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Kumar MS, Arulvendan H, Sanjana G, Priyadharshni B, Arumugam C, Durairaj J, Azariah F, Sinha M, Raghavan V, Thara R. Effectiveness of mental health literacy intervention and contact-based education on knowledge, attitude, and stigma towards mental health among secondary school students in Chennai, South India: A cluster randomized controlled trial. Asian J Psychiatr 2024; 102:104248. [PMID: 39341148 DOI: 10.1016/j.ajp.2024.104248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 09/15/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Global trends indicate a rise in mental health disorders among youth, prompting need for effective interventions. Mental health literacy interventions have demonstrated benefits such as improved knowledge, treatment understanding, help-seeking behaviors, and stigma reduction. This study aimed to assess the impact of a comprehensive mental health literacy program on knowledge, attitudes, and stigma related to mental health among secondary school students in Chennai. METHODS Cluster-randomized controlled trial was conducted among students from four secondary schools. Randomization was at cluster level to minimize contamination. Participating schools provided consent, and all ninth-grade students were invited to participate. Written informed consent was obtained from parents/guardians, and assent was obtained from students. There were no specific exclusion criteria, except for students who declined to participate. Analyses were performed using intention-to-treat principles, with multiple imputation for missing outcome data. RESULTS After adjusting for cluster effects, the intervention group showed a significant improvement in attitude scores compared to the control group (mean difference 0.85, 95 % CI: 0.32-1.39, p = 0.002). However, no significant differences were observed between the two groups in terms of knowledge and stigma. CONCLUSION The findings suggest that delivering a mental health literacy curriculum alongside contact-based education involving individuals with lived experiences of mental disorders positively influences students' attitudes toward mental health. Although no significant changes were observed in knowledge and stigma levels, the integration of mental health literacy programs with personal narratives from those with lived experiences holds promise for addressing mental health stigma and promoting positive attitudes among school students.
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Affiliation(s)
- M Suresh Kumar
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India; CitiesRISE, 33 W 60th Street FL2, New York, NY 10023, USA
| | - Hanisha Arulvendan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - G Sanjana
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - B Priyadharshni
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - Chiranjeevi Arumugam
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - Jothilakshmi Durairaj
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | | | | | - Vijaya Raghavan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India.
| | - R Thara
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
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Mkubwa B, Angwenyi V, Nzioka B, Newton CR, Sijbrandij M, Abubakar A. Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review. Int J Ment Health Syst 2024; 18:27. [PMID: 39014469 PMCID: PMC11253363 DOI: 10.1186/s13033-024-00644-8] [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: 10/02/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Child and adolescent mental health is a global priority. In sub-Saharan Africa, despite the high burden, there is a gap in health services for children and adolescents with mental health disorders. To bridge this gap, healthcare workers require a good understanding of child and adolescent mental health, the right attitude, and practices geared to improving child and adolescent mental health. This scoping review examined the knowledge, attitudes, and practices related to child and adolescent mental health among sub-Saharan African healthcare workers. METHODS The search was restricted between January 2010, the year when the Mental Health Gap Action Programme guidelines were launched, and April 2024. The review followed the methodological framework proposed by Arksey and O'Malley for conducting scoping reviews. The databases searched included CINHAL, PubMed, Web of Science, PsycINFO, and grey literature databases. Additional articles were identified through cited references of the studies included. A data extraction template was used to retrieve relevant text. A narrative synthesis approach was adopted to explore the relationships within and between the included studies. RESULTS The literature search yielded 4658 studies. Among these, 817 were identified as duplicates, and 3740 were excluded after screening. Only twenty-one articles met the criteria for inclusion in the review. The findings showed that healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health. CONCLUSION It is crucial to build capacity and improve healthcare workers' practices, knowledge, and attitudes toward child and adolescent mental health in sub-Saharan Africa. This could lead to better access to mental health services for children and adolescents in the region.
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Affiliation(s)
- Beatrice Mkubwa
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Brenda Nzioka
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Charles R Newton
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Neuroscience Unit, KEMRI-Wellcome Trust, Center for Geographic Medicine Research Coast, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Neuroscience Unit, KEMRI-Wellcome Trust, Center for Geographic Medicine Research Coast, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Nguyen GT, Gauvreau C, Mansuri N, Wight L, Wong B, Neposlan J, Petricca K, Denburg A. Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review. BMJ Paediatr Open 2024; 8:e002556. [PMID: 38830723 PMCID: PMC11149138 DOI: 10.1136/bmjpo-2024-002556] [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: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Despite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly in low-income and middle-income countries (LMICs). There is limited knowledge regarding the implementation of paediatric NCD policies and programmes in LMICs, despite their disproportionate burden of morbidity and mortality. We aimed to understand the barriers to and facilitators of paediatric NCD policy and programme implementation in LMICs. METHODS We systematically searched medical databases, Web of Science and WHOLIS for studies on paediatric NCD policy and programme implementation in LMICs. Screening and quality assessment were performed independently by researchers, using consensus to resolve differences. Data extraction was conducted within the WHO health system building-blocks framework. Narrative thematic synthesis was conducted. RESULTS 93 studies (1992-2020) were included, spanning 86 LMICs. Most were of moderate or high quality. 78% reported on paediatric NCDs outside the four major NCD categories contributing to the adult burden. Across the framework, more barriers than facilitators were identified. The most prevalently reported factors were related to health service delivery, with system fragmentation impeding the continuity of age-specific NCD care. A significant facilitator was intersectoral collaborations between health and education actors to deliver care in trusted community settings. Non-health factors were also important to paediatric NCD policies and programmes, such as community stakeholders, sociocultural support to caregivers and school disruptions. CONCLUSIONS Multiple barriers prevent the optimal implementation of paediatric NCD policies and programmes in LMIC health systems. The low sociopolitical visibility of paediatric NCDs limits their prioritisation, resulting in fragmented service delivery and constraining the integration of programmes across key sectors impacting children, including health, education and social services. Implementation research is needed to understand specific contextual solutions to improve access to paediatric NCD services in diverse LMIC settings.
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Affiliation(s)
- Gina T Nguyen
- University College Dublin School of Medicine, Dublin, Ireland
| | - Cindy Gauvreau
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lisa Wight
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Bryan Wong
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Josh Neposlan
- University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Kadia Petricca
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram Denburg
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Brown C, Nkemjika S, Ratto J, Dube SR, Gilbert L, Chiang L, Picchetti V, Coomer R, Kambona C, McOwen J, Akani B, Kamagate MF, Low A, Manuel P, Agusto A, Annor FB. Adverse Childhood Experiences and Associations with Mental Health, Substance Use, and Violence Perpetration among Young Adults in sub-Saharan Africa. CHILD ABUSE & NEGLECT 2024; 150:106524. [PMID: 38854869 PMCID: PMC11160582 DOI: 10.1016/j.chiabu.2023.106524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). Objective To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Participants and setting Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18-24 years. Methods Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. Result ACEs prevalence ranged from 7.8% (emotional violence) to 55.0% (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. Conclusion ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population.
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Affiliation(s)
- Colvette Brown
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jeffrey Ratto
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Shanta R. Dube
- Levine College of Health Sciences, Wingate University, Wingate, North Carolina
| | - Leah Gilbert
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Laura Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Viani Picchetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Rachel Coomer
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Namibia
| | - Caroline Kambona
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Kenya
| | - Jordan McOwen
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | - Bangaman Akani
- Department of Public Health, Felix Houphouet Boigny University, Abidjan, Cote d’ Ivoire
| | - Maman Fathim Kamagate
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Cote d’ Ivoire
| | - Andrea Low
- International Center for AIDS Care and Treatment Program (ICAP)at Columbia University, NY
| | - Pedro Manuel
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | | | - Francis B. Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
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Mensa-Kwao A, Sub Cuc I, Concepcion T, Kemp CG, Hughsam M, Sinha M, Collins PY. A mixed methods analysis of youth mental health intervention feasibility and acceptability in a North American city: Perspectives from Seattle, Washington. PLoS One 2024; 19:e0288214. [PMID: 38483880 PMCID: PMC10939237 DOI: 10.1371/journal.pone.0288214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This study aims to ascertain the kinds of support across the mental health care continuum recommended by young people and key stakeholders who could assist with implementation in Seattle. We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among youth. We complimented these data with a 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted a deductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ2 tests to summarize and compare participant characteristics stratified by age group. Qualitative informants attributed challenges to youth mental health to social isolation and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, and substance abuse prevention. Key informants and survey participants identified schools as the most important setting for mental health interventions. There were no significant differences among quantitative outcomes. Our findings highlight the need for interventions that reduce isolation and increase social connectedness to support youth mental health. As the city designs youth responsive interventions, schools and digital platforms should be prioritized. Engaging multiple stakeholders, particularly young people, tackling cultural stigma surrounding mental health, and improving access to safe community spaces are important considerations for youth mental health interventions.
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Affiliation(s)
- Augustina Mensa-Kwao
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ingrid Sub Cuc
- Department of Native American Studies, University of California Davis, Davis, California, United States of America
| | - Tessa Concepcion
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Christopher G. Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Pamela Y. Collins
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Collins PY, Sinha M, Concepcion T, Patton G, Way T, McCay L, Mensa-Kwao A, Herrman H, de Leeuw E, Anand N, Atwoli L, Bardikoff N, Booysen C, Bustamante I, Chen Y, Davis K, Dua T, Foote N, Hughsam M, Juma D, Khanal S, Kumar M, Lefkowitz B, McDermott P, Moitra M, Ochieng Y, Omigbodun O, Queen E, Unützer J, Uribe-Restrepo JM, Wolpert M, Zeitz L. Making cities mental health friendly for adolescents and young adults. Nature 2024; 627:137-148. [PMID: 38383777 PMCID: PMC10917657 DOI: 10.1038/s41586-023-07005-4] [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: 06/15/2022] [Accepted: 12/15/2023] [Indexed: 02/23/2024]
Abstract
Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for young people. Here we show a set of ranked characteristic statements, grouped by personal, interpersonal, community, organizational, policy and environmental domains of intervention. Life skills for personal development, valuing and accepting young people's ideas and choices, providing safe public space for social connection, employment and job security, centring youth input in urban planning and design, and addressing adverse social determinants were priorities by domain. We report the adversities that COVID-19 generated and link relevant actions to these data. Our findings highlight the need for intersectoral, multilevel intervention and for inclusive, equitable, participatory design of cities that support youth mental health.
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Affiliation(s)
- Pamela Y Collins
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Tessa Concepcion
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - George Patton
- Centre for Adolescent Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thaisa Way
- Dumbarton Oaks, Harvard University, Washington, DC, USA
| | - Layla McCay
- Centre for Urban Design and Mental Health, London, UK
| | - Augustina Mensa-Kwao
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Helen Herrman
- Orygen, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Evelyne de Leeuw
- Ecole de Sante Publique, Universite de Montreal, Montreal, Quebec, Canada
| | - Nalini Anand
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Yajun Chen
- Sun Yat Sen University, Guangzhou, China
| | | | - Tarun Dua
- World Health Organization, Geneva, Switzerland
| | | | | | - Damian Juma
- Healthy Brains Global Initiative, Nairobi, Kenya
| | | | - Manasi Kumar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- University of Nairobi, Nairobi, Kenya
| | - Bina Lefkowitz
- Sacramento County Board of Education, Sacramento, CA, USA
- Lefkowitz Consulting, Sacramento, CA, USA
| | | | - Modhurima Moitra
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | - Emily Queen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jürgen Unützer
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | - Lian Zeitz
- Climate Mental Health Network, Annapolis, MD, USA
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Tsheole P, Makhado L, Maphula A. Childhood Trauma and Exposure to Violence Interventions: The Need for Effective and Feasible Evidence-Based Interventions. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1760. [PMID: 38002851 PMCID: PMC10670457 DOI: 10.3390/children10111760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Several crimes in South Africa cause physical, economic, and mental problems. Xenophobic attacks, mob justice, and other violent conduct directly traumatise children. Service delivery riots and physical and sexual abuse are examples. This evaluation evaluates childhood trauma and exposure to violence interventions. The review describes the therapeutic methods for traumatised children exposed to violence, the healthcare professionals administering them, and the strategies used to tailor the interventions. The researcher systematically searched PsycINFO, Google Scholar, PubMed, Science Direct, and EBSCOhost. Literature from 2011 to 31 July 2023 was searched, and 19 papers were chosen for further review after the systematic search. The authors conducted an eligibility evaluation according to PRISMA guidelines. A thorough review of article texts identified 19 papers that met eligibility standards. Only nineteen studies have validated trauma and violence therapies for children. An effective multi-phased intervention that is feasible and adaptable to varied socioeconomic backgrounds is needed. Further studies on the mental health benefits of brief trauma intervention treatment are needed.
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Affiliation(s)
- Petunia Tsheole
- Department of Psychology, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Lufuno Makhado
- Public Health, Faculty of Health Care Sciences, University of Venda, Thohoyandou 0950, South Africa; (L.M.); (A.M.)
| | - Angelina Maphula
- Public Health, Faculty of Health Care Sciences, University of Venda, Thohoyandou 0950, South Africa; (L.M.); (A.M.)
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Mhango W, Michelson D, Gaysina D. "I felt I needed help, but I did not get any": A multiple stakeholder qualitative study of risk and protective factors, and barriers to addressing common mental health problems among perinatal adolescents in Malawi. Glob Ment Health (Camb) 2023; 10:e73. [PMID: 38024806 PMCID: PMC10663692 DOI: 10.1017/gmh.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Common mental health problems (particularly depression and anxiety) are common among adolescents during the perinatal period. Previous research has identified the distinctive needs of this group and called for contextually appropriate psychosocial interventions. The current study conducted in Malawi aimed to explore risk and protective factors for common mental health problems, and barriers to accessing mental health care, among perinatal adolescents, to develop a contextually relevant intervention for preventing and treating perinatal depression and anxiety. An exploratory qualitative study was conducted in antenatal and postnatal clinics in Zomba district, Malawi in January-March 2022. In-depth individual interviews were completed with perinatal adolescents aged ≤19 (n = 14); their family members (n = 4); and healthcare workers (n = 8). Interview data were subjected to thematic framework analysis. Data were organised around two themes: "psychosocial risk and protective factors" (potential causes of common mental health problems among adolescents); and "health care services" (maternal and mental health services available, and adolescents' experiences of using these services). Interventions need to go beyond targeting symptoms of depression and anxiety to addressing the wider contextual risk factors and barriers to care at the different socioecological levels.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, Brighton, UK
- Department of Psychology and Medical Humanities, University of Malawi, Zomba, Malawi
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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Garriott A, Gulubane G, Poku OB, Archibald N, Entaile P, Tshume O, Phoi O, Matshaba M, Ahmed CV, Lowenthal ED, Brooks M. Youth perspectives of working with near peer youth lay counsellors: The Safe Haven Pilot. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:3029-3043. [PMID: 37470744 PMCID: PMC10819599 DOI: 10.1002/jcop.23080] [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] [Received: 04/17/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
Youth living with HIV (YLWH) have higher rates of common mental disorders (CMDs) when compared with HIV-negative youth. We adapted the Friendship Bench to create a problem solving-based counselling intervention in Botswana delivered by near peer youth lay counsellors for YLWH called Safe Haven. In August 2020, and from June to August 2021, we conducted 22 semistructured interviews with youth aged 13-25 years with mild-to-moderate symptoms of CMDs. Two independent coders carried out an inductive thematic analysis of the transcribed interviews with discrepancies discussed to consensus. Safe Haven was seen as largely acceptable among the youth. Youth felt Safe Haven was a place where they had freedom of expression and could receive practical advice from well-trained and approachable counsellors. Trained youth lay peer counsellors show promise to meet the mental health needs of mild and moderately symptomatic youth, where mental health professionals are in short supply.
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Affiliation(s)
- Anna Garriott
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Ohemaa B. Poku
- Columbia-WHO Center for Global Mental Health, New York, New York, USA
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Nicole Archibald
- Columbia-WHO Center for Global Mental Health, New York, New York, USA
| | | | - Ontibile Tshume
- Botswana Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Onkemetse Phoi
- Botswana Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Charisse V. Ahmed
- Department of General Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Elizabeth D. Lowenthal
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Merrian Brooks
- Botswana UPENN Partnership, Gaborone, Botswana
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Webb L, Kyaddondo D, Ford T, Bergqvist A, Cox N. Psychosocial health in adolescent unmarried motherhood in rural Uganda: Implications for community-based collaborative mental health education, and empowerment strategies in the prevention of depression and suicide. Transcult Psychiatry 2023; 60:537-551. [PMID: 36628461 PMCID: PMC10486171 DOI: 10.1177/13634615221147361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Teenage pregnancy rates in Uganda are among the highest in sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and is recognised by Uganda's government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress, social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon among this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers' feelings of depression, whereas mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated a willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage and, in a context of poor mental health service access, there is a substantial role for community mobilisation and the promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach.
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Affiliation(s)
- Lucy Webb
- Faculty of Health & Education, Manchester Metropolitan University
| | | | | | - Anna Bergqvist
- Faculty of Health & Education, Manchester Metropolitan University
| | - Nigel Cox
- Faculty of Health & Education, Manchester Metropolitan University
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11
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De Cola MC, Ielo A, Lo Buono V, Quartarone A, Calabrò RS. Toward social-health integration in Sicily: description of the first hub and spoke model to improve the diagnostic therapeutic care paths for neurorehabilitation. Front Public Health 2023; 11:1141581. [PMID: 37261231 PMCID: PMC10229050 DOI: 10.3389/fpubh.2023.1141581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/13/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction The study describes a hub and spoke network for neuro-rehabilitation recently activated in Sicily, and evaluates the before-after changes yielded, in terms of integrated care. Methods A set of indicators based on data contained in the administrative database of inpatients of the Regional Health System are presented and discussed. Statistical analysis was conducted both globally and separately for the 9 Sicilian provinces (Agrigento, Caltanissetta, Catania, Enna, Messina, Palermo, Siracusa, Ragusa, and Trapani). Results Results showed an increase in admissions of people residing in the province where the Spokes have been opened: Trapani (+32.4%), Messina (+7.8%) and Palermo (+4.4%); besides a significant increase of patients from healthcare facilities proportion (p = 0.001) and from acute wards (p = 0.029). In addition, we found a decrease of discharge to protected healthcare facilities (p = 0.001) and to acute wards (p < 0.001), as well as an increase of discharges to home (p = 0.018). Discussion In conclusion, it would seem that the activation of this network has facilitated the management of these patients, avoiding unnecessary migrations to other provinces and/or regions, and improving the regional care service for neuro-rehabilitation. Future research will be direct to investigate this aspect, focusing on before-after variations in hospitalization rates and origin- destination patient flows.
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Agyapong B, Chishimba C, Wei Y, da Luz Dias R, Eboreime E, Msidi E, Abidi SSR, Mutaka-Loongo M, Mwansa J, Orji R, Zulu JM, Agyapong VIO. Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program. JMIR Res Protoc 2023; 12:e44370. [PMID: 36877571 PMCID: PMC10028515 DOI: 10.2196/44370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. OBJECTIVE The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. METHODS This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. RESULTS The Wellness4Teachers email program is expected to improve the participating teachers' mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program's launch. CONCLUSIONS The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program's impact on subscribers' mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44370.
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Affiliation(s)
- Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | - Rita Orji
- Faculty of Computer Sciences, Dalhousie University, Halifax, NS, Canada
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13
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Mindu T, Mutero IT, Ngcobo WB, Musesengwa R, Chimbari MJ. Digital Mental Health Interventions for Young People in Rural South Africa: Prospects and Challenges for Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1453. [PMID: 36674209 PMCID: PMC9859354 DOI: 10.3390/ijerph20021453] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Globally, most young people living with mental health conditions lack access to mental health care but have access to a mobile device. The growing access to mobile devices in South Africa has the potential to increase access to mental health care services through digital platforms. However, uptake of digital mental health interventions may be hampered by several factors, such as privacy, confidentiality, informed consent, and affordability. This study identified the prospects and challenges of implementing a mobile phone-based mental health intervention for young people in Ingwavuma area. Data were collected from 93 young people in three villages purposefully selected in Ingwavuma area. Participants included in the study were aged 16-24. Data were collected through a questionnaire. Thematic and descriptive analysis was performed on the qualitative and quantitative data, respectively. Mental health education was low, with only 22% of participants having received prior education on mental health. About 50% of the participants had come across a mental health app, but none of them had used any of these apps; 87% of participants had Internet access; 60% preferred to use social media to contact a health worker; and 92% suggested that use of digital apps would improve mental health literacy among young people. Barriers to access of digital mental health interventions were identified as the high cost of data, restrictive religious beliefs, limited privacy, lack of native languages on most digital platforms, low digital literacy, and complicated user interface. In uMkhanyakude, uptake of digital mental health apps among the young people was low. We recommend that, developers create context-specific digital applications catered for young people from different cultural backgrounds. Socio-economic issues such as affordability also need to be addressed in developing these tools.
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Affiliation(s)
- Tafadzwa Mindu
- Department of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Innocent Tinashe Mutero
- Department of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | | | | | - Moses John Chimbari
- Department of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Research and Innovation, Great Zimbabwe University, Masvingo P.O. Box 1235, Zimbabwe
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14
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Korhonen J, Axelin A, Stein DJ, Seedat S, Mwape L, Jansen R, Groen G, Grobler G, Jörns-Presentati A, Katajisto J, Lahti M. Mental health literacy among primary healthcare workers in South Africa and Zambia. Brain Behav 2022; 12:e2807. [PMID: 36326480 PMCID: PMC9759138 DOI: 10.1002/brb3.2807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders. METHODS The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. RESULTS Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. CONCLUSION The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.
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Affiliation(s)
- Joonas Korhonen
- Health and Well-being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lonia Mwape
- Levy Mwanawasa Medical University, School of Nursing and Midwifery Sciences, Lusaka, Zambia
| | - Ronelle Jansen
- School of Nursing, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
| | - Gunter Groen
- Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Gerhard Grobler
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Astrid Jörns-Presentati
- Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Lahti
- Health and Well-being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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- Health and Well-being, Turku University of Applied Science, Turku, Finland
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15
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Panneh M, Gafos M, Nyariki E, Liku J, Shah P, Wanjiru R, Wanjiru M, Beksinska A, Pollock J, Jama Z, Babu H, Kaul R, Seeley J, Bradley J, Kimani J, Beattie T. Mental health challenges and perceived risks among female sex Workers in Nairobi, Kenya. BMC Public Health 2022; 22:2158. [PMID: 36418973 PMCID: PMC9685887 DOI: 10.1186/s12889-022-14527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) in Kenya are at an increased risk of violence, poverty, police arrest, and problematic alcohol and other substance use, all of which are linked to poor mental health and suicidal ideation. Despite the psychological stressors experienced by FSWs, there is no published qualitative methods research investigating their mental health experiences in Kenya. In this paper, we draw on data from in-depth interviews to examine FSWs' lifetime mental health experiences and perceived risk factors. METHODS We used baseline in-depth interviews of the Maisha Fiti longitudinal study of FSWs in Nairobi. We randomly selected 40 FSWs from 1003 FSWs who attended a baseline behavioural-biological interview as part of the Maisha Fiti study. The interview guide was semi-structured, and participants were asked to detail their life stories, including narrating specific events such as entry into sex work, experiences of violence, mental health experiences, and use of alcohol and other substances. Interviews were recorded in Kiswahili/ English and transcribed in English. Data were coded and thematically analysed in Nvivo (v.12). RESULTS Results indicated that the majority of participants understood 'mental health' as 'insanity', 'stress', 'depression', and 'suicide'; nevertheless, a number described mental health symptomatically, while a few believed that mental health problems were caused by witchcraft. Interestingly, poverty, low levels of education, poor job opportunities, a lack of family support, harmful gender norms, intimate partner violence and subsequent relationship breakdowns, and family bereavement all contributed to poor mental health and subsequent entry into sex work. In addition, the consequences of sex work such as sexual risks, and ongoing violence from police and clients, further exacerbated poor mental health. CONCLUSIONS There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy.
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Affiliation(s)
- Mamtuti Panneh
- LSHTM, Department for Global Health and Development, London, UK.
| | - Mitzy Gafos
- LSHTM, Department for Global Health and Development, London, UK
| | - Emily Nyariki
- LSHTM, Department for Global Health and Development, London, UK
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Pooja Shah
- LSHTM, Department for Global Health and Development, London, UK
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | | | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- LSHTM, Department for Global Health and Development, London, UK
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Janet Seeley
- LSHTM, Department for Global Health and Development, London, UK
| | - John Bradley
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tara Beattie
- LSHTM, Department for Global Health and Development, London, UK
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16
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Palfreyman A, Gazeley U. Adolescent perinatal mental health in South Asia and Sub-Saharan Africa: A systematic review of qualitative and quantitative evidence. Soc Sci Med 2022; 313:115413. [PMID: 36215926 DOI: 10.1016/j.socscimed.2022.115413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023]
Abstract
Despite the contribution of mental ill-health to perinatal morbidity and mortality, the experiences of adolescent girls and young women (AGYW) in low- and middle-income countries remain overlooked. This review explores potential intersecting vulnerabilities for perinatal mental health to identify the prevalence, risk factors, interventions, and implications for health services and future research. We searched mixed-methods English-language studies in four databases (MEDLINE, PsycInfo, Global Health, Embase) published between January 1, 2000 and April 30, 2022 reporting age-disaggregated data on the prevalence, risk factors, and interventions for AGYW's mental health during pregnancy through one year postpartum (quantitative) and/or the mental health experiences of AGYW in the perinatal period (qualitative). Our search yielded 3205 results, of which 48 met the inclusion criteria. Both regions observe a paucity of robust evidence and intervention evaluations, particularly South Asia. While meta-analysis was infeasible due to study heterogeneity, quantitative studies do identify individual-level risk factors for perinatal depression. Qualitative studies emphasise stigma's impact, among other societal-level social risk factors, on diverse perinatal mental health outcomes of importance to AGYW themselves. Rigorous evaluations of interventions are lacking bar two protocols with forthcoming results. Evidence gaps persist concerning prevalence of outcomes beyond depression and implications of AGYW's perinatal experiences including pregnancy/perinatal loss and obstetric and postpartum complications. High-quality research, including comparable prevalence and multi-method evidence identifying risk and protective factors and promising interventions is urgently needed to improve adolescent wellbeing in the perinatal period. A key strength of this review is our assessment of available evidence for both regions. In doing so, we address a critical blind spot of prior reviews that focused either on adult perinatal mental health in low- and middle-income countries, or on AGYW perinatal mental health in high-income settings but neglected the intersection of these potential vulnerabilities for these high-burden, low-resource contexts.
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Affiliation(s)
- Alexis Palfreyman
- Institute for Global Health, University College London, London, WC1N 1EH, UK.
| | - Ursula Gazeley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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17
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Sodi T, Quarshie ENB, Oppong Asante K, Radzilani-Makatu M, Makgahlela M, Nkoana S, Mutambara J. Mental health literacy of school-going adolescents in sub-Saharan Africa: a regional systematic review protocol. BMJ Open 2022; 12:e063687. [PMID: 36127093 PMCID: PMC9490578 DOI: 10.1136/bmjopen-2022-063687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Assessing mental health literacy has implications for the identification and treatment of mental health problems. Adolescents have been identified as a particularly important target group for initiating and improving mental health literacy. However, much of what we know about adolescent mental health literacy comes from high-income countries. This proposed review seeks to synthesise the available published primary evidence from sub-Saharan Africa on the status and measurement of mental health literacy among school-going adolescents. METHODS AND ANALYSIS We will perform a systematic review reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020). We will systematically search selected global databases (EMBASE, PsycINFO, PubMed and MEDLINE) and regional electronic databases (African Index Medicus and African Journals OnLine) up to December 2021 for observational and qualitative studies published in English and French. The standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst criteria) will be used to appraise the methodological quality of the included studies. The Petticrew-Roberts 3-step approach to narrative synthesis will be applied to the included studies. ETHICS AND DISSEMINATION We will not seek ethical approval from an institutional review board, as this is a systematic review of available and accessible literature. When completed, the full report of this review will be submitted to a journal for peer-reviewed publication; the key findings will be presented at local and international conferences with-partial or full-focus on (adolescent) mental health (literacy). PROSPERO REGISTRATION NUMBER CRD42021229011.
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Affiliation(s)
- Tholene Sodi
- Psychology Department, University of Limpopo, Sovenga, South Africa
| | - Emmanuel Nii-Boye Quarshie
- Department of Psychology, College of Humanities, University of Ghana, Accra, Ghana
- School of Psychology, University of Leeds, Leeds, UK
| | - Kwaku Oppong Asante
- Department of Psychology, College of Humanities, University of Ghana, Accra, Ghana
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | | | | | - Shai Nkoana
- Psychology Department, University of Limpopo, Sovenga, South Africa
| | - Julia Mutambara
- Department of Psychiatry, Midlands State University, Gweru, Zimbabwe
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18
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Exploring mental health interventions for youth in Southern Africa: A rapid review. Acta Psychol (Amst) 2022; 229:103699. [PMID: 35952512 DOI: 10.1016/j.actpsy.2022.103699] [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: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
A significant mental health treatment gap prevails in Southern Africa. Whilst some treatments exist for adults and school children, treatment options for young adults, at a particularly vulnerable time of life, are scarce. Understanding success mechanisms of existing youth mental health interventions is vital for informed development and scaling of interventions to address this critical gap. This rapid review identifies 27 recent health interventions addressing common youth mental disorders in Southern Africa. Eight studies that quantitatively measured success found significant mental health improvements as an intervention result. Studies that identified success via non-statistical means also found, albeit self-reported, generally favourable outcomes. No single best-practice intervention was identified to replicate throughout the region. Our review instead highlights three important mechanisms for intervention success: including youth in intervention design and delivery; indirectly addressing mental health; and developing multi-modal interventions. We recommend collaborative, ecological approaches to youth mental health interventions in Southern Africa.
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Brooks MJ, Phetogo BK, Schwennesen H, Phoi O, Tshume O, Matshaba M, Lowenthal E. Building a Community Based Mental Health Program for Adolescents in Botswana: Stakeholder Feedback. Community Ment Health J 2022; 58:1068-1075. [PMID: 34826035 PMCID: PMC9172915 DOI: 10.1007/s10597-021-00915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND When planning interventions for adolescents, adult interventions should not be used 'as is' in youth settings. Stakeholder engagement can help understand the overall adolescent mental health ecosystem and adapt existing evidence-based interventions for the youth. OBJECTIVE To understand the overall mental health needs of adolescents in Botswana and the necessary adaptations required for an adolescent lay counselor based intervention in the country. METHODS We used the theory of change model and the nominal group technique in five stakeholder meetings. Meetings were held to discuss the mental health needs of youth in Botswana and identify priorities for a lay counsellor based intervention modelled after the Friendship Bench intervention, an existing mental health intervention for adults. RESULTS The root causes of mental health problems among Botswana's youth identified by stakeholders included limited mental health knowledge among the youth and the community, family problems, poor communication, low self-esteem, the rapid growth of technology, and biological/genetic predisposition. Structurally barriers included: mental illness-related stigma, lack of psychosocial support, incomplete follow up for health services, cultural beliefs about mental illness, and fragmented mental health services. The stakeholders envisage a program that could empower adolescents and youth counselors to address mental health concerns for a healthier community. The group identified and prioritized several key elements of an effective lay counselor intervention. CONCLUSIONS A diverse group of community stakeholders can illustrate critical mental health needs and elements that countries could use to adapt and contextualize a lay counsellor based mental health intervention for new populations such as the youth.
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Affiliation(s)
- Merrian J Brooks
- Botswana-UPenn Partnership, Gaborone, Botswana. .,Children's Hospital of Philadelphia, Buerger Center, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,University of Pennsylvania, Philadelphia, USA.
| | | | | | - Onkemetse Phoi
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.,Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Elizabeth Lowenthal
- Botswana-UPenn Partnership, Gaborone, Botswana.,Children's Hospital of Philadelphia, Buerger Center, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.,University of Pennsylvania, Philadelphia, USA
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20
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Vostanis P, Ruby F, Jacob J, Eruyar Ş, Mironga Getanda E, Haffejee S, Krishna M, Edbrooke-Childs J. Youth and professional perspectives of mental health resources across eight countries. CHILDREN AND YOUTH SERVICES REVIEW 2022; 136:106439. [PMID: 35521438 PMCID: PMC8972066 DOI: 10.1016/j.childyouth.2022.106439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/25/2022] [Accepted: 02/20/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. METHODS The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14-24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. RESULTS Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. CONCLUSION The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring.
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Affiliation(s)
- Panos Vostanis
- University of Leicester, School of Media, Communication and Sociology, University Road, Leicester, UK
| | - Florence Ruby
- Anna Freud Centre, Child Outcomes Research Consortium, 4-8 Rodney Street, London N1 9JH, UK
| | - Jenna Jacob
- Anna Freud Centre, Child Outcomes Research Consortium, 4-8 Rodney Street, London N1 9JH, UK
| | - Şeyda Eruyar
- Necmettin Erbakan University, Department of Psychology, Köyceğiz 42140 Meram, Konya, Turkey
| | | | - Sadiyya Haffejee
- University of Johannesburg, Auckland Park, Johannesburg 2092, South Africa
| | - Murali Krishna
- FRAMe Mysore, New Kanthraj Urs Road, Kuvempunagar, Mysore 570023, India
| | - Julian Edbrooke-Childs
- Anna Freud Centre, Child Outcomes Research Consortium, 4-8 Rodney Street, London N1 9JH, UK
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21
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Effectiveness of Mental Health Literacy Programs in Primary and Secondary Schools: A Systematic Review with Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040480. [PMID: 35455524 PMCID: PMC9026781 DOI: 10.3390/children9040480] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
In recent years, there has been an increase in studies evaluating the effectiveness of mental health literacy programs within the context of education as a universal, preventive intervention. A systematic review and meta-analysis regarding the effectiveness of mental health literacy interventions in schools, from 2013 to the present, on mental health knowledge, stigma, and help-seeking is conducted. Of the 795 identified references, 15 studies met the inclusion criteria. Mental health knowledge increased after the interventions (standardized mean difference: SMD = 0.61; 95% CI (0.05, 0.74)), at two months (SMD = 0.60; 95% CI (0.4, 1.07)) and six months (SMD = 0.39; 95% CI (0.27, 0.51)). No significant differences were observed between stigma and improving help-seeking. Mental health literacy interventions are effective in augmenting mental health knowledge, but not in reducing stigma or improving help-seeking behavior.
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22
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Jumbe S, Nyali J, Simbeye M, Zakeyu N, Motshewa G, Pulapa SR. ‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention. PLoS One 2022; 17:e0265530. [PMID: 35349575 PMCID: PMC8963557 DOI: 10.1371/journal.pone.0265530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/03/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose There is limited knowledge on how to tackle mental health problems among youth in Africa. Literature describing community engagement (CE) approaches in low/middle-income countries (LMICs) health research is sparse. CE with youth from LMICS can help steer and shape culturally relevant interventions for stigmatised topics like mental health, resulting in better healthcare experiences. We share our experience of engaging youth in Malawi through advocacy organisations to inform cultural adaptation of a mental health literacy intervention. Methods Young people were recruited using social media from universities and community youth organisations in Malawi to participate in focus group discussions to help culturally adapt content of an existing mental health literacy intervention. Nine online focus groups with 44 individuals were conducted. Discussions involved views and experiences of mental health, including impact of the coronavirus pandemic. Discussions were recorded, transcribed verbatim and analysed using content analysis. Results Transcript analyses revealed a vicious cycle of poverty and mental health problems for youth in Malawi. Four key themes were identified, 1) poverty-related socioeconomic and health challenges, 2) no one talks about mental health, 3) lacking mental health support and 4) relationship issues. These themes fed into one another within this vicious cycle which perpetually and negatively impacted their lives. The coronavirus pandemic worsened socioeconomic issues, health challenges, mental health and substance use issues, and burden on Malawi’s already weak mental health system. Conclusion Findings suggest increasing untreated mental health burden among Malawi’s youth. It highlights great need to address mental health literacy using existing community structures like educational settings to minimise burden on a weak health system. Online focus groups are an effective way of acquiring views from various young people in Malawi on mental health. This CE approach has grown our stakeholder network, strengthening potential for future CE activities and broader research dissemination.
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Affiliation(s)
- Sandra Jumbe
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Millennium University, Blantyre, Malawi
- * E-mail:
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23
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Obasi A, Seekles M, Boshe J, Dow D, Mmbaga B, Ngakongwa F, Okello E, Renju J, Shayo E, Simbee G, Todd J, Oriyo N. Adolescent mental health research in Tanzania: a study protocol for a priority setting exercise and the development of an interinstitutional capacity strengthening programme. BMJ Open 2022; 12:e054163. [PMID: 35110319 PMCID: PMC8811585 DOI: 10.1136/bmjopen-2021-054163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/06/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Poor adolescent mental health is a barrier to achieving several sustainable development goals in Tanzania, where adolescent mental health infrastructure is weak. This is compounded by a lack of community and policy maker awareness or understanding of its burden, causes and solutions. Research addressing these knowledge gaps is urgently needed. However, capacity for adolescent mental health research in Tanzania remains limited. The existence of a National Institute for Medical Research (NIMR), with a nationwide mandate for research conduct and oversight, presents an opportunity to catalyse activity in this neglected area. Rigorous research priority setting, which includes key stakeholders, can promote efficient use of limited resources and improve both quality and uptake of research by ensuring that it meets the needs of target populations and policy makers. We present a protocol for such a research priority setting study and how it informs the design of an interinstitutional adolescent mental health research capacity strengthening strategy in Tanzania. METHODS AND ANALYSIS From May 2021, this 6 month mixed-methods study will adapt and merge the James Lind Alliance approach and validated capacity strengthening methodologies to identify priorities for research and research capacity strengthening in adolescent mental health in Tanzania. Specifically, it will use online questionnaires, face-to-face interviews, focus groups, scoping reviews and a consensus meeting to consult expert and adolescent stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented and an integrated strategy to address capacity gaps will be designed to align with the nationwide infrastructure and overall strategy of NIMR. ETHICS AND DISSEMINATION National and institutional review board approvals were sought and granted from the National Health Research Ethics Committee of the NIMR Medical Research Coordinating Committee (Tanzania) and the Liverpool School of Tropical Medicine (United Kingdom). Results will be disseminated through a national workshop involving all stakeholders, through ongoing collaborations and published commentaries, reviews, policy briefs, webinars and social media.
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Affiliation(s)
- Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maaike Seekles
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Judith Boshe
- Psychiatry and Mental Health, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Dorothy Dow
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Blandina Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Kilimanjaro Clinicial Research Institute, Moshi, United Republic of Tanzania
| | - Fileuka Ngakongwa
- Department of Psychiatry and Mental Health, Muhimbuli National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Elialilia Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Research Centre, Mwanza, United Republic of Tanzania
| | - Jenny Renju
- The London School of Hygiene & Tropical Medicine, London, UK
- Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Elizabeth Shayo
- Department of Policy Analysis and Advocacy, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Gema Simbee
- Mirembe National Psychiatric Hospital, Dodoma, United Republic of Tanzania
| | - Jim Todd
- National Institute for Medical Research Mwanza Research Centre, Mwanza, United Republic of Tanzania
- Department of Population Health, London School of Health and Tropical Medicine, London, UK
| | - Ndekya Oriyo
- National Insititute for Medical Research, Dar es Salaam, United Republic of Tanzania
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Mutahi J, Larsen A, Cuijpers P, Peterson SS, Unutzer J, McKay M, John-Stewart G, Jewell T, Kinuthia J, Gohar F, Lai J, Wamalwa D, Gachuno O, Kumar M. Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review. EClinicalMedicine 2022; 44:101289. [PMID: 35198916 PMCID: PMC8851289 DOI: 10.1016/j.eclinm.2022.101289] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pregnant adolescent girls and young women (AGYW, aged 12-24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region. METHODS We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies. FINDINGS Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, N = 1 case report). The most frequently studied mental health problem was depression (N = 9 studies); the most frequently utilized measurement tool was the Edinburgh Postnatal Depression Scale (N = 3). Studies reported life course factors, individual, microsystem, exosystem, macrosystem, and chronosystem-level factors associated with mental health problems. Gaps in mental health service delivery for pregnant AGYW included lack of confidentiality, judgmental healthcare worker attitudes, and lack of services tailored to their unique needs. INTERPRETATION Gaps remain in research and services for mental health among pregnant AGYW in SSA. Integration of mental health services within school, community, and healthcare settings that are tailored to pregnant AGYW could strengthen health systems within SSA. FUNDING Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F31HD101149 to AL) and the Fogarty International Center (K43TW010716 to MK). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.
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Affiliation(s)
- Joan Mutahi
- Department of Psychiatry, College of Health Sciences, University of Nairobi, 00100 (19676), Nairobi, Kenya
| | - Anna Larsen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherland
| | | | - Jurgen Unutzer
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mary McKay
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Teresa Jewell
- University of Washington Libraries, Seattle, WA, United States
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Fatima Gohar
- United Nations Children's Fund (UNICEF), New York, NY, United States
| | - Joanna Lai
- United Nations Children's Fund (UNICEF), New York, NY, United States
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Onesmus Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, 00100 (19676), Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Kenya
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25
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Mabrouk A, Mbithi G, Chongwo E, Too E, Sarki A, Namuguzi M, Atukwatse J, Ssewanyana D, Abubakar A. Mental health interventions for adolescents in sub-Saharan Africa: A scoping review. Front Psychiatry 2022; 13:937723. [PMID: 36061286 PMCID: PMC9429610 DOI: 10.3389/fpsyt.2022.937723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Globally, adolescents are vulnerable to mental health problems, particularly those from sub-Saharan Africa (SSA) due to impoverished living conditions and a higher prevalence of chronic conditions such as HIV/AIDS in the region. The COVID-19 pandemic has further exacerbated this risk. This calls for an urgent need for evidence-based adolescent mental health interventions to reduce the risk and burden of mental health problems in SSA. The review aims to identify and characterize existing adolescent mental health interventions in SSA, as well as to evaluate their implementation strategies and effectiveness. METHODS We systematically searched PubMed, African Index Medicus, PsycINFO, Web of Science, and CINAHL databases for relevant articles. Furthermore, we searched gray literature databases, including Think Tank search, open gray, NGO search engine, and IGO search engine for additional relevant articles. The scoping review was conducted to identify original research articles on mental health interventions among adolescents in sub-Saharan Africa published from database inception to 31 December 2021. We carried out a narrative synthesis to report our findings. RESULTS Our literature search generated 4,750 studies, of which 1,141 were duplicates, 3,545 were excluded after screening, and 64 articles met the inclusion criteria. The 64 studies describe a total of 57 unique mental health interventions comprising 40,072 adolescents. The nature of these interventions was diverse, encompassing various implementation strategies such as economic-based, family strengthening, psychoeducation, interpersonal psychotherapy, Cognitive Behavioral Therapy, and resilience training, among others. Most of the interventions were selective interventions that targeted adolescents at high risk of developing mental health problems including adolescents living with HIV, war-affected adolescents, orphans, adolescents from poorer backgrounds, and survivors of sexual violence. Half of the interventions were delivered by lay persons. Sixty-two of the eligible studies examined the effectiveness of the mental health interventions, of which 55 of them reported a positive significant impact on various mental health outcomes. CONCLUSIONS The review findings show that there exist several diverse interventions that promote mental health among adolescents in sub-Saharan Africa. These interventions can be implemented in diverse settings including schools, communities, health facilities, and camps, and can be delivered by lay persons.
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Affiliation(s)
- Adam Mabrouk
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Gideon Mbithi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Esther Chongwo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Ezra Too
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Ahmed Sarki
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.,Family and Youth Health Initiative (FAYOHI), Dutse, Jigawa State, Nigeria
| | - Mary Namuguzi
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Joseph Atukwatse
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Derrick Ssewanyana
- Alliance for Human Development, Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.,Neurosciences Group, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
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26
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Mmanga C, Ndasauka Y, Kainja J, Kondowe F, Mchenga M, Maliwichi L, Nyamali S. The world is coming to an end! COVID-19, depression, and anxiety among adolescents in Malawi. Front Psychiatry 2022; 13:1024793. [PMID: 36684001 PMCID: PMC9849886 DOI: 10.3389/fpsyt.2022.1024793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION This paper assessed the effects of Covid-19 on adolescent mental health in Malawi. There is minimal research on adolescent mental health in Africa, Malawi in particular. The study shows a link between the pandemic and mental health. Some factors that may have contributed to this link include; Covid-19 preventive measures, media exposure and the increase in unemployment. METHODS The study used a mixed methods approach, quantitative and qualitative methods. It was conducted in Malawi's four districts (Blantyre, Mangochi, Lilongwe and Karonga). RESULTS Overall 22%, 21%, and 23% of the respondents had depression, anxiety and post-traumatic stress disorder, respectively. The Chi-square test showed that significantly more adolescents with secondary education (28%) had anxiety than those with primary education (14%). Further, regression analysis revealed that adolescents with anxiety were 18 [95%CI: 9.34, 35.8] times more likely to have depression compared to those who did not have anxiety. The study found no significant differences in the proportions of adolescents with the three outcomes when comparing different groups within the explanatory variable. The ratio of female and male adolescents with depression and anxiety was the same. DISCUSSION The adolescents expressed that Covid-19 affected their social, academic, and financial status. These effects had a significant bearing on their mental health in that they led to depression, anxiety, fear of the unknown, and stress. During the Covid-19 pandemic, adolescents' mental health diminished and posed a considerable risk to productivity of adolescents. As a result, adolescents may not fully realize their potential, form and maintain good relationships, contribute to their community and become resilient. These effects have devastating consequences for this young generation without proper coping strategies.
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Affiliation(s)
| | | | - Jimmy Kainja
- Department of Philosophy, University of Malawi, Zomba, Malawi
| | - Fiskani Kondowe
- Department of Philosophy, University of Malawi, Zomba, Malawi
| | - Martina Mchenga
- Department of Media and Communication Studies, University of Cape Town, Cape Town, South Africa
| | | | - Simunye Nyamali
- Department of Mathematical Sciences, University of East Anglia, Norwich, United Kingdom
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Korhonen J, Axelin A, Katajisto J, Lahti M. Construct validity and internal consistency of the revised Mental Health Literacy Scale in South African and Zambian contexts. Nurs Open 2021; 9:966-977. [PMID: 34822738 PMCID: PMC8859090 DOI: 10.1002/nop2.1132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/10/2021] [Accepted: 10/31/2021] [Indexed: 01/10/2023] Open
Abstract
AIM The aim of this study was to evaluate the construct validity and internal consistency of the revised Mental Health Literacy Scale (MHLS) in South Africa (SA) and Zambia. DESIGN This cross-sectional study was conducted between October 2018 and December 2019. METHODS The study population comprised PHC workers (n = 454) in five districts in SA and Zambia. Principal component analysis (PCA) was used to explore the construct validity, and Cronbach's alpha was applied to measure the internal consistency of the MHLS. RESULTS Cronbach's alpha values for three attributes were below the appropriate level, but the value was strong (0.804) for the whole scale. The study found nine components explaining ~59% of the total variance of variables. All MHLS items loaded to main attributes based on the theory of MHL. The results stated that the revised version of the MHLS is a construct valid instrument with strong internal consistency.
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Affiliation(s)
- Joonas Korhonen
- Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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Pinchoff J, Friesen EL, Kangwana B, Mbushi F, Muluve E, Ngo TD, Austrian K. How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya? J Adolesc Health 2021; 69:713-720. [PMID: 34531095 DOI: 10.1016/j.jadohealth.2021.07.023] [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: 04/08/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Adolescent mental health has been under-researched, particularly in Africa. COVID-19-related household economic stress and school closures will likely have adverse effects. We investigate the relationship among adolescent mental health, adult income loss, and household dynamics during the pandemic in Kenya. METHODS A cross-sectional mobile phone-based survey was conducted with one adult and adolescent (age 10-19 years) pair from a sample of households identified through previous cohort studies in three urban Kenyan counties (Nairobi, Kilifi, Kisumu). Survey questions covered education, physical and mental health, and COVID-19-related impacts on job loss, food insecurity, and healthcare seeking. Logistic regression models were fit to explore relationships among adult income loss, household dynamics, food insecurity, and adult and adolescent depressive symptoms (defined as PHQ-2 score ≤2). RESULTS A total of 2,224 adult-adolescent pairs (Nairobi, n = 814; Kilifi, n = 914; Kisumu, n = 496) completed the survey. Over a third (36%) of adolescents reported depressive symptoms, highest among older (15-19 years) boys. Adult loss of income was associated with skipping meals, depressive symptoms, household tensions/violence, and forgoing healthcare. Adolescents had 2.5 higher odds of depressive symptoms if COVID-19 was causing them to skip meals (odds ratio 2.5, 95% confidence interval 2.0-3.1), if their adult head of household reported depressive symptoms (odds ratio 2.6, 95% confidence interval 2.1-3.2). CONCLUSIONS Income loss during the pandemic adversely affects food insecurity, household dynamics, healthcare-seeking behavior, and worsening adolescent depressive symptoms. With schools reopening, adolescent mental health should be formally addressed, potentially through cash transfers, school or community-based psychosocial programming.
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Affiliation(s)
- Jessie Pinchoff
- Social and Behavioral Science Research Department, Population Council, New York, New York.
| | | | - Beth Kangwana
- Social and Behavioral Science Research Department, Population Council, Nairobi, Kenya
| | - Faith Mbushi
- Social and Behavioral Science Research Department, Population Council, Nairobi, Kenya
| | - Eva Muluve
- Social and Behavioral Science Research Department, Population Council, Nairobi, Kenya
| | - Thoai D Ngo
- Social and Behavioral Science Research Department, Population Council, New York, New York
| | - Karen Austrian
- Social and Behavioral Science Research Department, Population Council, Nairobi, Kenya
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Simelane SRN, de Vries PJ. Child and adolescent mental health services and systems in low and middle-income countries: from mapping to strengthening. Curr Opin Psychiatry 2021; 34:608-616. [PMID: 34419969 DOI: 10.1097/yco.0000000000000740] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Most of the world's children and adolescents live in low and middle-income countries (LMICs) where mental health services are very limited. Here, we reviewed literature over the last 18 months describing the current landscape of child and adolescent mental health services and systems (CAMHSS) in LMICs, and present findings from systems strengthening research. RECENT FINDINGS The challenges in CAMHSS are well described with little change over the last two decades. Fortunately, research has started to move from 'mapping' towards systems 'strengthening'. Using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) framework, we reviewed recent CAMHSS innovations. Clinical care and human resource innovations focused on primary care with validation of screening tools, training and task-sharing for capacity-building. Intersectoral collaboration emerged as a priority domain for strengthening, alongside a theme around the importance of participatory research to inform policy reforms. The potential role of digital technology to strengthen CAMHSS was identified as an emerging theme. SUMMARY There is an urgent need to increase the priority of CAMHSS in LMICs. This will require innovations at multiple levels aimed at all CAMHSS domains, with active participation of all relevant local stakeholders to ensure the translation of research into policy and practice.
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Affiliation(s)
- Simphiwe R N Simelane
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Laher S, Bain K, Bemath N, de Andrade V, Hassem T. Undergraduate psychology student experiences during COVID-19: challenges encountered and lessons learnt. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/0081246321995095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
National strategies to manage COVID-19, including lockdown, have caused significant disruption to student learning and to the ways that students engage with staff and peers. The transition to online learning, alongside common anxieties associated with the disease itself, was likely to have affected student mental health. This study explored psychology student mental health experiences during Lockdown Phase 3 at the University of the Witwatersrand. A convenience sample of 160 first- and second-year psychology students completed a questionnaire consisting of the General Mental Health Scale, the Hospital Anxiety and Depression Scale, the Burnout Measure, the Brief Coping Orientation to Problems Experienced, the Connor–Davidson Resilience Scale, and the Generalised Self Efficacy Scale. In addition, six open-ended questions asking students about their experiences and support during this time were included. Descriptive statistics were used to analyse quantitative data, whereas content and thematic analysis was used for the open-ended responses. Results indicated that students’ scores were not elevated on the mental health scales. However, the thematic analysis of responses revealed significant concerns with regard to psychological wellbeing, online learning, and home dynamics. These are discussed with a view to providing recommendations for supporting students in circumstances that may require emergency remote teaching.
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Affiliation(s)
- Sumaya Laher
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine Bain
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nabeelah Bemath
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor de Andrade
- Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tasneem Hassem
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
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Clarke E, Boshe J, Spencer-Rogers A, Jacques C, Walker R. Holes in the wall: Examining gaps in knowledge in child and adolescent mental health in Tanzania - Scoping review. Trop Med Int Health 2021; 26:258-271. [PMID: 33274527 DOI: 10.1111/tmi.13535] [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: 12/28/2022]
Abstract
OBJECTIVES To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. METHODS An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. RESULTS Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. CONCLUSION There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.
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Affiliation(s)
- Ellisiv Clarke
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Boshe
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | | | - Cara Jacques
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Walker
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare Foundation Trust, Newcastle, UK
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32
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Perry EW, Culbreth R, Swahn M, Kasirye R, Self-Brown S. Psychological Distress Among Orphaned Youth and Youth Reporting Sexual Exploitation in Kampala, Uganda. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105587. [PMID: 33363296 PMCID: PMC7755130 DOI: 10.1016/j.childyouth.2020.105587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Psychological distress is a priority health issue in low- and middle-income countries; however, it is inadequately addressed among vulnerable youth living in extremely underserved communities (i.e., on the streets and in the slums) who are at a high risk of experiencing adversity. The purpose of this study was to compute the prevalence of self-reported psychological distress among youth living in the slums of Kampala, Uganda, and examine how orphan status and commercial sexual exploitation (CSE) are related to youth psychological distress. Analyses are based on a 2014 cross-sectional survey of service-seeking youth (N = 1134) in Kampala, Uganda. Bivariate and multivariable multinomial regression analyses were used to determine associations between orphan status, sexual exploitation, and psychological distress (defined as experiencing the following proxy variables for more complex psychopathology: hopelessness and/or worry). Among all youth participants, 83.2% (n = 937) reported at least one type of psychological distress; 51.3% (n = 578) reported experiencing both types. The reported prevalence of any type of psychological distress was highest among youth who reported experiencing sexual exploitation (91.2%), double orphans (90.0%), and single orphans (83.8%); however, a high prevalence (76.7%) of any type of distress was also found among youth who reported both parents alive. Experiencing both types of distress was associated with being a double orphan (adjusted odds ratio [AOR] = 2.92, 95% confidence interval [CI] = [1.77, 4.81]), reporting CSE (AOR = 2.71, 95% CI = [1.67, 4.41]), and increased age (AOR = 1.31, 95% CI = [1.20, 1.44]). Psychological distress is prevalent among all youth living in the slums of Kampala and is independently associated with being a double orphan and experiencing CSE. These findings underscore the urgent need to intervene with all youth who reside in this particular underserved community, especially those who have lost both parents, and to prevent CSE among this vulnerable, underserved population.
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Affiliation(s)
| | - Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Monica Swahn
- School of Public Health, Georgia State University, Atlanta, GA, USA
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Kutcher S, Wei Y. School mental health: a necessary component of youth mental health policy and plans. World Psychiatry 2020; 19:174-175. [PMID: 32394554 PMCID: PMC7214948 DOI: 10.1002/wps.20732] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stanley Kutcher
- Department of Psychiatry, Dalhousie UniversityHalifaxNSCanada
| | - Yifeng Wei
- Department of Psychiatry, Dalhousie UniversityHalifaxNSCanada
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