietnamese mothers would also be recommended.
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Affiliation(s)
| | - Anh Phuong Hoang
- College of Health Sciences, Vin University, Hanoi, Vietnam.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Ly Thi Kim Do
- 47B General Surgery Department, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Lubotzky-Gete S, Gete M, Levy R, Kurzweil Y, Calderon-Margalit R. Comparing the Different Manifestations of Postpartum Mental Disorders by Origin, among Immigrants and Native-Born in Israel According to Different Mental Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111513. [PMID: 34770030 PMCID: PMC8582687 DOI: 10.3390/ijerph182111513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022]
Abstract
We conducted a prospective study, aimed to study whether the prevalence of mental disorders after birth differs by country of origin. Parturient mothers of Ethiopian origin, Former-USSR (FSU) origin, or nonimmigrant, native-Israeli origin (n = 974, all Jewish) were recruited in hospitals in Israel and were followed 6–8 weeks and one year after birth. General linear models were used to study the associations between origin and mental health, comparing Ethiopian and FSU origin with native-Israeli. Ethiopian and FSU mothers were more likely to report on somatic symptoms, compared with native-Israeli women. Ethiopian origin was negatively and significantly associated with anxiety in all three interviews (β = −1.281, β = −0.678 and β = −1.072, respectively; p < 0.05 in all). FSU origin was negatively associated with depression after birth (β = −0.709, p = 0.036), and negatively associated with anxiety after birth and one-year postpartum (β = −0.494, and β = −0.630, respectively). Stressful life events were significantly associated with all mental disorders in the three time points of interviews. Our findings suggest that immigrants tend to express higher mental distress with somatic symptoms. Additional tools are needed for mental distress screening among immigrants.
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Affiliation(s)
- Shakked Lubotzky-Gete
- Hadassah Braun School of Public Health, Hebrew University, Jerusalem 9112102, Israel;
- Correspondence: ; Tel.: +972-2-6778647 or +972-528-586201
| | - Maru Gete
- Otolaryngology (ENT) and Head-Neck Surgery, Shaarei-Tzedek Medical Center, Jerusalem 9103102, Israel;
| | - Roni Levy
- Hadasa School of Medicine, Hebrew University, Jerusalem 9112102, Israel;
| | - Yaffa Kurzweil
- The Nursing Administration, Shamir Medical Center, Zeriffin 60930, Israel;
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Xing JW, Chen MM, Tian XY, Pan DQ, Peng XH, Gao PF. 919 syrup inhibits ROS-mediated leptin-induced anorexia by activating PPARγ and improves gut flora abnormalities. Biomed Pharmacother 2021; 138:111455. [PMID: 33711553 DOI: 10.1016/j.biopha.2021.111455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Women with postpartum psychiatric disorders are prone to severe anorexia. Clinical studies have revealed the efficacy of 919 syrup, a traditional Chinese medicine mixture against postpartum illnesses, such as in regulating maternal mood and improving postpartum anorexia. AIM This study investigated the mechanisms through which 919 syrup improved anorexia induced by postpartum stress, focussing on the combined peroxisome proliferator-activated receptor gamma (PPARγ) and leptin signalling pathway, and its effects on the structure of the gut flora. METHODS Mice were randomly divided into five groups-control group, immobilisation stressed (IS) group (normal saline), pioglitazone (Piog; western medicine control) group, 919 syrup low-dose (TJD; 13.5 g/kg) group, and 919 syrup high-dose (TJG; 27.0 g/kg) group. The control group was housed normally. The other groups received IS for 3 h daily for 21 days. The treatments were initiated following the first postnatal day and were administered by gastric gavage. All mice were sacrificed under anaesthesia on postnatal day 22. Blood, hypothalamus, stomach, and faecal specimens were collected. Gene and protein expression levels of components of the PPARγ-leptin signalling pathway in the serum, hypothalamus, and stomach were determined. Immunofluorescence staining for proopiomelanocortin (POMC), phosphorylated signal transducer and activator of transcription 3 (pSTAT3), and leptin was performed to observe their spatial distributions in the hypothalamus and stomach. 16s rRNA gene sequencing and bioinformatics analysis of fecal specimens were performed. RESULTS After IS, postpartum mice showed significantly reduced appetite and body weight, accompanied by abnormalities in the structure of the gut flora. Treatment with 919 syrup (27.0 g/kg) downregulated malondialdehyde and upregulated catalase, glutathione peroxidase, and superoxide dismutase by activating PPARγ, thereby affecting the expression of leptin signalling pathway components (leptin, leptin receptor, pSTAT3, POMC, and cocaine and amphetamine-related transcript and neuropeptide Y), and modulated the gut flora in stressed mice. CONCLUSION 919 syrup improved appetite in mice with postnatal stress by activating PPARγ to induce crosstalk with the leptin signalling pathway, this mechanism was similar to that of PPARγ agonists. 919 syrup also improved gut flora structure, and the changes in the relative abundances of the gut flora strongly correlated with the expression levels of PPARγ and leptin pathway components.
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Affiliation(s)
- Jing-Wei Xing
- Department of Traditional Chinese Medicine, Jinshan Hospital of Fudan University, Shanghai, China
| | - Man-Man Chen
- Department of Traditional Chinese Medicine, Huashan Hospital of Fudan University, Shanghai, China
| | - Xin-Yun Tian
- Department of Traditional Chinese Medicine, Jinshan Hospital of Fudan University, Shanghai, China
| | - Dan-Qing Pan
- Department of Traditional Chinese Medicine, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiu-Hua Peng
- Department of Animal Experiments, Shanghai Public Health Clinical Center, Shanghai, China
| | - Peng-Fei Gao
- Department of Traditional Chinese Medicine, Jinshan Hospital of Fudan University, Shanghai, China.
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Stocker R, Nguyen T, Tran T, Tran H, Tran T, Hanieh S, Biggs BA, Fisher J. Social and economic development and pregnancy mental health: secondary analyses of data from rural Vietnam. BMC Public Health 2020; 20:1001. [PMID: 32586374 PMCID: PMC7318479 DOI: 10.1186/s12889-020-09067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to establish whether changes in the socioeconomic context were associated with changes in population-level antenatal mental health indicators in Vietnam. METHODS Social, economic and public policies introduced in Vietnam (1986-2010) were mapped. Secondary analyses of data from two cross-sectional community-based studies conducted in 2006 (n = 134) and 2010 (n = 419), involving women who were ≥ 28 weeks pregnant were completed. Data for these two studies had been collected in structured individual face-to-face interviews, and included indicators of antenatal mental health (mean Edinburgh Postnatal Depression Scale Vietnam-validation (EPDS-V) score), intimate partner relationships (Intimate Bonds Measure Vietnam-validation) and sociodemographic characteristics. Socioeconomic characteristics and mean EPDS-V scores in the two study years were compared and mediation analyses were used to establish whether indicators of social and economic development mediated differences in EPDS-V scores. RESULTS Major policy initiatives for poverty reduction, hunger eradication and making domestic violence a crime were implemented between 2006 and 2010. Characteristics and circumstances of pregnant women in Ha Nam improved significantly. Mean EPDS-V score was lower in 2010, indicating better population-level antenatal mental health. Household wealth and intimate partner controlling behaviours mediated the difference in EPDS-V scores between 2006 and 2010. CONCLUSIONS Changes in the socioeconomic and political context, particularly through policies to improve household wealth and reduce domestic violence, appear to influence women's lives and population-level antenatal mental health. Cross-sectoral policies that reduce social risk factors may be a powerful mechanism to improve antenatal mental health at a population level.
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Affiliation(s)
- Ruby Stocker
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Trang Nguyen
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
- Research and Training Centre for Community Development, No 39 Lane 255, Vong Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Thach Tran
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Ha Tran
- Research and Training Centre for Community Development, No 39 Lane 255, Vong Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Tuan Tran
- Research and Training Centre for Community Development, No 39 Lane 255, Vong Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Sarah Hanieh
- Department of Medicine and Victorian Infectious Diseases Services at the Doherty Institute, University of Melbourne, 792 Elizabeth Street, Melbourne, 3000, Australia
| | - Beverley-Ann Biggs
- Department of Medicine and Victorian Infectious Diseases Services at the Doherty Institute, University of Melbourne, 792 Elizabeth Street, Melbourne, 3000, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
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Klinger-König J, Grabe HJ. [Perinatal and postnatal treatment of traumatized parents with mental disorders: impact on parents and their children]. DER NERVENARZT 2019; 90:260-266. [PMID: 30643953 DOI: 10.1007/s00115-018-0660-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In traumatized parents with mental disorders, pregnancy and related medical examinations can lead to high emotional distress and flashbacks and increase the already tense emotional situation. Besides psychiatric burdens, parental insecurity concerning dealing with and reduced sensitivity for the child often exist. The children themselves have a higher risk of being neglected or abused and to also develop mental disorders. OBJECTIVE How does interventional research take the special needs of traumatized parents with mental disorders into account? What kind of interventions predominate and what impact do they have on parents and children? MATERIAL AND METHODS Publications on perinatal and postnatal interventions for traumatized and mentally disordered parents were included in the review if at least one intervention was explicitly described, a parental trauma was discussed and the impact of the intervention on the parents and children was analyzed. RESULTS A total of 2 reviews and 10 interventional studies were included. Interventions were primarily based on professional educational counseling, psychoeducation, nurse home visits, individual and group therapies and inpatient mother-baby units. The interventions led to reduced psychiatric symptoms, enhanced parental sensitivity for the child's needs, enhanced quality of nurturing and care and an improved mother-child bonding. CONCLUSION Although only few studies focused on the special needs of traumatized, mentally disordered parents, the described interventions show promising effect sizes, especially in combination with several kinds of interventions. Nevertheless, an adequate integration of fathers into the therapies has so far been neglected.
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Affiliation(s)
- Johanna Klinger-König
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17489, Greifswald, Deutschland.
| | - Hans J Grabe
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17489, Greifswald, Deutschland.,Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen, Greifswald, Deutschland
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Nhị TT, Hạnh NTT, Gammeltoft TM. Emotional violence and maternal mental health: a qualitative study among women in northern Vietnam. BMC WOMENS HEALTH 2018; 18:58. [PMID: 29699557 PMCID: PMC5921269 DOI: 10.1186/s12905-018-0553-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
Background Worldwide, intimate partner violence (IPV) during pregnancy is a pressing and prevalent public health problem. Existing research has found close associations between IPV and perinatal mental health, yet little is known about women’s own perceptions of these associations. This study aimed to explore Vietnamese women’s experiences of emotional partner violence and their perceptions of the implications of such violence for their mental health. Methods The data were collected through in-depth interviews with 20 women living in Hanoi, Vietnam who had reported exposure to emotional partner violence and attained high depression scores in a prospective cohort study. Ten women were pregnant and ten had recently given birth. The data were analysed by qualitative content analysis. Results The women described emotional partner violence as a major life stressor. Their accounts pointed to three particularly significant dimensions of emotional violence: being ignored by the husband; being denied support; and being exposed to controlling behaviours. These experiences affected the women’s sense of wellbeing profoundly, causing sadness and distress. The women’s accounts indicated that experiences of emotional violence were significantly shaped by dominant kinship arrangements: practices of patrilocal residence and principles of patrilineal descent tended to aggravate women’s vulnerabilities to partner violence. Conclusions This qualitative study from Vietnam documents close associations between emotional partner violence and perinatal distress, while also pointing to kinship arrangements as particularly significant structural contexts shaping women’s experiences of partner violence. The study findings suggest that effective policies and programs to decrease women’s vulnerability to intimate partner violence must take into account the kinship arrangements that prevail in a given society.
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Affiliation(s)
- Trần Thơ Nhị
- Department of Population, Institute for Preventive Medicine and Public Health, Hanoi Medical University, No.1 Ton That Tung, Khuong Thuong, Dong Da, Hanoi, Vietnam.
| | - Nguyễn Thị Thúy Hạnh
- Department of Population, Institute for Preventive Medicine and Public Health, Hanoi Medical University, No.1 Ton That Tung, Khuong Thuong, Dong Da, Hanoi, Vietnam
| | - Tine M Gammeltoft
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
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Banks LM, Kuper H, Polack S. Poverty and disability in low- and middle-income countries: A systematic review. PLoS One 2017; 12:e0189996. [PMID: 29267388 PMCID: PMC5739437 DOI: 10.1371/journal.pone.0189996] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs). METHODS Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics. RESULTS From the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67% of lower-middle and 72% of upper-middle income countries finding a positive relationship. By age group, the proportion of studies reporting a positive association between disability and poverty was lowest for older adults and highest for working-age adults (69% vs. 86%). CONCLUSIONS There is strong evidence for a link between disability and poverty in LMICs and an urgent need for further research and programmatic/policy action to break the cycle.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Falah-Hassani K, Shiri R, Dennis CL. The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychol Med 2017; 47:2041-2053. [PMID: 28414017 DOI: 10.1017/s0033291717000617] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.
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Affiliation(s)
| | - R Shiri
- Finnish Institute of Occupational Health,Helsinki,Finland
| | - C-L Dennis
- University of Toronto,Toronto, ON,Canada
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Brown N, Finch JE, Obradović J, Yousafzai AK. Maternal care mediates the effects of nutrition and responsive stimulation interventions on young children's growth. Child Care Health Dev 2017; 43:577-587. [PMID: 28480514 DOI: 10.1111/cch.12466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Undernutrition contributes to at least half the estimated six million annual childhood deaths worldwide. Furthermore, one in three children fails to meet their developmental potential because of risks including stunting, illness, under-stimulation, poor responsive interactions and maternal depressive symptoms. Our study investigates the role of caregiving processes on children's height-for-age at 2 and 4 years. METHODS The Pakistan Early Child Development Scale-up study assessed the longitudinal effectiveness of early nutrition and responsive stimulation interventions on growth and development at 4 years of age. In total, 1302 children were followed up from birth to 4 years. We leveraged path analyses to explore potential mediators of early intervention effects on children's height-for-age at 4 years, including maternal depressive symptoms, mother-child interaction quality, diarrhoeal illness and height-for-age at 2 years. RESULTS Our final model had excellent model fit (comparative fix index = 0.999, Tucker-Lewis index = 0.998, root mean square error of approximation = 0.008) and showed that mother-child interaction quality mediated the effects of both enhanced nutrition and responsive stimulation interventions on height-for-age at 4 years via its longitudinal stability from 2 years of age (β = 0.016, p = 0.005; β = 0.048, p < 0.001, respectively). Further, diarrhoeal illness mediated the effects of maternal depressive symptoms at 1 year post partum on children's height-for-age at 4 years via the longitudinal stability of height-for-age z-score from 2 years of age onwards (β = -0.007, p = 0.019). CONCLUSIONS The quality of early caregiving experience mediated the association between both interventions and height-for-age. The effect of maternal depressive symptoms on growth was mediated by diarrhoeal illness. Programmatic approaches to child nutrition and growth must address all these potentially modifiable factors.
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Affiliation(s)
- N Brown
- Department of Paediatrics, Salisbury District Hospital, Salisbury, UK.,Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - J E Finch
- Graduate School of Education, Stanford University, Stanford, CA, USA
| | - J Obradović
- Graduate School of Education, Stanford University, Stanford, CA, USA
| | - A K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
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Chang FW, Lee WY, Liu YP, Yang JJ, Chen SP, Cheng KC, Lin YC, Ho TW, Chiu FH, Hsu RJ, Liu JM. The relationship between economic conditions and postpartum depression in Taiwan: a nationwide population-based study. J Affect Disord 2016; 204:174-9. [PMID: 27362733 DOI: 10.1016/j.jad.2016.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/27/2016] [Accepted: 06/11/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Understanding mothers' economic conditions and postpartum depression (PPD) is important for determining how they will take care of themselves and their infants during the postnatal period, especially for low-income families. This study examined the relationship between economic conditions and PPD to elucidate the effect of economic contraction on PPD. METHODS Our population-based nationwide study used 2000-2013 the National Health Insurance Research Database of Taiwan. A total of 1240 newly diagnosed PPD patients were recruited. We used the database of the Directorate General of Budget, Accounting, and Statistics of Executive Yuan of Taiwan for national economic indicators. The correlation between economic indicators and PPD was examined. RESULTS The PPD incidence was positively correlated with yearly unemployment rate, consumer price index, and gross domestic product. During the great recession of 2008-2009, PPD was positively correlated with inflation rate. Consumer price index had a positive correlation with PPD incidence per month when comparing PPD in 2010 with the economic indicators during the great recession. LIMITATIONS As this retrospective study evaluated macroeconomic indicators, it is unclear whether the macroeconomic indicators' effect on PPD totally reflects the effect of true personal economic status on PPD. CONCLUSIONS There was a significant association between PPD and economic conditions. This study shows that mothers' familial environment plays an important role in the development of PPD. The impact of the worldwide economic downturn of the great recession on women is persistent. This useful finding may give health policy planners a hint of early discovering and dealing with PPD when worldwide economic downturn.
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Affiliation(s)
- Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Wen-Ying Lee
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan; Department of Pathology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yueh-Ping Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jing-Jung Yang
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
| | - Shu-Pin Chen
- Division of Genetics and endocrinology, Chang Gung Children's and Memorial Hospital, Taoyuan, Taiwan.
| | - Kuan-Chen Cheng
- Graduate Institute of Food Science and Technology, National Taiwan University, Taipei, Taiwan; Institute of Biotechnology, National Taiwan University, Taipei, Taiwan.
| | - Yan-Cen Lin
- Chang Gung University of Science and Technology, Department of Nursing, Taoyuan, Taiwan.
| | - Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
| | - Feng-Hsiang Chiu
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Superintendent office, Lihuili Eastern Hospital, Ningbo 315040, Zhejiang province, China.
| | - Ren-Jun Hsu
- Biobank Management Center of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
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Abrams D, Nguyen LT, Murphy J, Lee YA, Tran NK, Wiljer D. Perceptions and experiences of perinatal mental disorders in rural, predominantly ethnic minority communities in northern Vietnam. Int J Ment Health Syst 2016; 10:10. [PMID: 26913065 PMCID: PMC4765075 DOI: 10.1186/s13033-016-0043-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/11/2016] [Indexed: 12/31/2022] Open
Abstract
Background Preliminary research has suggested that perinatal mental disorders (PMDs), including post-partum depression, are prevalent in Vietnam. However the extent to which these disorders are recognized at the community level remains largely undocumented in the literature. PMDs have also never been investigated within Vietnam’s significant ethnic minority populations, who are known to bear a greater burden of maternal and infant health challenges than the ethnic majority. Objective To investigate knowledge and perceptions of PMDs and their treatments at the community level in a rural, predominantly ethnic minority region of northern Vietnam. Methods Qualitative semi-structured interviews were conducted on the topic of common PMDs. Participant groups were primary health workers (PHWs) working at local community health centers, and pregnant or postpartum women enrolled in a program for maternal and infant health that was not mental health related. Interviews included vignette scenarios that asked respondents to interpret cases of women experiencing PMDs, as well as open-ended questions about mental disorders and their treatments. Results Twelve PHWs and 14 perinatal women completed the study. Major themes that emerged from the interviews included (1) Family relationships impact psychological well-being, (2) Nutrition contributes to perinatal mental health, (3) Both traditional and western medicine play roles in perinatal health, (4) There was a lack of personal experience with women experiencing PMDs, (5) Descriptions of mental health symptoms focused on behaviours, and (6) Community care is the primary mental health support. Conclusions PHWs reported having almost never treated a woman with a PMD. However, anecdotal evidence from the women interviewed suggests that there are incidents of mental disorders during the perinatal period that go largely unaddressed. Willingness to present to primary care appears to be high, and presents an opportunity to address this need by training PHWs in effective screening, treatment, and referral. Such training should account for culturally specific presentations of mental disorders as well as the importance of the patient’s social context. To the best of the author’s knowledge, this research presents the first evidence of a PMD burden within Vietnam’s ethnic minority communities.
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Affiliation(s)
| | - Liem T Nguyen
- Institute of Population, Health and Development, Hanoi, Vietnam
| | | | | | - Nhu K Tran
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - David Wiljer
- University of Toronto, Toronto, Canada ; Centre for Addiction and Mental Health, Toronto, Canada
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15
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Fisher J, Tran T, Nguyen TT, Nguyen H, Tran TD. Common mental disorders among women, social circumstances and toddler growth in rural Vietnam: a population-based prospective study. Child Care Health Dev 2015; 41:843-52. [PMID: 25708782 DOI: 10.1111/cch.12235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Common mental disorders (CMD) and adverse social circumstances are widespread among mothers of infants and toddlers in resource-constrained settings. These can undermine early childhood development through compromised caregiving and insufficient access to essential resources. The aim was to examine the effect of maternal CMD and social adversity in the post-partum year on toddler's length-for-age index in a rural low-income setting. METHODS A population-based prospective cohort study of women in Ha Nam province, Vietnam who completed baseline assessments in either late pregnancy or 4-6 weeks post partum and were followed up, with their toddlers, 15 months later. CMD were assessed at both points by psychiatrist-administered Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Diagnoses. Anthropometric indices were calculated from toddler's age, sex, weight and length using World Health Organization Child Growth Standards. Social adversities were assessed by study-specific questions and locally validated psychometric instruments. The hypothesized model of factors governing toddler's length-for-age Z score (LAZ) was tested using path analysis. RESULTS In total, 211/234 (90.1%) mother-toddler pairs provided complete data. Baseline prevalence of CMD among women was 33.6% and follow-up was 18.5%. The mean LAZ among toddlers was -1.03 and stunting prevalence (LAZ < -2) was 15.6%. Maternal CMD at baseline were indirectly related to toddler LAZ via maternal CMD at follow-up (regression coefficient = -0.05, 95% CI -0.11 to -0.01). Maternal CMD at follow-up was associated significantly with toddler LAZ (regression coefficient = -0.15, 95% CI -0.28 to -0.05). Poorer quality of marital relationship, mothers' experiences of childhood abuse and <30 days dedicated post-partum care were associated indirectly with lower toddler LAZ via maternal CMD. CONCLUSIONS Maternal post-natal CMD are associated with child growth measured by LAZ in this resource-constrained setting. Social adversities affect child growth indirectly through increasing the risk of maternal CMD. Interventions to reduce stunting in low-income settings may need to address maternal CMD and social adversities in order to improve impact.
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Affiliation(s)
- J Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - T Tran
- Research and Training Centre for Community Development, Hanoi, Vietnam
| | - T T Nguyen
- Research and Training Centre for Community Development, Hanoi, Vietnam
| | - H Nguyen
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - T D Tran
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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16
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Silove D, Rees S, Tam N, Mohsin M, Tay AK, Tol W. Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste. BJPsych Open 2015; 1:34-41. [PMID: 27703721 PMCID: PMC4995583 DOI: 10.1192/bjpo.bp.115.000190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/14/2015] [Accepted: 05/27/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Little is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies. AIMS To investigate the prevalence and correlates of explosive anger among this population in Timor-Leste. METHOD We assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3-6 months post-partum) residing in two districts of Timor-Leste (response >99%). RESULTS Two-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence. CONCLUSIONS A combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Derrick Silove
- , MB ChB, FRANZCP, MD, Professor and Director, Psychiatry Research and Teaching Unit and Ingham Institute, University of New South Wales, Sydney, Australia
| | - Susan Rees
- , PhD, MSocPol, Senior Lecturer, Psychiatry Research and Teaching Unit, University of New South Wales and Ingham Institute, Liverpool Hospital, Sydney, Australia
| | - Natalino Tam
- , In Country Project Manager, Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia
| | - Mohammed Mohsin
- , PhD, Senior Research Officer, Psychiatry Research and Teaching Unit, Southwest Sydney Local Health District, Sydney, Australia
| | - Alvin Kuowei Tay
- , MForPsych, Senior Research Officer, Psychiatry Research and Teaching Unit, Southwest Sydney Local Health District, Sydney, Australia
| | - Wietse Tol
- , PhD, Dr Ali & Rose Kawi Assistant Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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