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Teixeira DS, Fortes S, Kestenberg C, Alves K, Campos MR, Neto AO, Ortega F, García-Campayo J, Demarzo M. Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil. Front Med (Lausanne) 2024; 11:1356040. [PMID: 39040898 PMCID: PMC11261806 DOI: 10.3389/fmed.2024.1356040] [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: 12/14/2023] [Accepted: 06/07/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC. Objective To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil. Methods The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups. Results and discussion Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy. Conclusion Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.
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Affiliation(s)
- Débora Silva Teixeira
- Department of Integral Family and Community Medicine, Medical Sciences College, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Fortes
- Medical Sciences College, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celia Kestenberg
- Nursing School, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kali Alves
- Pedro Ernesto University Hospital – State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Alfredo Oliveira Neto
- Primary Health Care Department, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Ortega
- Catalan Institution of Research and Advanced Study, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Marcelo Demarzo
- Mente Aberta – The Brazilian Center for Mindfulness and Health Promotion – Department of Preventive Medicine, Paulista Medical School – Federal University of São Paulo, São Paulo, Brazil
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Wolf S, Seiffer B, Zeibig JM, Frei AK, Studnitz T, Welkerling J, Meinzinger E, Bauer LL, Baur J, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Günak MM, Kropp S, Peters S, Flagmeier AL, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. A transdiagnostic group exercise intervention for mental health outpatients in Germany (ImPuls): results of a pragmatic, multisite, block-randomised, phase 3 controlled trial. Lancet Psychiatry 2024; 11:417-430. [PMID: 38670127 DOI: 10.1016/s2215-0366(24)00069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Globally, mental health conditions pose a substantial burden of disease. Despite the availability of evidence-based pharmacological and psychological treatments, the symptoms of a substantial subgroup of patients do not respond to these interventions, and only a minority of patients have access to them. This study aimed to assess the efficacy of ImPuls, a 6-month transdiagnostic group exercise intervention, plus treatment-as-usual, compared with treatment-as-usual alone in outpatients with various mental disorders. METHODS In this pragmatic, two-arm, multisite, randomised controlled trial in Germany, ten outpatient rehabilitative and medical care facilities were involved as study sites. Participants were outpatients diagnosed according to ICD-10 with one or more of the following disorders based on structured clinical interviews: moderate or severe depression, primary insomnia, post-traumatic stress disorder (PTSD), panic disorder, or agoraphobia. Participants were required to be aged between 18 years and 65 years, insured by the health insurers Allgemeine Ortskrankenkasse Baden-Württemberg or Techniker Krankenkasse, fluent in German, and without medical contraindications for exercise. Blocks of six participants were randomly allocated to ImPuls plus treatment-as-usual or treatment-as-usual alone (allocation ratio: 1:1), stratified by study site. The randomisation sequence was generated by an external data manager. The team responsible for data collection and management was masked to the randomisation sequence. The ImPuls intervention comprised evidence-based outdoor exercises lasting 30 min, and aimed at achieving at least moderate intensity. It also incorporated behavioural change techniques targeting motivational and volitional determinants of exercise behaviour. Treatment-as-usual was representative of typical outpatient health care in Germany, allowing patients access to any standard treatments. The primary outcome was global symptom severity at 6 months after randomisation, measured using self-report on the Brief Symptom Inventory (BSI-18) and analysed in the intention-to-treat sample. No individuals with lived experience of mental illness were involved in conducting the study or writing the final publication. Safety was assessed in all participants. The trial was registered with the German Clinical Trials Register (DRKS00024152) with a completion date of June 30, 2024. FINDINGS 600 patients provided informed consent, were recruited to the study, and underwent a diagnostic interview between Jan 1, 2021, and May 31, 2022. Following this, 199 were excluded on the basis of inclusion and exclusion criteria and one withdrew consent during the baseline assessment. Of the 400 eligible participants, 284 (71%) self-identified as female, 106 (27%) self-identified as male, and nine (2%) self-identified as other. The mean age was 42·20 years (SD 13·23; range 19-65). Ethnicity data were not assessed. 287 (72%) participants met the criteria for moderate or severe depression, 81 (20%) for primary insomnia, 37 (9%) for agoraphobia, 46 (12%) for panic disorder, and 72 (18%) for PTSD. 199 participants were allocated to the intervention group of ImPuls plus treatment-as-usual and 201 to the control group of treatment-as-usual alone. 38 (19%) participants did not receive the minimum ImPuls intervention dose. ImPuls plus treatment-as-usual demonstrated superior efficacy to treatment-as-usual alone in reducing global symptom severity, with an adjusted difference on BSI-18 of 4·11 (95% CI 1·74-6·48; d=0·35 [95% CI 0·14-0·56]; p=0·0007) at 6 months. There were no significant differences in the total number of adverse events or serious adverse events between the two groups. There was one serious adverse event (male, torn ligament) related to the intervention. INTERPRETATION ImPuls is an efficacious transdiagnostic adjunctive treatment in outpatient mental health care. Our findings suggest that exercise therapy should be implemented in outpatient mental health care as an adjunctive transdiagnostic treatment for mental disorders such as depression, insomnia, panic disorder, agoraphobia, and PTSD. Transdiagnostic group exercise interventions might ameliorate the existing disparity in care provision between the many individuals in need of evidence-based treatment and the few who are receiving it. FUNDING The German Innovation Fund of the Federal Joint Committee of Germany.
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Edith Meinzinger
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Julia Baur
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany; International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Eva Herzog
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany; Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Tristan Nakagawa
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany
| | - Mia Maria Günak
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich, Munich, Germany
| | - Stefan Peters
- German Association for Health-Enhancing Physical Activity and Exercise Therapy, Hürth-Efferen, Germany; Department of Human Sciences, Institute of Sport Science, Bundeswehr University Munich, Munich, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich, Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany; Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Tecnalia, Basque Research and Technology Alliance, San Sebastián, Spain; Athenea Neuroclinics, San Sebastián, Spain
| | - Martin Hautzinger
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany; German Center for Mental Health, Munich, Germany
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Doherty S, Kianian B, Dass G, Edward A, Kone A, Manolova G, Sivayokan S, Solomon M, Surenthirakumaran R, Lopes-Cardozo B. Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02684-4. [PMID: 38713387 DOI: 10.1007/s00127-024-02684-4] [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: 01/03/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Research indicates that exposure to conflict, natural disasters, and internal displacement can increase mental health conditions. Since the end of the civil conflict within Sri Lanka, the country has worked to increase access to mental health services to meet the needs of conflict-affected populations, however, gaps remain. To address this, integration of mental health services into primary care can reduce the strain on growing specialized care. As part of a larger study primary care practitioners (doctors), public health professionals (nurses, midwives), and community representatives (teachers, social workers) were trained to deliver mental health services in primary care across the heavily impacted Northern Province. The aim was to reduce mental health stigma among enrolled healthcare workers and community representatives by 50%. METHODS Stigma was measured across all participant groups at six time points: pre- and post- initial training at baseline, pre- and post- refresher training 3-months after initial training, and pre- and post- refresher training 6-months after initial training. RESULTS Results indicate a small improvement in average stigma scores at the 6-month refresher point for primary care practitioners, and no meaningful difference in average scores across time points for public health professionals or community representatives. CONCLUSION World Health Organization mhGAP training appears to reduce stigma among primary care practitioners and could be an effective strategy to counteract mental health stigma in low resource settings. Future research should investigate underlying mechanisms of stigma reduction to improve delivery of mental health services in primary care and community settings.
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Affiliation(s)
- Shannon Doherty
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK.
| | - Behzad Kianian
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Giselle Dass
- THEME Institute, 50/13, Old Kesbawa Road, Boralesgamuwa, Sri Lanka
| | - Anne Edward
- THEME Institute, 50/13, Old Kesbawa Road, Boralesgamuwa, Sri Lanka
| | - Ahoua Kone
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Gergana Manolova
- World Health Organization, Av. Appia 20, 1211, Geneva, Switzerland
| | - Sambasivamoorthy Sivayokan
- Department of Community and Family Medicine, University of Jaffna, Ramanathan Road, PO Box 57, Thirunelvely, Jaffna, Sri Lanka
| | - Madonna Solomon
- THEME Institute, 50/13, Old Kesbawa Road, Boralesgamuwa, Sri Lanka
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, University of Jaffna, Ramanathan Road, PO Box 57, Thirunelvely, Jaffna, Sri Lanka
| | - Barbara Lopes-Cardozo
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
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Sapag JC, Mancevski A, Perry A, Norman CD, Barnsley J, Ferris LE, Rush B. Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America. Community Ment Health J 2024; 60:426-437. [PMID: 37815700 DOI: 10.1007/s10597-023-01186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023]
Abstract
To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.
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Affiliation(s)
- Jaime C Sapag
- Departments of Public Health and Family Medicine, Division of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Division of Public Health and Family Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 (Second Floor), Piso 2 (Salud Pública)-Comuna de Santiago, 8330077, Santiago, Chile.
| | | | - Andrés Perry
- Departments of Public Health and Family Medicine, Division of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cameron D Norman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Cense Ltd., Toronto, ON, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lorraine E Ferris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Bernard C, Mané I, Ziadeh S, Tine JM, Diaw A, Benzekri N, Ndiaye I, Samba O, Font H, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Perceptions, facilitators and barriers to the implementation of interpersonal group therapy to treat depression among people living with HIV in Senegal: a qualitative study. Front Public Health 2024; 12:1295181. [PMID: 38327573 PMCID: PMC10848853 DOI: 10.3389/fpubh.2024.1295181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Background Depression is highly prevalent in people living with HIV (PLWH) but remains under treated in Sub-Saharan Africa. In this context, we conducted the first study of Group Interpersonal Therapy (IPT) to treat depression in PLWH in Senegal. We assessed the perceptions and experiences of patients and group facilitators, as well as barriers to implementation. Methods This study was conducted at the Fann National University Hospital Center in Dakar, the urban capital of Senegal. Qualitative data were collected during the implementation phase (February to June 2020 and then from January to February 2021), with a 6-month pause due to the COVID-19 pandemic. Twenty-five patients and three group facilitators were individually interviewed by a socio-anthropologist. Qualitative data were analyzed thematically. Results Group IPT was perceived as successful and beneficial by patients and facilitators. Patients reported positive experiences with group IPT and sustained outcomes. Beyond improving depressive symptoms, patients reported improvements in their social and professional lives, and the development of skills to prevent relapse. Group facilitators noted the benefits of therapy for their patients and for their professional skills, reporting greater clinical competence and improved supportive skills. Challenges to intervention implementation included confidentiality and patient privacy concerns, healthcare accessibility issues, and time demands. Conclusion In this first qualitative study of group IPT for depression in PLWH in Senegal, participants described both positive experiences with the intervention and challenges to its implementation. Future studies, conducted in suburban and rural communities outside of Dakar, would further inform the implementation of IPT in Senegal.
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Affiliation(s)
- Charlotte Bernard
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Idrissa Mané
- CNRS, Université de Pau et des Pays de l’Adour, Pau, France
| | - Salaheddine Ziadeh
- Université Libanaise, Faculté de Santé Publique, Sidon, Lebanon
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - Abibatou Diaw
- Centre de Traitement ambulatoire, CHNU de Fann, Dakar, Senegal
| | - Noëlle Benzekri
- Department of Medicine-Infectious Diseases, University of Washington, Seattle, WA, United States
| | | | - Oumar Samba
- Service de psychiatrie, CHNU de Fann, Dakar, Senegal
| | - Hélène Font
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | | | | | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - François Dabis
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Moussa Seydi
- Service des maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
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Rabie S, Poudyal A, King A, Ndwandwa ES, Marais A, Andersen L, Joska J, Sikkema K. A Supervision Framework for Task-Shared Mental Health Workers: Implications for Clinical Trials and Beyond. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300092. [PMID: 38050095 PMCID: PMC10749652 DOI: 10.9745/ghsp-d-23-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
The rise in task-shared interventions that address the mental health treatment gap in low- and middle-income countries (LMICs) has highlighted the need for additional support and supervision of nonspecialist mental health workers (NHWs). The supervision of NHWs in most resource-limited settings is still primarily disorganized, without clear guidelines that provide the necessary structure for supervision. The need for supervision is even greater for NHWs working in the context of trauma, not only to provide training and ensure adequate delivery of care but also to provide support to minimize the psychological impact of their work. In South Africa, women face intersecting epidemics of HIV, intimate partner violence, and sexual trauma. This syndemic highlights the importance of integrating mental health treatment in HIV care, especially in settings like South Africa, where mental health services are limited. In this context, our group developed and is evaluating the effectiveness of ImpACT+, a task-shared coping intervention to improve clinical and mental health outcomes among HIV-infected women with sexual trauma in South Africa. We describe the ImpACT+ supervision model that is currently being implemented in the context of a hybrid effectiveness-implementation clinical trial. Combining experiences from clinical psychology, task-shared interventions, and trauma-informed care, the supervision model integrates formal elements of clinical supervision into categories that are suitable for use in task-shared trauma interventions in low-resource settings. To the best of our knowledge, such a trauma-informed supervision approach has not been widely documented in the literature, particularly in task-shared interventions in LMICs. In this article, we describe the ImpACT+ intervention, provide an overview of the supervision model, and provide illustrative examples of how the supervision model has been implemented.
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Affiliation(s)
- Stephan Rabie
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Aisha King
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
- Department of Community Health and Health Policy, School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Esona-Sethu Ndwandwa
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Adele Marais
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lena Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kathleen Sikkema
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
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Asokan N. Community Dermatology: Current Status and the Way Forward. Indian Dermatol Online J 2023; 14:762-768. [PMID: 38099039 PMCID: PMC10718120 DOI: 10.4103/idoj.idoj_497_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/17/2023] Open
Abstract
Community health interventions in dermatology have the potential to deliver healthcare to large populations. Such interventions can bridge the gap between increasing demands from vast populations and limited availability and asymmetric geographical distribution of specialist doctors. This narrative review aims to delineate various areas in which community dermatology initiatives are useful, the different approaches used, and the factors which could determine their effectiveness. We did a PubMed search using the search terms, "Community Health Services"[Mesh]) AND "Dermatology"[Mesh]. A further literature search was performed by cross-referencing these articles. In addition to its primary purpose of increasing access, community involvement can augment medical education, foster research, and help to develop more patient-centered clinical guidelines, understand disease trends and influences of the environment on various diseases, and formulate population-centered health policy. Task shifting, development of culture-sensitive and gender-sensitive community healthcare teams, disease-specific patient support groups, and use of advances in technology such as telemedicine are some of the important methods used in community dermatology. Task shifting may be performed at different levels - general practitioners, pharmacists, nurses, and community health workers. Community interventions harness volunteerism among health professionals as well as various stakeholders in the community. Partnering with non-governmental organizations, involving members of the community, and being a part of a long-term public health program help to sustain community interventions. The interventions should adapt to the ethical and cultural norms of the community. Continuity of care, fidelity, and evidence support are crucial for the success of community interventions in dermatology.
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Affiliation(s)
- Neelakandhan Asokan
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
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Paquin-Goulet M, Krishnadas R, Beattie L. A systematic review of factors prolonging or reducing the duration of untreated psychosis for people with psychosis in low- and middle-income countries. Early Interv Psychiatry 2023; 17:1045-1069. [PMID: 37823582 DOI: 10.1111/eip.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
AIM This review aims to identify factors that may prolong or reduce the duration of untreated psychosis for people with psychosis in low- and middle-income countries. METHODS Electronic searches of six databases were conducted, to find studies from low- and middle-income countries on people with psychotic disorders provided they statistically measured an association between factors that may prolong or reduce the duration of untreated psychosis. Studies were critically appraised and a narrative synthesis exploring differences between and within studies is presented. A socio-ecological model is used to convey the main findings. RESULTS Thirty studies of 16 473 participants in total were included in this review. Taken together participants were 51.5% male and 48.5% female. Various factors potentially associated with longer duration of untreated psychosis for people with psychosis in low- and middle-income countries were found. Examples of these factors are an insidious mode of onset, greater family stigma and low social class. Other factors, such as marital status, educational level, diagnostic type, predominant symptoms and employment status, yielded inconsistent results. CONCLUSIONS The methodological quality of the included studies limits the conclusions of this review. The results indicate an urgent need for further high-quality research in these countries. The socio-ecological model is a helpful framework for clinicians, scholars, and decision-makers to conceptualize factors that may affect the duration of untreated psychosis, highlight gaps in the literature as well as reflect on potential prevention strategies that may ultimately support early intervention services for people with psychosis in developing countries.
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Affiliation(s)
| | | | - Louise Beattie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Gyimah L, Ofori-Atta A, Asafo S, Curry L. Seeking Healing for a Mental Illness: Understanding the Care Experiences of Service Users at a Prayer Camp in Ghana. JOURNAL OF RELIGION AND HEALTH 2023; 62:1853-1871. [PMID: 36066726 PMCID: PMC9986410 DOI: 10.1007/s10943-022-01643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Human rights abuses in mental health care are a global concern. Addressing the problem requires input from key stakeholders, particularly from people using mental health services. This study explored the experiences of persons with mental illness receiving care in a faith-based setting in Ghana. The study employed a qualitative design, with in-depth interviews (n = 23) and focus groups (n = 18 participants in 3 groups). The constant comparative method of analysis was used to identify themes in participants' descriptions of their experiences. The first three themes identified are consistent with human rights and coercion, and the last two themes related to service users' views on participation in spiritual practices. Themes included: decision-making around care; consent and efficacy of religious healing; experiences with chaining; views around biomedical treatment; participation in religious activities as part of healing and recognition of the need for spiritual healing. It was observed that participants with prior experience of psychiatric treatment were happy about the absence of chaining in psychiatric facilities but strongly disliked the side effects of medications. These findings underscore the need for faith-based institutions to provide care that is consistent with patient preferences, thereby helping to address the resultant human rights abuses.
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Affiliation(s)
- L Gyimah
- Pantang Hospital, P.O. Box PL81, Legon, Accra, Ghana.
| | - A Ofori-Atta
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - S Asafo
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - L Curry
- Yale University, New Haven, USA
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Zeibig JM, Seiffer B, Frei AK, Takano K, Sudeck G, Rösel I, Hautzinger M, Wolf S. Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 64:102340. [PMID: 37665821 DOI: 10.1016/j.psychsport.2022.102340] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 09/06/2023]
Abstract
BACKGROUND Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects. METHODS Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling. RESULTS From T1 to T3, the intervention group significantly improved on global symptom severity (d = -0.43, p = .031), depression among a depressed subsample (d = -0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = -0.28, p = .037) and clinically significant changes (ß = -0.24, p = .042). CONCLUSIONS The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.
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Affiliation(s)
- Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki, 305-8560, Japan
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Inka Rösel
- Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biostatistics, University of Tuebingen, 72074, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tuebingen, 72074, Tuebingen, Germany
| | - Sebastian Wolf
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
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11
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Musoni-Rwililiza E, Arnbjerg CJ, Murekatete C, Carlsson J, Kallestrup P, Gishoma D. Group psychoeducation for persons with bipolar disorder in Rwanda: a study protocol for a randomized controlled trial. Trials 2022; 23:971. [PMID: 36461128 PMCID: PMC9716550 DOI: 10.1186/s13063-022-06926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The efficacy of psychoeducation as an add-on treatment to pharmacotherapy is well documented in treating symptoms and in relapse prevention for persons with bipolar disorder in western countries. Yet, no studies on psychosocial interventions for persons with bipolar disorder have been conducted in a low-income country in Africa. AIM To develop a bipolar group psychoeducation program contextualized to the Rwandese setting, and determine its effect on symptom severity, medical adherence, and internalized stigma. METHODS A culturally adapted guide manual was developed by local mental health professionals, including nurses, psychologists, and medical doctors. In-depth interviews with participants were held prior to and will be held following the intervention to address the cultural aspect of living with bipolar disease and the impact of the program. A two-armed randomized controlled trial has been set up at the tertiary mental health hospitals in Rwanda, with an intervention and a waiting list arm. A sample size of at least 50 in each arm was calculated as a requirement. The study's primary outcome measure will be the difference in relapse rate measured on the Young Mania Rating Scale and Hamilton Depression Scale-17. Differences in mean change on scales for medical adherence and internalized stigma will be secondary outcomes. Data will be analyzed according to the intention-to-treat principle. Participants will be assessed subsequently at baseline, at the end of the intervention period, and three months and 12 months post-intervention. DISCUSSION This study will be one of the first intervention trials on bipolar disorder in a low-income country. If proven successful in reducing morbidity and increasing the quality of life in persons with bipolar disorder, it is anticipated that the psychoeducation program can be implemented at the district and community level and act as inspiration for other low-resource settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04671225. Registered on November 2020.
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Affiliation(s)
- E. Musoni-Rwililiza
- grid.10818.300000 0004 0620 2260College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.418074.e0000 0004 0647 8603Mental Health Department, University Teaching Hospital of Kigali, Kigali, Rwanda ,grid.7048.b0000 0001 1956 2722Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - C. J. Arnbjerg
- grid.10818.300000 0004 0620 2260College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.7048.b0000 0001 1956 2722Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - C. Murekatete
- grid.418074.e0000 0004 0647 8603Mental Health Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - J. Carlsson
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P. Kallestrup
- grid.7048.b0000 0001 1956 2722Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - D. Gishoma
- grid.10818.300000 0004 0620 2260College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Maupin J, Hackman J. Food insecurity, morbidity, and susto: Factors associated with depression severity in Guatemala measured with the Personal Health Questionnaire 9. Int J Soc Psychiatry 2022; 68:1654-1662. [PMID: 34558338 DOI: 10.1177/00207640211047883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression is the largest contributor to non-fatal health loss globally and the majority of this burden occurs in low- and middle-income countries. Yet, estimates of prevalence rates and severity in these contexts may be uncertain due to limited screening, lack of mental health providers, and stigma around mental disorders which may prevent individuals from seeking care. In Guatemala, estimates of depression vary, due in part to the range of screening and diagnostic instruments used and diversity of sample populations. Most studies emphasize personal experiences with violence as a predictor of depression in Guatemala, although high rates of inequality, discrimination, and resource scarcity in the country potentially play a role. AIMS In this study, we examine factors associated with depression severity categories measured with the Personal Health Questionnaire 9 (PHQ-9) among a random sample of women in a small urban community in the Central Highlands of Guatemala. METHODS Participants were recruited through a randomized sample of households in a small urban community. Participants completed a questionnaire which included questions on demographics, illness history, food insecurity, and the PHQ-9. In total, 101 women were included in the analysis. RESULTS Food insecurity, 2-week symptom reporting, and experiencing susto are associated with higher depression severity categories. CONCLUSION This research highlights need for more research on factors related to the prevalence and severity of mental disorders, and the relationship between mental disorders and cultural constructs of distress, particularly in areas like Guatemala with limited mental health services.
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Affiliation(s)
- Jonathan Maupin
- School of Human Evolution and Social Change, Arizona State University, Tempe, USA
| | - Joseph Hackman
- Department of Anthropology, Utah State University, Salt Lake City, USA
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13
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Alibudbud R. An infodemiological study of worldwide google search volumes for major depressive disorder and persistent depressive disorder from 2004 to 2021. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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14
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Brathwaite R, Ssewamala FM, Bahar OS, McKay MM, Neilands TB, Namatovu P, Kiyingi J, Zmachinski L, Nabayinda J, Huang KY, Kivumbi A, Bhana A, Mwebembezi A, Petersen I, Hoagwood K. The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on oppositional defiant disorder and impaired functioning among children in Uganda: analysis of a cluster randomized trial from the SMART Africa-Uganda scale-up study (2016-2022). J Child Psychol Psychiatry 2022; 63:1252-1260. [PMID: 34989404 PMCID: PMC9256858 DOI: 10.1111/jcpp.13566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Oppositional Defiant Disorders (ODDs) and other Disruptive Behavior Disorders (DBDs) are common among children and adolescents in poverty-impacted communities in sub-Saharan Africa. Without early intervention, its progression into adulthood can result in dire consequences. We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu designed to reduce ODDs and other DBDs among school-going children residing in low-resource communities in Uganda. METHODS We used longitudinal data from the SMART Africa-Uganda study (2016-2022). Public primary schools were randomized to: (1) Control condition (receiving usual care comprising generalized psychosocial functioning literature), 10 schools; (2) intervention delivered via parent peers (Amaka-parents), 8 schools or; (3) intervention delivered via community healthcare workers (Amaka-community), 8 schools. All the participants were blinded. At baseline, 8- and 16-weeks postintervention initiation, caregivers completed the Iowa Conners Scale, which measured Oppositional Defiant Disorder (ODD) and Impairment Rating Scale to evaluate children's overall impairment and impaired functioning with peers, siblings, and parents; impaired academic progress, self-esteem, and family functioning. Three-level linear mixed-effects models were fitted to each outcome. Pairwise comparisons of postbaseline group means within each time point were performed using Sidak's adjustment for multiple comparisons. Only children positive for ODD and other DBDs were analyzed. RESULTS Six hundred and thirty-six children screened positive for ODDs and other DBDs (Controls: n = 243; Amaka-parents: n = 194; Amaka-community: n = 199). At 8 weeks, Amaka-parents' children had significantly lower mean scores for overall impairment compared to controls, (mean difference: -0.71, p = .001), while Amaka-community children performed better on ODD (mean difference: -0.84, p = .016). At 16 weeks, children in both groups were performing better on ODD and IRS than controls, and there were no significant differences between the two intervention groups. CONCLUSIONS The Amaka Amasanyufu intervention was efficacious in reducing ODD and impaired functioning relative to usual care. Hence, the Amaka Amasanyufu intervention delivered either by Amaka-community or Amaka-parents has the potential to reduce negative behavioral health outcomes among young people in resource-limited settings and improve family functioning. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.
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Affiliation(s)
- Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Fred M. Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Torsten B. Neilands
- Division of Prevention Science, University of California, San Francisco, California, 94143, U.S.A
| | - Phionah Namatovu
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Lily Zmachinski
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Keng-Yen Huang
- Department of Child and Adolescent Psychiatry, and Department of Population Health, New York University School of Medicine, 227 East 30th Street, First Floor, New York, NY 10016
| | - Apollo Kivumbi
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | - Arvin Bhana
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, 7505 Tygerberg, South Africa
- University of KwaZulu-Natal, 38 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa
| | - Abel Mwebembezi
- Reach the Youth-Uganda, Plot 1676 Bukoto-Kisasi Road opp. Kabira Country Club P.O Box 24928, Kampala – Uganda
| | - Inge Petersen
- University of KwaZulu-Natal, 38 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry at the School of Medicine, New York University, 1 Park Avenue, Seventh Floor, New York, NY 10016
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Szlamka Z, Hanlon C, Tekola B, Pacione L, Salomone E, Servili C, Hoekstra RA. Exploring contextual adaptations in caregiver interventions for families raising children with developmental disabilities. PLoS One 2022; 17:e0272077. [PMID: 36170237 PMCID: PMC9518887 DOI: 10.1371/journal.pone.0272077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
There are increasing efforts to scale up services globally for families raising children with developmental disabilities (DDs). Existing interventions, often developed in high income, Western settings, need substantial adaptation before they can be implemented in different contexts. The aim of this study was to explore perspectives on the role that context plays in the adaptation and implementation of interventions targeting caregivers of children with DDs across settings. The study question was applied to the Caregiver Skills Training (CST) programme of the World Health Organization specifically, as well as to stakeholder experiences with caregiver interventions more broadly. Two focus group discussions (FGDs; n = 15 participants) and 25 individual semi-structured interviews were conducted. Participants were caregivers of children with DDs and professionals involved in adapting or implementing the CST across five continents and different income settings. Data were analysed thematically. Four main themes were developed: 1) Setting the scene for adaptations; 2) Integrating an intervention into local public services; 3) Understanding the reality of caregivers; 4) Challenges of sustaining an intervention. Informants thought that contextual adaptations were key for the intervention to fit in locally, even more so than cultural factors. The socio-economic context of caregivers, including poverty, was highlighted as heavily affecting service access and engagement with the intervention. Competing health priorities other than DDs, financial constraints, and management of long-term collaborations were identified as barriers. This study validates the notion that attention to contextual factors is an essential part of the adaptation of caregiver interventions for children with DDs, by providing perspectives from different geographical regions. We recommend a stronger policy and research focus on contextual adaptations of interventions and addressing unmet socio-economic needs of caregivers.
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Affiliation(s)
- Zsofia Szlamka
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethlehem Tekola
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Laura Pacione
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Salomone
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - WHO CST Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Rosa A. Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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16
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Panter‐Brick C. Energizing partnerships in research‐to‐policy projects. AMERICAN ANTHROPOLOGIST 2022. [DOI: 10.1111/aman.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine Panter‐Brick
- Department of Anthropology and Jackson School of Global Affairs, Yale University New Haven CT USA
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Setiyawati D, Jatmika WN, Puspakesuma N, Retnowati S, Colucci E. Suicide first aid guidelines for Indonesia: a Delphi consensus study. J Ment Health 2022; 31:410-431. [DOI: 10.1080/09638237.2021.2022632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Diana Setiyawati
- Center for Public Mental Health, Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wulan Nur Jatmika
- Center for Public Mental Health, Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nabila Puspakesuma
- Center for Public Mental Health, Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sofia Retnowati
- Center for Public Mental Health, Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Erminia Colucci
- Department of Psychology, School of Science and Technology, Middlesex University London, London, UK
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Beniwal RP, Shrivastava MK, Gupta V, Sharma V, Sharma S, Kumari S, Bhatia T, Deshpande SN. Why Do People Live or Die? A Retrospective Study from a Crisis Intervention Clinic in North India. Indian J Psychol Med 2022; 44:17-21. [PMID: 35509647 PMCID: PMC9022914 DOI: 10.1177/02537176211022508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Suicide results from complex interactions of various risk factors-reasons for dying (RFD)-and protective factors-reasons for living (RFL). Suicide is not necessarily a wish to die but may be an appeal for help. We analyzed RFD and RFL in persons who had attempted suicide, through their clinical records at a Crisis Intervention Clinic (CIC). METHODS We retrospectively analyzed demographic and clinical data, and classified RFD and RFL, among patients with either ideas or attempt of suicide registered at our CIC (N = 83). Using two open-ended questions from the clinical history data, we derived their RFD or RFL; (n = 53) completed these questions regarding RFD-RFL. RESULTS In the total sample, males and females were equally represented and educated, but males were significantly older. Most common diagnosis was nonpsychotic mood disorder. Commonest mode of suicide attempt was hanging. Family conflict vs. family responsibility, hope vs. hopelessness, stressful life events, and negative cognitions about the self and the world were important RFD. RFL included feeling responsible, love for family and for self, hope, career success, and religious beliefs. CONCLUSION RFD and RFL could both be grouped in similar categories related to family, career, hope, etc.
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Affiliation(s)
- Ram Pratap Beniwal
- Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Manohar Kant Shrivastava
- Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Varsha Gupta
- Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Vikas Sharma
- Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Satyam Sharma
- Dept. of Psychology, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Sunita Kumari
- Dept. of Psychiatric Social Work, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Triptish Bhatia
- Dept. of Psychology, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
| | - Smita N Deshpande
- Dept. of Psychiatry and De-addiction, Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital, New Delhi, India
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Rose AL, Fenelon DL, Fils-Aimé JR, Dubuisson W, Singer SFC, Smith SL, Jerome G, Eustache E, Raviola G. Development of an Innovative Digital Data Collection System for Routine Mental Health Care Delivery in Rural Haiti. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:990-999. [PMID: 34933992 PMCID: PMC8691881 DOI: 10.9745/ghsp-d-20-00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Mental health information systems in low-resource settings are scarce worldwide. Data collection was accurate, yet sustainable staffing was a challenge when using task-shared clinical providers for data collection in health centers in rural Haiti. Integrating mental health data collection within existing data collection systems would help close this key gap. Introduction: Effective digital health management information systems (HMIS) support health data validity, which enables health care teams to make programmatic decisions and country-level decision making in support of international development targets. In 2015, mental health was included within the Sustainable Development Goals, yet there are few applications of HMIS of any type in the practice of mental health care in resource-limited settings. Zanmi Lasante (ZL), one of the largest providers of mental health care in Haiti, developed a digital data collection system for mental health across 11 public rural health facilities. Program Intervention: We describe the development, implementation, and evaluation of the digital system for mental health data collection at ZL. To evaluate system reliability, we assessed the number of missing monthly reports. To evaluate data validity, we calculated concordance between the digital system and paper charts at 2 facilities. To evaluate the system's ability to inform decision making, we specified and then calculated 4 priority indicators. Results: The digital system was missing 5 of 143 monthly reports across all facilities and had 74.3% (55/74) and 98% (49/50) concordance with paper charts. It was possible to calculate all 4 indicators, which led to programmatic changes in 2 cases. In response to implementation challenges, it was necessary to use strategies to increase provider buy-in and ultimately to introduce dedicated data clerks to keep pace with data collection and protect time for clinical work. Lessons Learned: While demonstrating the potential of collecting mental health data digitally in a low-resource rural setting, we found that it was necessary to consider the ongoing roles of paper records alongside digital data collection. We also identified the challenge of balancing clinical and data collection responsibilities among a limited staff. Ongoing work is needed to develop truly sustainable and scalable models for mental health data collection in resource-limited settings.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA.
- Partners In Health, Boston, MA, USA
| | | | | | | | | | - Stephanie L Smith
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Giuseppe Raviola
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Kapanee ARM, Meena KS, Nattala P, Sudhir PM. Mental health orientation among ASHAs: A study from Karnataka State, India. J Family Med Prim Care 2021; 10:3748-3752. [PMID: 34934675 PMCID: PMC8653458 DOI: 10.4103/jfmpc.jfmpc_764_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction The high mental health treatment gap in India, necessitates mental health service delivery through the primary health care system. Accredited Social Health Activists (ASHAs) as frontline community health workers are a key member of the primary health care team. The ASHAs training needs related to mental health, require to be determined in order to accordingly tailor capacity-building programs. In this context, the present study aims to examine the ASHAs mental health orientation utilizing a factorially validated Indian tool. Methods In this cross-sectional study, 91 ASHAs from a taluk of Bengaluru Urban District, responded to the self-administered Orientation towards Mental Illness (OMI) scale. Data were analysed using descriptive statistics viz. frequencies, percentages, means, and standard deviations. Results The ASHAs reported an overall unfavourable mental health orientation and the specific OMI factors on which unfavourable orientation was observed were Psychosocial stress, Non-restrained behaviour, Weak cognitive control, Fidgety behaviour, Bizarre behaviour, Psychosocial manipulation, and Hypo-functioning. Conclusion The findings of the study suggest that capacity-building programs for ASHAs will need to first examine their orientation to mental health and collaboratively address an unfavourable orientation when present, as it would have a bearing on ASHAs mental health service delivery in the community.
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Affiliation(s)
| | - K S Meena
- Department of Mental Health Education, NIMHANS, Bengaluru, Karnataka, India
| | | | - Paulomi M Sudhir
- Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
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21
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Estimating the global treatment rates for depression: A systematic review and meta-analysis. J Affect Disord 2021; 295:1234-1242. [PMID: 34665135 DOI: 10.1016/j.jad.2021.09.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/02/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is considered a global crisis due to its high prevalence and associated disabilities. The burden posed by depression could be reduced by increasing access to timely treatment. Limited information is available on treatment rates of depression, particularly in low- and middle-income countries. This study aimed to estimate the treatment rates for depression in the general adult population by World Bank income classification. METHODS We searched PubMed, EMBASE, PsycINFO, and CINAHL, supplemented with hand-search of reference lists to identify community-based studies. The overall treatment rate for depression was estimated from studies that reported any treatment (behavioral or pharmacological treatments) in healthcare or informal non-healthcare settings. Data were pooled using a random-effects meta-analysis model. Subgroup analyses by income classification were completed. Meta-regression was conducted by study characteristics. The protocol was pre-registered at PROSPERO (CRD42020161683). RESULTS We included 65 studies comprising 1.1 million participants from 79 countries and territories. The global 12-month/lifetime pooled treatment rate was 34.8% (95% confidence interval: 29.9, 39.9%). The treatment rates were 48.3% (43.0, 53.6%) in high-income countries, 21.4% (15.1, 27.7%) in middle-income countries, and 16.8% (11.3, 23.0%) in low-income countries. Among the treated samples, 12-month minimally adequate treatment was estimated to be 40%. LIMITATION We reported a substantial level of between-study heterogeneity, which was partially explained by study characteristics in the meta-regression. CONCLUSION Globally, approximately one-third of people with depression receive treatment. Three in five treated people with depression did not receive minimally adequate treatment. Depression treatment rates are considerably lower in low-and middle-income countries.
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22
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Sengupta K, Shah H, Ghosh S, Sanghvi D, Mahadik S, Dani A, Deshmukh O, Pacione L, Dixon P, Salomone E, Servili C. World Health Organisation-Caregiver Skills Training (WHO-CST) Program: Feasibility of Delivery by Non-Specialist Providers in Real-world Urban Settings in India. J Autism Dev Disord 2021; 53:1444-1461. [PMID: 34853959 DOI: 10.1007/s10803-021-05367-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The World Health Organization-Caregiver Skills Training Program, a parent-mediated early intervention facilitated by non-specialist providers piloted in urban India was evaluated using mixed-methods for feasibility and effects on child and caregiver outcomes. Caregivers (n = 22) of children (2-9 years) with social-communication delays participated in a single-group pre-post study. High rates of caregiver attendance, improved caregiver fidelity, and facilitator competency suggested program feasibility. Caregivers voiced acceptability of various intervention-components. The intervention was associated with improved caregiver-reported skills and knowledge (p < 0.00), reduction in stress (p = 0.03), improved child developmental outcomes on communication and social interaction (p < 0.00), and adaptive behaviors (p < 0.00). Challenges about logistics and availability of time were highlighted. Implications of results in resource-poor settings and recommendations for future feasibility trials are discussed.
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Affiliation(s)
- Koyeli Sengupta
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India.
| | - Henal Shah
- Department of Psychiatry, T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Subharati Ghosh
- Research Insights and Innovation, Population Health and Safety, SEIU 775 Benefits Group, Seattle, USA
| | - Disha Sanghvi
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Sanchita Mahadik
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Allauki Dani
- Department of Psychiatry, T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Oshin Deshmukh
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Laura Pacione
- Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Pamela Dixon
- Autism Speaks, 1060 State Rd, Princeton, NJ, USA
| | - Erica Salomone
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | | | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Wolf S, Seiffer B, Zeibig JM, Welkerling J, Bauer LL, Frei AK, Studnitz T, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Kropp S, Franke S, Peters S, El-Kurd N, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial. BMC Psychiatry 2021; 21:540. [PMID: 34717567 PMCID: PMC8556805 DOI: 10.1186/s12888-021-03541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). METHODS This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention "ImPuls", among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. DISCUSSION Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany.
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Eva Herzog
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Tristan Nakagawa
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Sebastian Franke
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Stefan Peters
- German Association for health-related Fitness and Exercise Therapy (German: DVGS), Hürth-Efferen, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
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Zeibig JM, Seiffer B, Sudeck G, Rösel I, Hautzinger M, Wolf S. Transdiagnostic efficacy of a group exercise intervention for outpatients with heterogenous psychiatric disorders: a randomized controlled trial. BMC Psychiatry 2021; 21:313. [PMID: 34158000 PMCID: PMC8218400 DOI: 10.1186/s12888-021-03307-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Exercise efficaciously reduces disorder-specific symptoms of psychiatric disorders. The current study aimed to examine the efficacy of a group exercise intervention on global symptom severity and disorder-specific symptoms among a mixed outpatient sample. METHODS Groups of inactive outpatients, waiting for psychotherapy, with depressive disorders, anxiety disorders, insomnia, and attention-deficit/hyperactivity disorders were randomized to a manualized 12-week exercise intervention, combining moderate to vigorous aerobic exercise with techniques for sustainable exercise behaviour change (n = 38, female = 71.1% (n = 27), Mage = 36.66), or a passive control group (n = 36, female = 75.0% (n = 27), Mage = 34.33). Primary outcomes were global symptom severity and disorder-specific symptoms, measured with the Symptom Checklist-90-Revised and Pittsburgh Sleep Quality Index pre- and post-treatment. Secondary outcome was the self-reported amount of exercise (Physical Activity, Exercise, and Sport Questionnaire), measured pre-treatment, intermediate-, and post-treatment. Intention-to-treat analyses were conducted using linear mixed models. Linear regressions were conducted to examine the effect of the change of exercise behaviour on the change of symptoms. RESULTS The intervention significantly improved global symptom severity (d = 0.77, p = .007), depression (d = 0.68, p = .015), anxiety (d = 0.87, p = .002), sleep quality (d = 0.88, p = .001), and increased the amount of exercise (d = 0.82, p < .001), compared to the control group. Post-treatment differences between groups were significant for depression (d = 0.63, p = .031), sleep quality (d = 0.61, p = .035) and the amount of exercise (d = 1.45, p < .001). Across both groups, the reduction of global symptom severity was significantly predicted by an increase of exercise (b = .35, p = .012). CONCLUSIONS The exercise intervention showed transdiagnostic efficacy among a heterogeneous clinical sample in a realistic outpatient setting and led to sustained exercise behaviour change. Exercise may serve as an efficacious and feasible transdiagnostic treatment option improving the existing treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (ID: NCT03542396 , 25/04/2018).
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Affiliation(s)
- Johanna-Marie Zeibig
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany.
| | - Britta Seiffer
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany
| | - Gorden Sudeck
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany
| | - Inka Rösel
- Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biostatistics, University of Tuebingen, 72074, Tuebingen, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy, Faculty of Science, Psychological Institute, University of Tuebingen, 72074, Tuebingen, Germany
| | - Sebastian Wolf
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany.,Department of Clinical Psychology and Psychotherapy, Faculty of Science, Psychological Institute, University of Tuebingen, 72074, Tuebingen, Germany
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25
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Newman PA, Prabhu SM, Akkakanjanasupar P, Tepjan S. HIV and mental health among young people in low-resource contexts in Southeast Asia: A qualitative investigation. Glob Public Health 2021; 17:1200-1214. [PMID: 33977867 DOI: 10.1080/17441692.2021.1924822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Young people aged 15-24 years comprise one-fourth of incident HIV infections in Southeast Asia. Given the high prevalence and impact of mental health issues among young people, we explored intersections of HIV and mental health, with a focus on adolescent and young key populations (AYKP) in Indonesia, the Philippines, Thailand, and Vietnam. Sixteen focus group discussions (4/country) with young people (n = 132; 16-24 years) and 41 key informant interviews with multisectoral HIV experts explored young people's lived experiences and unmet needs, existing programmes, and strategic directions for local and regional HIV responses. Cross-cutting challenges emerged in healthcare, family, school, and peer domains amid fragmented and under-resourced HIV and mental health services in socio-politically fraught environments. We identified strategic opportunities and initiatives in development and integration of youth-friendly HIV and mental health services; programmes to promote parent-adolescent communication about sex and HIV; and teacher training and resources to advance HIV and mental health awareness, serve as first-responders, and provide community referrals. Youth-led peer education programmes and LGBT-networks were central to the HIV response-promoting HIV prevention, sexual health, and mental health awareness for young people, and resilience and socioeconomic empowerment of peer educators themselves-thereby transforming sociocultural and political contexts of vulnerability.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,VOICES-Thailand Foundation, Chiang Mai, Thailand
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26
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Wolf S, Seiffer B, Zeibig JM, Welkerling J, Brokmeier L, Atrott B, Ehring T, Schuch FB. Is Physical Activity Associated with Less Depression and Anxiety During the COVID-19 Pandemic? A Rapid Systematic Review. Sports Med 2021; 51:1771-1783. [PMID: 33886101 PMCID: PMC8060908 DOI: 10.1007/s40279-021-01468-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Covid-19 pandemic is affecting the entire world population. During the first spread, most governments have implemented quarantine and strict social distancing procedures. Similar measures during recent pandemics resulted in an increase in post-traumatic stress, anxiety and depression symptoms. The development of novel interventions to mitigate the mental health burden are of utmost importance. OBJECTIVE In this rapid review, we aimed to provide a systematic overview of the literature with regard to associations between physical activity (PA) and depression and anxiety during the COVID-19 pandemic. DATA SOURCE We searched major databases (PubMed, EMBASE, SPORTDiscus, and Web of Science) and preprint servers (MedRxiv, SportRxiv, ResearchGate, and Google Scholar), for relevant papers up to 25/07/2020. STUDY ELIGIBILITY CRITERIA We included observational studies with cross-sectional and longitudinal designs. To qualify for inclusion in the review, studies must have tested the association of PA with depression or anxiety, using linear or logistic regressions. Depression and anxiety must have been assessed using validated rating scales. STUDY APPRAISAL AND SYNTHESIS METHODS Effect sizes were represented by fully adjusted standardized betas and odds ratios (OR) alongside 95% confidence intervals (CI). In case standardized effects could not be obtained, unstandardized effects were presented and indicated. RESULTS We identified a total of 21 observational studies (4 longitudinal, 1 cross-sectional with retrospective analysis, and 16 cross-sectional), including information of 42,293 (age 6-70 years, median female = 68%) participants from five continents. The early evidence suggests that people who performed PA on a regular basis with higher volume and frequency and kept the PA routines stable, showed less symptoms of depression and anxiety. For instance, those reporting a higher total time spent in moderate to vigorous PA had 12-32% lower chances of presenting depressive symptoms and 15-34% of presenting anxiety. CONCLUSION Performing PA during Covid-19 is associated with less depression and anxiety. To maintain PA routines during Covid-19, specific volitional and motivational skills might be paramount to overcome Covid-19 specific barriers. Particularly, web-based technologies could be an accessible way to increase motivation and volition for PA and maintain daily PA routines.
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Affiliation(s)
- Sebastian Wolf
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
- Institute of Sport Science, Department of Education & Health Research, University of Tuebingen, Tuebingen, Germany.
| | - Britta Seiffer
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Institute of Sport Science, Department of Education & Health Research, University of Tuebingen, Tuebingen, Germany
| | - Johanna-Marie Zeibig
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Institute of Sport Science, Department of Education & Health Research, University of Tuebingen, Tuebingen, Germany
| | - Jana Welkerling
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Institute of Sport Science, Department of Education & Health Research, University of Tuebingen, Tuebingen, Germany
| | - Luisa Brokmeier
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Beatrice Atrott
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
- Institute of Sport Science, Department of Education & Health Research, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Felipe Barreto Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
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Yuval K, Aizik-Reebs A, Lurie I, Demoz D, Bernstein A. A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention. Transcult Psychiatry 2021; 58:268-282. [PMID: 33292082 DOI: 10.1177/1363461520965436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.
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Affiliation(s)
| | | | - Ido Lurie
- Shalvata Mental Health Center, Hod HaSharon, Israel and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University
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Are A, Olisah V, Bella-Awusah T, Ani C. Controlled clinical trial of teacher-delivered Cognitive Behavioural Therapy (CBT) for adolescents with clinically diagnosed depressive disorder in Nigeria. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1891361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amos Are
- International Training Fellow (MTI), Child and Adolescent Mental Health Service, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Victor Olisah
- Professor of Psychiatry, Department of Psychiatry, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Tolulope Bella-Awusah
- Senior Lecturer, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Cornelius Ani
- Honorary Clinical Senior Lecturer, Division of Psychiatry, Imperial College London, and Consultant Child and Adolescent Psychiatrist, Surrey and Borders Partnership NHS Foundation Trust, London, UK
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29
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Wood S, Seevak E, Bhatia U, McBain R, Nadkarni A. "I will not step back": A Qualitative Study of Lay Mental Health Workers' Experiences in India. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:695-706. [PMID: 33452945 DOI: 10.1007/s10488-020-01102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
A significant treatment gap exists for mental illnesses across the world, particularly in low- and middle-income countries (LMICs). Task-sharing, a potentially scalable strategy to bridge the treatment gap, has been shown to be feasible and effective for the treatment of a range of mental illnesses. However, there is a lack of research examining lay mental health workers' experiences in such task-sharing roles. The aim of our study was to understand the barriers and facilitators that lay health workers (LHWs) face in delivering mental healthcare. We conducted in-depth interviews with 32 lay mental health workers recruited through maximum variation sampling and 18 stakeholders leading mental health programs at a variety of non-governmental organisations across India. Interviews were semi-structured and data was analyzed using the thematic analysis approach. Results showed that LHWs perceived barriers and facilitators at three levels: individually (related to personal characteristics and family support, and in their daily work such as in relationship building and supervision), organizationally (for example, related to compensation), and societally (such as encountering gender discrimination and stigma). Each of these areas should be taken into consideration when planning and implementing task-sharing interventions for mental illnesses. As the first qualitative study to explore broad LHW experiences in mental healthcare delivery in a diverse set of programs from a LMIC, this study shows that LHW voices should be central to program design and decision-making for mental health interventions.
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Affiliation(s)
- Sheena Wood
- Addictions Research Group, Sangath, Porvorim, Goa, 403501, India
| | - Emma Seevak
- Addictions Research Group, Sangath, Porvorim, Goa, 403501, India
- Harvard University, Cambridge, MA, USA
| | - Urvita Bhatia
- Addictions Research Group, Sangath, Porvorim, Goa, 403501, India
- Oxford Brookes University, Oxford, UK
| | | | - Abhijit Nadkarni
- Addictions Research Group, Sangath, Porvorim, Goa, 403501, India.
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Development of the mental health cultural adaptation and contextualization for implementation (mhCACI) procedure: a systematic framework to prepare evidence-based psychological interventions for scaling. Glob Ment Health (Camb) 2021; 8:e6. [PMID: 33996110 PMCID: PMC8082944 DOI: 10.1017/gmh.2021.5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 01/13/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Because of the high burden of untreated mental illness in humanitarian settings and low- and middle-income countries, scaling-up effective psychological interventions require a cultural adaptation process that is feasible and acceptable. Our adaptation process incorporates changes into both content and implementation strategies, with a focus on local understandings of distress and treatment mechanisms of action. METHODS Building upon the ecological validity model, we developed a 10-step process, the mental health Cultural Adaptation and Contextualization for Implementation (mhCACI) procedure, and piloted this approach in Nepal for Group Problem Management Plus (PM+), a task-sharing intervention, proven effective for adults with psychological distress in low-resource settings. Detailed documentation tools were used to ensure rigor and transparency during the adaptation process. FINDINGS The mhCACI is a 10-step process: (1) identify mechanisms of action, (2) conduct a literature desk review for the culture and context, (3) conduct a training-of-trainers, (4) translate intervention materials, (5) conduct an expert read-through of the materials, (6) qualitative assessment of intervention population and site, (7) conduct practice rounds, (8) conduct an adaptation workshop with experts and implementers, (9) pilot test the training, supervision, and implementation, and (10) review through process evaluation. For Group PM+, key adaptations were harmonizing the mechanisms of action with cultural models of 'tension'; modification of recruitment procedures to assure fit; and development of a skills checklist. CONCLUSION A 10-step mhCACI process could feasibly be implemented in a humanitarian setting to rapidly prepare a psychological intervention for widespread implementation.
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Boustani MM, Daleiden E, Bernstein A, Michelson D, Gellatly R, Malik K, Patel V, Chorpita B. Using relevance mapping methodology to design an adolescent mental health intervention in India. Glob Health Action 2020; 13:1775062. [PMID: 32588780 PMCID: PMC7480414 DOI: 10.1080/16549716.2020.1775062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adolescents in low and middle-income countries experience pronounced mental health needs in contexts where infrastructure and resources are scarce. While evidence-based treatment are readily available, they may not fit the unique needs of certain contexts. OBJECTIVE This manuscript illustrates the systematic process of applying 'relevance mapping' methodology to leverage the youth mental health evidence base to identify candidate practices for inclusion in the development of a contextually appropriate psychological treatment protocol for common adolescent mental health problems in India. METHODS The practice identification was informed by two datasets obtained from adolescent samples in India. The first was an epidemiological dataset from a large community sample in Goa (N = 2,048); the second incorporated 'youth top problems' reported by service-seeking students presenting to school counsellors in Goa and Delhi (N = 78). Problems identified in each dataset were categorized using structured codes. Problem codes and youth demographics were then indexed against a database of hundreds of evidence-based psychological treatments and their associated clinical trials. This methodology revealed the most common practice elements (discrete therapeutic strategies) and their most efficient combinations with evidence of effectiveness matching the demographics and diagnostic category (anxiety, disruptive behaviors and depression) prevalent in the planned treatment population. RESULTS For anxiety, the most common practice elements for this age group were exposure, cognitive coping, and psychoeducation. For disruptive behaviors, the most common practices were problem-solving, goal-setting, and rapport-building. For depression, cognitive coping, behavioral activation, and psychoeducation were the most common practice elements. CONCLUSION These practice elements provided the treatment development team with a preliminary list of candidate content for the development of an intensive psychological treatment within a stepped care service model to address common adolescent mental health problems in schools in India.
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Affiliation(s)
- Maya M Boustani
- Department of Psychology, Loma Linda University , Loma Linda, CA, USA
| | | | | | | | - Resham Gellatly
- Department of Psychology, University of California , Los Angeles, CA, USA
| | | | - Vikram Patel
- Sangath , Goa, India.,Department of Global Health and Population, Harvard Medical School , Cambridge, MA, USA
| | - Bruce Chorpita
- Department of Psychology, University of California , Los Angeles, CA, USA
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Bernecker SL, Williams JJ, Caporale-Berkowitz NA, Wasil AR, Constantino MJ. Nonprofessional Peer Support to Improve Mental Health: Randomized Trial of a Scalable Web-Based Peer Counseling Course. J Med Internet Res 2020; 22:e17164. [PMID: 32955451 PMCID: PMC7536598 DOI: 10.2196/17164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/16/2020] [Accepted: 07/26/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Millions of people worldwide are underserved by the mental health care system. Indeed, most mental health problems go untreated, often because of resource constraints (eg, limited provider availability and cost) or lack of interest or faith in professional help. Furthermore, subclinical symptoms and chronic stress in the absence of a mental illness diagnosis often go unaddressed, despite their substantial health impact. Innovative and scalable treatment delivery methods are needed to supplement traditional therapies to fill these gaps in the mental health care system. OBJECTIVE This study aims to investigate whether a self-guided web-based course can teach pairs of nonprofessional peers to deliver psychological support to each other. METHODS In this experimental study, a community sample of 30 dyads (60 participants, mostly friends), many of whom presented with mild to moderate psychological distress, were recruited to complete a web-based counseling skills course. Dyads were randomized to either immediate or delayed access to training. Before and after training, dyads were recorded taking turns discussing stressors. Participants' skills in the helper role were assessed before and after taking the course: the first author and a team of trained research assistants coded recordings for the presence of specific counseling behaviors. When in the client role, participants rated the session on helpfulness in resolving their stressors and supportiveness of their peers. We hypothesized that participants would increase the use of skills taught by the course and decrease the use of skills discouraged by the course, would increase their overall adherence to the guidelines taught in the course, and would perceive posttraining counseling sessions as more helpful and their peers as more supportive. RESULTS The course had large effects on most helper-role speech behaviors: helpers decreased total speaking time, used more restatements, made fewer efforts to influence the speaker, and decreased self-focused and off-topic utterances (ds=0.8-1.6). When rating the portion of the session in which they served as clients, participants indicated that they made more progress in addressing their stressors during posttraining counseling sessions compared with pretraining sessions (d=1.1), but they did not report substantive changes in feelings of closeness and supportiveness of their peers (d=0.3). CONCLUSIONS The results provide proof of concept that nonprofessionals can learn basic counseling skills from a scalable web-based course. The course serves as a promising model for the development of web-based counseling skills training, which could provide accessible mental health support to some of those underserved by traditional psychotherapy.
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Affiliation(s)
- Samantha L Bernecker
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | | | | | - Akash R Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
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Evans AC, Bufka LF. The Critical Need for a Population Health Approach: Addressing the Nation's Behavioral Health During the COVID-19 Pandemic and Beyond. Prev Chronic Dis 2020; 17:E79. [PMID: 32762806 PMCID: PMC7417017 DOI: 10.5888/pcd17.200261] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 global pandemic highlights the necessity for a population health approach to identify and implement strategies across systems to improve behavioral health. Adopting a population health approach helps to address the needs of the total population, including at-risk subgroups, through multiple levels of intervention and to promote the public’s behavioral health and psychological well-being.
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Affiliation(s)
- Arthur C Evans
- American Psychological Association, Washington, District of Columbia
| | - Lynn F Bufka
- American Psychological Association, 750 First St, NE, Washington, DC 20002.
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Capella Palacios M, Jadhav S. How coloniality shapes the making of Latin American psychologists: ethnographic evidence from Ecuador. Int Rev Psychiatry 2020; 32:348-358. [PMID: 32648498 DOI: 10.1080/09540261.2020.1761777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper provides ethnographic evidence on how coloniality shapes the making of Latin American psychologists. A critical ethnography was conducted at a psychology training institution in Ecuador, consisting of twelve months of participant observation; forty-one semi-structured interviews; and analysis of academic discourse, photos, videos and relevant social media content. The research was guided by the tradition of Critical Psychology - specifically Liberation Psychology - and Critical Discourse Analysis. Findings suggest the pervasiveness of coloniality in the making of Ecuadorian psychologists and, hypothetically, of others in Latin America and the wider Global South. Interpretations also highlight the non-essentialist, non-dichotomist, 'messy' nature of such processes, a consideration which may advance current ethical and analytical debates on decolonisation. Echoing ongoing critical arguments, authors suggest that a 'help-as-war' metaphor is a category with potential value to contribute to such advancement, an approach that has important theoretical and pragmatic implications for researchers and practitioners.
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Affiliation(s)
| | - Sushrut Jadhav
- Division of Psychiatry, University College London, London, UK
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Ramachandran R. A qualitative study on perspective of parents of children with autism on the nature of parent-professional relationship in Kerala, India. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1521-1530. [PMID: 32329373 DOI: 10.1177/1362361320912156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT This study explored the nature of relationship between parents of children with autism and professionals who provide therapy-based services for autism in Kerala, India. Given the shortage of professionally qualified therapists and educators (particularly in the case of autism) in low- and medium-income countries, parent-mediated interventions where professionals and parents work as partners are recommended as an effective means to meet the demand. However, for parent-mediated interventions to be effective, we first need to understand the customary nature of parent-professional relationship and develop the intervention accordingly. It is within this context that parents of 21 children with autism whose age ranged between 5.8 and 17.3 years were interviewed in order to understand the customary nature of parent-professional relationship. There was a dearth of scheduled, in-depth, and personalized one-on-one interaction between the parent and the professional. Though parents were involved hands on in their child's training under professional direction, they remained mere information providers in decision making. The parent-professional relationship did not nurture parent's self efficacy. This led to parents feeling inadequate to provide for their child's developmental needs and being apprehensive about adulthood. The customary nature of parent-professional relationship observed may be a reflection of the collectivist culture in India. The findings suggest that parent-mediated interventions will need to focus on enabling parents to break cultural barriers that might be holding them back from partnering with professionals as equals.
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Affiliation(s)
- Rajani Ramachandran
- Indian Institute of Management Kozhikode, India.,University of Calicut, India
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Hook K, Vera E. Best Practices in Global Mental Health: An Exploratory Study of Recommendations for Psychologists. ACTA ACUST UNITED AC 2020; 9:67-83. [PMID: 33927913 DOI: 10.1037/ipp0000125] [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] [Indexed: 10/24/2022]
Abstract
Recommendations for best practice are useful in guiding the ethical and effective practice of psychology. Global mental health (GMH), which works to improve mental health treatment and access on a worldwide scale, is a growing field with many opportunities for psychologists, though such best practice recommendations have not been articulated. Using a grounded theory approach, this qualitative study recruited and interviewed psychologists identified as leaders in the field. Findings included broad categories of recommendations related to overarching variables (consideration of cultural/contextual variables; collaboration), program level characteristics (sustainability; formative and summative evaluation; flexibility; attention to systems; multidisciplinary teams; clinical knowledge and perspective; attention to spectrum of mental health), and individual level characteristics (perseverance; ongoing mentorship/supervision; self-awareness; boundary setting). Future directions include recommendations to recreate this study with a more geographically diverse sample, as well as with community members and service users of global mental heath projects. Increased attention to individual level competencies that impact global mental health projects are warranted. Recommendations for best practice and implications for training are also considered.
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Affiliation(s)
- Kimberly Hook
- Boston University School of Medicine/Boston Medical Center
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R Kottai S, Ranganathan S. Task-Shifting in Community Mental Health in Kerala: Tensions and Ruptures. Med Anthropol 2020; 39:538-552. [DOI: 10.1080/01459740.2020.1722122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sudarshan R Kottai
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, Hyderabad, India
| | - Shubha Ranganathan
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, Hyderabad, India
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Green B, Colucci E. Traditional healers' and biomedical practitioners' perceptions of collaborative mental healthcare in low- and middle-income countries: A systematic review. Transcult Psychiatry 2020; 57:94-107. [PMID: 31937197 DOI: 10.1177/1363461519894396] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Access to mental healthcare in low- and middle-income countries (LMICs) is one of the greatest challenges in public health today. One suggestion for improving accessibility is through collaboration between biomedical practitioners and traditional healers. This paper reviews studies of traditional healers' and biomedical practitioners' perceptions of collaboration. We conducted a systematic review of online databases, selected journals, and reference lists for relevant studies. Eligible papers were assessed using a tool designed for this review for quality and study characteristics, and qualitative data demonstrating participants' views were extracted. A total of 14 papers from seven countries were included. The published literature on this topic is relatively homogenous and studies are of variable quality. The findings suggest that, despite differing conceptualisations of mental illness causation, both traditional healers and biomedical practitioners recognise that patients can benefit from a combination of both practices and demonstrate a clear willingness to work together. There are concerns about patients' safety and human rights regarding traditional methods and some healers are sceptical about the effectiveness of Western psychiatric medication. Despite keeping the inclusion criteria open to all LMICs, 13 of the studies were conducted in Africa, seven of which were in South Africa. This limits the applicability of the findings of this review to the wider LMIC context. The paper concludes with recommendations for research and practice.
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Cardoso LCB, Arruda GOD, Giacon-Arruda BCC, Paiano M, Pinho LBD, Marcon SS. WORK PROCESS AND MENTAL HEALTH CARE FLOW IN PRIMARY HEALTH CARE. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to know the work process and mental health care flow in Primary Health Care from the perspective of Family Health Strategy professionals. Method: a descriptive and qualitative study developed in six of the 34 Basic Health Units in a city in northwestern Paraná. Twenty-nine Family Health Strategy professionals participated in the study. Data were collected from February to June 2018 through an open, single, individual and recorded interview. The statements were transcribed in full, and the resulting material was organized in the IRaMuTeQ® software and subjected to thematic content analysis. Results: from participants’ reports, it was possible to create a service flowchart, and after the data processing steps in the software, together with content analysis, three categories emerged. The importance of community health workers’ work, family presence, referring patients to therapeutic groups and a specialized network, assistance provided to individuals in times of acute disorder and patient referral to the unit stood out. Conclusion: it can be understood that the mental health care network in Primary Health Care is complex and there is a need for communicability between services, as disarticulation generates ambiguities in continuity of care.
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Ortega F, Müller MR. Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil. FRONTIERS IN SOCIOLOGY 2020; 5:535125. [PMID: 33869481 PMCID: PMC8022440 DOI: 10.3389/fsoc.2020.535125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/20/2020] [Indexed: 05/08/2023]
Abstract
Global Mental Health (GMH) is the field of study, research, and intervention, which aims at improving access to mental health worldwide. It is based on the global burden of disease research program and on the existence of a large "treatment gap" between the need and availability of mental health services, displaying individual and social costs of undiagnosed and untreated mental disorders, especially in low- and middle-income countries (LMIC). Few academic publications in Brazil dialogue directly with the field of GMH, although several issues drawn from its agenda have been the subject of mental health policies in the country. Brazil can be classified as a middle-income country with a well-structured national health system. This system is oriented toward primary health care, which integrates both community mental health services and the broader health care network. The debate between GMH advocates and critics has unearthed old controversies in psychiatry such as universality or cultural specificity of mental disorders, their expressions, and their relationship with social and economic factors. We intend to examine how these controversies reverberate in the Brazilian mental health scenario, taking as an illustration the debates around Attention Deficit Hyperactivity Disorder (ADHD) in the country. ADHD discussions oppose those who argue that the condition is underdiagnosed and undertreated, and those who claim that there is overdiagnosis and overtreatment and thus, medicalization of childhood. This article presents the current status of the Brazilian mental health literature on ADHD, with emphasis on tensions around diagnosis, prevalence and interventions. Our aim is to highlight how the differential in discourse shapes the debate on ADHD in Brazil and how this may contribute to the GMH agenda. This goal will be undertaken in three steps. First, we will briefly examine studies around GMH and ADHD. Secondly, we address Brazilian studies on this theme, considering the specificities regarding the constitution of the mental health field. Finally, we will examine the debate of treatment gap vs. medicalization in the country in order to underscore the potentials and limitations of each perspective.
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Mongelli F, Georgakopoulos P, Pato MT. Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:16-24. [PMID: 32047393 PMCID: PMC7011222 DOI: 10.1176/appi.focus.20190028] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article investigates the gap in access to and quality of mental health care in the United States. This work first discusses how minority populations are most affected by the treatment gap. It summarizes recent literature on the topic for better understanding the needs of psychiatrically underserved and disenfranchised populations and the causes of mental health disparities. It reviews some of the barriers to behavioral health care, including lack of insurance coverage, lack of community-based interventions, unequal access to evidence-based practices, stigma, mental health workforce shortages, and geographical maldistribution of providers. Second, it reviews opportunities to address these disparities. The article provides examples of effective interventions that researchers worldwide have already implemented to address the gap of mental health services within the collaborative care model and global mental health initiatives. Telepsychiatry and improvements in training of the mental health workforce are also listed as useful implementations to overcome the treatment gap for patients seeking mental health care.
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Affiliation(s)
- Francesca Mongelli
- Institute for Genomic Health, Department of Psychiatry, College of Medicine (Pato), and Institute for Genomic Health (Georgakopoulos), SUNY Downstate, Brooklyn, NY; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy (Mongelli)
| | - Penelope Georgakopoulos
- Institute for Genomic Health, Department of Psychiatry, College of Medicine (Pato), and Institute for Genomic Health (Georgakopoulos), SUNY Downstate, Brooklyn, NY; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy (Mongelli)
| | - Michele T Pato
- Institute for Genomic Health, Department of Psychiatry, College of Medicine (Pato), and Institute for Genomic Health (Georgakopoulos), SUNY Downstate, Brooklyn, NY; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy (Mongelli)
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Ottman KE, Kohrt BA, Pedersen GA, Schafer A. Use of role plays to assess therapist competency and its association with client outcomes in psychological interventions: A scoping review and competency research agenda. Behav Res Ther 2019; 130:103531. [PMID: 31902517 DOI: 10.1016/j.brat.2019.103531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
A major challenge in scaling-up psychological interventions worldwide is how to evaluate competency among new workforces engaged in psychological services. One approach to measuring competency is through standardized role plays. Role plays have the benefits of standardization and reliance on observed behavior rather than written knowledge. However, role plays are also resource intensive and dependent upon inter-rater reliability. We undertook a two-part scoping review to describe how competency is conceptualized in studies evaluating the relationship of competency with client outcomes. We focused on use of role plays including achieving inter-rater reliability and the association with client outcomes. First, we identified 4 reviews encompassing 61 studies evaluating the association of competency with client outcomes. Second, we identified 39 competency evaluation tools, of which 21 were used in comparisons with client outcomes. Inter-rater reliability (intraclass correlation coefficient) was reported for 15 tools and ranged from 0.53 to 0.96 (mean ICC = 0.77). However, we found that none of the outcome comparison studies measured competency with standardized role plays. Instead, studies typically used therapy quality (i.e., session ratings with actual clients) as a proxy for competency. This reveals a gap in the evidence base for competency and its role in predicting client outcomes. We therefore propose a competency research agenda to develop an evidence-base for objective, standardized role plays to measure competency and its association with client outcomes. OPEN SCIENCE REGISTRATION #: https://osf.io/nqhu7/.
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Affiliation(s)
- Katherine E 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
| | - 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.
| | - 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
| | - Alison Schafer
- World Health Organization, Department of Mental Health and Substance Use, Avenue Appia 20, Geneva 27, 1211, Switzerland
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Fagan AA, Bumbarger BK, Barth RP, Bradshaw CP, Cooper BR, Supplee LH, Walker DK. Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1147-1168. [PMID: 31444621 PMCID: PMC6881430 DOI: 10.1007/s11121-019-01048-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.
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Affiliation(s)
- Abigail A Fagan
- Department of Sociology, Criminology & Law, University of Florida, 3362 Turlington Hall, P.O. Box 117330, Gainesville, FL, 32611-7330, USA.
| | | | - Richard P Barth
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
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Mills C, Hilberg E. 'Built for expansion': the 'social life' of the WHO's mental health GAP Intervention Guide. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41 Suppl 1:162-175. [PMID: 31599988 DOI: 10.1111/1467-9566.12870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The focus of this study is the WHO's mhGAP-Intervention Guide (mhGAP-IG) 2.0 (2016), an evidence-based tool and guideline to help detect, diagnose and manage the most common mental disorders, designed for use by non-specialists globally but particularly in low- and middle-income countries. This research is a starting point in tracing the multiple 'doings' of mhGAP-IG - connecting questions of how it is 'done' and what does it 'do' - to the living histories and wider global mental health assemblages that make the tool possible and shape its global circulation. We examine the conditions of possibility that produce and legitimate mhGAP-IG, and the ways these are 'black boxed' through casting mhGAP-IG in technical rather than epistemological terms. The study illuminates how its explicit design for global expansion positions mhGAP-IG as open to questioning from those who are technical 'insiders' and setting the epistemological parameters of its own critique. It analyses mhGAP-IG as an 'inscription device' that inscribes and materialises algorithmic imaginaries of mental health that impact on design and local implementation. This study is one attempt at initiating dialogue with the WHO from perspectives and methodological approaches not usually included in the conversation.
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Affiliation(s)
- China Mills
- School of Health Sciences, City, University of London, London, UK
| | - Eva Hilberg
- Sheffield Institute for International Development, University of Sheffield, Sheffield, UK
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Simmonds-Buckley M, Kellett S, Waller G. Acceptability and Efficacy of Group Behavioral Activation for Depression Among Adults: A Meta-Analysis. Behav Ther 2019; 50:864-885. [PMID: 31422844 DOI: 10.1016/j.beth.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/29/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
The evidence base for behavioral activation (BA) as a front-line treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at posttreatment/follow-up, recovery and dropout rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes postgroup BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k=13, N=461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k=15, N=526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The dropout rate for group BA (14%) was no different from other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
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Affiliation(s)
| | - Stephen Kellett
- University of Sheffield, and Sheffield Health and Social Care NHS Foundation Trust
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Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China. Cult Med Psychiatry 2019; 43:181-210. [PMID: 30426360 DOI: 10.1007/s11013-018-9608-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.
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von Peter S, Aderhold V, Cubellis L, Bergström T, Stastny P, Seikkula J, Puras D. Open Dialogue as a Human Rights-Aligned Approach. Front Psychiatry 2019; 10:387. [PMID: 31214063 PMCID: PMC6555154 DOI: 10.3389/fpsyt.2019.00387] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022] Open
Abstract
Throughout the last 20 years, the human rights perspective has increasingly developed into a paradigm against which to appraise and evaluate mental health care. This article investigates to what extent the Finnish open dialogue (OD) approach both aligns with human rights and may be qualified to strengthen compliance with human rights perspectives in global mental health care. Being a conceptual paper, the structural and therapeutic principles of OD are theoretically discussed against the background of human rights, as framed by the Universal Declaration of Human Rights, the UN Convention on the Rights of People with Disabilities, and the two recent annual reports of the Human Rights Council. It is shown that OD aligns well with discourses on human rights, being a largely non-institutional and non-medicalizing approach that both depends on and fosters local and context-bound forms of knowledge and practice. Its fundamental network perspective facilitates a contextual and relational understanding of mental well-being, as postulated by contemporary human rights approaches. OD opens the space for anyone to speak (out), for mutual respect and equality, for autonomy, and to address power differentials, making it well suited to preventing coercion and other forms of human rights violation. It is concluded that OD can be understood as a human rights-aligned approach.
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Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Medical University Brandenburg, Neuruppin, Germany
| | - Volkmar Aderhold
- Department of Psychiatry and Psychotherapy, Medical University Greifswald, Greifswald, Germany
| | - Lauren Cubellis
- Department of Anthropology, Washington University St. Louis, St. Louis, MO, United States
| | - Tomi Bergström
- Department of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Jaakko Seikkula
- Department of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Dainius Puras
- Department of Psychiatry and Psychology, Vilnius University, Vilnius, Lithuania
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Hoeft TJ, Wilcox H, Hinton L, Unützer J. Costs of implementing and sustaining enhanced collaborative care programs involving community partners. Implement Sci 2019; 14:37. [PMID: 30999936 PMCID: PMC6471861 DOI: 10.1186/s13012-019-0882-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/25/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Collaborative care is an evidence-based program for treating depression in primary care. We sought to expand this model by recruiting clinics interested in incorporating community partners (i.e., community-based organizations (CBO) and/or family members) in the care team. Seven sites implemented evidence-based collaborative care programs with community partners while collecting information on costs of implementing and sustaining programs. METHODS Sites retrospectively collected data on planning and implementation costs with technical assistance from study researchers. Sites also prospectively collected cost of care activities over a 1-month period once the program was implemented to determine resources needed to sustain programs. Personnel salary costs were adjusted, adding 30% for benefits and 30% for administrative overhead. RESULTS The programs implemented varied considerably in staffing, involvement of care partners, and allocation of costs. Total planning and implementation costs varied from $39,280 to $60,575. The largest implementation cost category involved workflow development and ranged from $16,325 to $31,375 with the highest costs in this category attributed to the most successful implementation among clinic-CBO programs. Following implementation, cost per patient over the 1-month period ranged from $154 to $544. Ongoing strategic decision-making and administrative costs, which were included in cost of care, ranged from $284 to $2328 for the month. CONCLUSIONS Sites implemented collaborative care through differing partnerships, staffing, and related costs. Costs to implement and sustain programs developed in partnership are often not collected but are crucial to understanding financial aspects of developing sustainable partnerships. Assessing such costs is feasible and can inform future partnership efforts.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, 98195-6560, USA.
| | - Heather Wilcox
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, 98195-6560, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, 98195-6560, USA
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Wright J, Maliwichi-Senganimalunje L. Pluralism and practicality: village health workers' responses to contested meanings of mental illness in Southern Malawi. Anthropol Med 2019; 27:32-48. [PMID: 30714836 DOI: 10.1080/13648470.2018.1507103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The individual and social construction of psychological distress is fundamental to help-seeking and the extent to which interventions are seen as credible. Where pluralistic attributions for mental health problems predominate, the development of global mental health (GMH) interventions in the form of task-shifting approaches create increased access to new ways of understanding and responding to distress. However, little is known about how participants in these initiatives manage these encounters. This qualitative study in Malawi explored village-based health workers' (HSAs) and patients' and carers' views of the causes of distress and how these beliefs influenced help-seeking and the health workers' response.Eight HSAs and nine paired patients/carers were interviewed separately to enable each of nine experiences of distress to be explored. Findings revealed a complex set of personal, social and cultural influences that informed causative attributions and help-seeking decisions. Patients/carers viewed psychosocial stresses as compelling explanations and readily reported others attributing their distress to supernatural causes (bewitchment). Yet attributional beliefs alone were not the only influence over help-seeking, which evolved pragmatically in response to the impact of treatments and social pressure for conformity. In turn HSAs navigated the interactions with patients/carers by emphasising the biomedical approach and discrediting bewitchment attributions. This caused tensions when biomedical interventions were unhelpful or the traditional healers' approach proved beneficial.Conclusions add to the call for such task-shifting approaches to work with communities to discern authentic and practical responses to mental distress that mirror the 'pluralism and pragmatism' found in the communities they serve.
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Affiliation(s)
- Jerome Wright
- Department of Health Sciences, University of York, York UK
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Menezes ALDA, Muller MR, Soares TRDA, Figueiredo AP, Correia CRDM, Corrêa LM, Ortega F. Parallels between research in mental health in Brazil and in the field of Global Mental Health: an integrative literature review. CAD SAUDE PUBLICA 2018; 34:e00158017. [PMID: 30484560 DOI: 10.1590/0102-311x00158017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 06/28/2018] [Indexed: 12/13/2022] Open
Abstract
Global Mental Health is a field of teaching, research, and practice whose goal is to improve access to mental health and reduce inequalities in mental health outcomes for all people worldwide, especially proposing action in low- and middle-income countries like Brazil. Given this global scenario and Brazil's progress in health and psychiatric reforms, it is important to investigate the current status of the Brazilian mental health literature and its relationship to Global Mental Health, describing how Brazilian research deals with key topics in the Global Mental Health field. The authors performed an integrative literature review using a qualitative and descriptive approach. The article search was performed for the years 2014 and 2015 in Portuguese and English, using the terms "mental health" and "Brazil", combined with key words corresponding to the principal themes addressed by authors in Global Mental Health. The search yielded 88 articles, which were analyzed according to authorship, periodicals and regions, and the analytical categories of access, primary care, community mental health services, social determinants of health, human rights, and equity. Brazil's mental health research revealed a rich and diverse body of studies, showing parallels with the literature on global mental health, but with limited systematization. Although the review revealed efforts to generate knowledge in this field within Brazil, some barriers may be limiting Brazil's participation in the international debate on Global Mental Health.
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Affiliation(s)
- Alice Lopes do Amaral Menezes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Laboratório Interdisciplinar de Pesquisa em Atenção Primária à Saúde, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Manuela R Muller
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Faculdade de Medicina, Universidade Estácio de Sá, Rio de Janeiro, Brasil
| | | | | | | | - Letícia Moraes Corrêa
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Francisco Ortega
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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