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Ali R, Brown FL, Stevenson K, Jordans M, Taha K, Amine ME, Steen F, Meksassi B, Elias J, Aoun M, Roberts B, Sijbrandij M, Cuijpers P, Akhtar A, Malik A, Woodward A, Fuhr DC. Implementing a Non-Specialist Delivered Psychological Intervention for Young Adolescents in a Protracted Refugee Setting: a Qualitative Process Evaluation in Lebanon. J Behav Health Serv Res 2024; 51:377-394. [PMID: 38087061 PMCID: PMC11180626 DOI: 10.1007/s11414-023-09870-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
There has been an increase in the evaluation and implementation of non-specialist delivered psychological interventions to address unmet mental health needs in humanitarian emergencies. While randomized controlled trials (RCTs) provide important evidence about intervention impact, complementary qualitative process evaluations are essential to understand key implementation processes and inform future scaling up of the intervention. This study was conducted as part of an RCT of the Early Adolescents Skills for Emotions (EASE) psychological intervention for young adolescents with elevated psychological distress (predominantly with a Syrian refugee background) in Lebanon. Our aims were firstly to conduct a qualitative process evaluation to understand stakeholder experiences and perceived impact of the intervention and identify barriers and facilitators for implementation, and secondly to explore considerations for scaling up. Eleven key informant interviews and seven focus groups were conducted with 39 respondents including adolescent and caregiver participants, trainers, providers, outreach workers, and local stakeholders. Data were analyzed using inductive and deductive thematic analysis. Respondents perceived the intervention to be highly needed and reported improvements in adolescent mental health and wellbeing. Key implementation factors that have potential to influence engagement, adherence, and perceived impact included the socio-economic situation of families, mental health stigma, coordination within and between sectors (particularly for scaling up), embedding the intervention within existing service pathways, having clear quality and accountability processes including training and supervision for non-specialists, and sustainable funding. Our findings provide important context for understanding effectiveness outcomes of the RCT and highlights factors that need to be considered when implementing a mental health intervention on a larger scale in a complex crisis.
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Affiliation(s)
- Rayane Ali
- Research and Development Department, War Child, Amsterdam, The Netherlands
- War Child Lebanon, Beirut, Lebanon
| | - Felicity L Brown
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Kerrie Stevenson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Mark Jordans
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Karine Taha
- Research and Development Department, War Child, Amsterdam, The Netherlands
- War Child Lebanon, Beirut, Lebanon
| | - Mounif El Amine
- Research and Development Department, War Child, Amsterdam, The Netherlands
- War Child Lebanon, Beirut, Lebanon
| | - Frederik Steen
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Bassel Meksassi
- Research and Development Department, War Child, Amsterdam, The Netherlands
- War Child Lebanon, Beirut, Lebanon
| | - Joseph Elias
- Research and Development Department, War Child, Amsterdam, The Netherlands
- War Child Lebanon, Beirut, Lebanon
| | - May Aoun
- Research and Development Department, War Child, Amsterdam, The Netherlands
- War Child Lebanon, Beirut, Lebanon
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aniek Woodward
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Daniela C Fuhr
- Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany.
- Health Sciences, University of Bremen, Bremen, Germany.
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Brown FL, Steen F, Taha K, Koppenol-Gonzalez GV, Aoun M, Bryant R, Jordans MJD. Validation of Arabic versions of the child psychosocial distress screener and pediatric symptom checklist for young adolescents living in vulnerable communities in Lebanon. Int J Ment Health Syst 2024; 18:21. [PMID: 38812016 PMCID: PMC11137983 DOI: 10.1186/s13033-024-00640-y] [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: 07/10/2022] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In humanitarian settings, brief screening instruments for child psychological distress have potential to assist in assessing prevalence, monitoring outcomes, and identifying children and adolescents in most need of scarce resources, given few mental health professionals for diagnostic services. Yet, there are few validated screening tools available, particularly in Arabic. METHODS We translated and adapted the Child Psychosocial Distress Screener (CPDS) and the Pediatric Symptom Checklist (PSC) and conducted a validation study with 85 adolescents (aged 10-15) in Lebanon. We assessed internal consistency; test-retest reliability; convergent validity between adolescent- and caregiver-report and between the two measures; ability to distinguish between clinical and non-clinical samples; and concurrent validity against psychiatrist interview using the Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS The translated and adapted child-reported PSC-17 and PSC-35, and caregiver-reported PSC-35 all showed adequate internal consistency and test-retest reliability and high concurrent validity with psychiatrist interview and were able to distinguish between clinical and non-clinical samples. However, the caregiver-reported PSC-17 did not demonstrate adequate performance in this setting. Child-reported versions of the PSC outperformed caregiver-reported versions and the 35-item PSC scales showed stronger performance than 17-item scales. The CPDS showed adequate convergent validity with the PSC, ability to distinguish between clinical and non-clinical samples, and concurrent validity with psychiatrist interview. Internal consistency was low for the CPDS, likely due to the nature of the brief risk-screening tool. There were discrepancies between caregiver and child-reports, worthy of future investigation. For indication of any diagnosis requiring treatment, we recommend cut-offs of 5 for CPDS, 12 for child-reported PSC-17, 21 for child-reported PSC-35, and 26 for caregiver-reported PSC-35. CONCLUSIONS The Arabic PSC and CPDS are reliable and valid instruments for use as primary screening tools in Lebanon. Further research is needed to understand discrepancies between adolescent and caregiver reports, and optimal methods of using multiple informants.
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Affiliation(s)
- Felicity L Brown
- Research and Development Department, War Child Alliance, Helmholtzstraat 61G, Amsterdam, The Netherlands.
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam , 1098LE, The Netherlands.
| | - Frederik Steen
- Research and Development Department, War Child Alliance, Helmholtzstraat 61G, Amsterdam, The Netherlands
| | | | | | - May Aoun
- War Child Alliance Lebanon, Beirut, Lebanon
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Mark J D Jordans
- Research and Development Department, War Child Alliance, Helmholtzstraat 61G, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam , 1098LE, The Netherlands
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3
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Musanje K, Kasujja R, Camlin CS, Hooper N, Hope-Bell J, Sinclair DL, Kibanja GM, Mpirirwe R, Kalyango JN, Kamya MR. Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial. PLoS One 2024; 19:e0301988. [PMID: 38722926 PMCID: PMC11081388 DOI: 10.1371/journal.pone.0301988] [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: 08/19/2023] [Accepted: 03/20/2024] [Indexed: 05/13/2024] Open
Abstract
Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- School of Psychology, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- School of Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, United States of America
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, United Kingdom
| | - Josh Hope-Bell
- School of Medicine, Cardiff University, Wales, United Kingdom
| | | | | | - Ruth Mpirirwe
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Joan N. Kalyango
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala, Uganda
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Leresche E, Hossain M, De Rubeis ML, Hermans V, Burtscher D, Rossi R, Lonsdale C, Singh NS. How is the implementation of empirical research results documented in conflict-affected settings? Findings from a scoping review of peer-reviewed literature. Confl Health 2023; 17:39. [PMID: 37605198 PMCID: PMC10464477 DOI: 10.1186/s13031-023-00534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Implementation science scholars argue that knowing 'what works' in public health is insufficient to change practices, without understanding 'how', 'where' and 'why' something works. In the peer reviewed literature on conflict-affected settings, challenges to produce research, make decisions informed by evidence, or deliver services are documented, but what about the understanding of 'how', 'where' and 'why' changes occur? We explored these questions through a scoping review of peer-reviewed literature based on core dimensions of the Extended Normalization Process Theory. We selected papers that provided data on how something might work (who is involved and how?), where (in what organizational arrangements or contexts?) and why (what was done?). We searched the Global Health, Medline, Embase databases. We screened 2054 abstracts and 128 full texts. We included 22 papers (of which 15 related to mental health interventions) and analysed them thematically. We had the results revised critically by co-authors experienced in operational research in conflict-affected settings. Using an implementation science lens, we found that: (a) implementing actors are often engaged after research is produced to discuss feasibility; (b) new interventions or delivery modalities need to be flexible; (c) disruptions affect how research findings can lead to sustained practices; (d) strong leadership and stable resources are crucial for frontline actors; (e) creating a safe learning space to discuss challenges is difficult; (f) feasibility in such settings needs to be balanced. Lastly, communities and frontline actors need to be engaged as early as possible in the research process. We used our findings to adapt the Extended Normalization Process Theory for operational research in settings affected by conflicts. Other theories used by researchers to document the implementation processes need to be studied further.
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Affiliation(s)
- Enrica Leresche
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mazeda Hossain
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Global Health, Nottingham Trent University, Nottingham, UK
| | | | - Veerle Hermans
- LuxOR, Médecins Sans Frontières Operational Centre Brussels, Luxembourg, Luxembourg
| | - Doris Burtscher
- Médecins Sans Frontières Vienna Evaluation Unit, Vienna, Austria
| | - Rodolfo Rossi
- Centre for Operational Research and Experience (CORE), International Committee of the Red Cross, Geneva, Switzerland
| | - Cordelia Lonsdale
- Elrha's Research for Health in Humanitarian Crises Programme, Cardiff, UK
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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5
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Brown FL, Taha K, Steen F, Kane J, Gillman A, Aoun M, Malik A, Bryant R, Sijbrandij M, El Chammay R, Servili C, van Ommeren M, Akhtar A, Zoghbi E, Jordans MJD. Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon. BMC Psychiatry 2023; 23:131. [PMID: 36858980 PMCID: PMC9979451 DOI: 10.1186/s12888-023-04571-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Globally, there is a vast mental health treatment gap, whereby the majority of adolescents living in low- and middle-income countries requiring mental health services, do not have access to adequate care. To improve access, the World Health Organization (WHO) developed a range of interventions, designed to be low-cost and delivered by non-specialists. We conducted a two-arm, individually randomised group treatment feasibility trial of a new WHO group intervention for young adolescents with emotional distress ('Early Adolescent Skills for Emotions'; EASE) in Lebanon. METHOD The aim of this study was to determine the feasibility of the intervention and study procedures. Adolescents aged 10 to 14 years were eligible to take part if they scored above a validated cut-off on the Child Psychosocial Distress Screener. Participants were randomized to EASE or enhanced treatment as usual (ETAU) control using a 1:1 ratio. EASE consisted of seven group sessions with adolescents and three sessions with caregivers. ETAU consisted of a single brief psychoeducation home visit. Child and caregiver outcomes were measured by blind assessors at baseline, endline (8 weeks post-randomisation), and three month follow-up (20 weeks post-randomisation), with the primary outcome measure being child psychological symptoms on the Pediatric Symptom Checklist. Qualitative interviews were conducted with adolescents (n = 13), caregivers (n = 17), facilitators (n = 6), trainers (n = 3), and outreach staff (n = 1) at endline to assess barriers and facilitators related to the feasibility and delivery of EASE and study procedures. RESULTS Of 154 adolescents screened, 67 (43%) were eligible, completed baseline, and were randomized. Sixty adolescents (90%) completed endline assessments (31 EASE, 29 ETAU), and fifty-nine (88%) completed three-month assessments (29 EASE, 30 ETAU). Qualitatively, participants provided overall positive feedback about the intervention. Several challenges and suggestions for improvement were raised around logistics, intervention content, and acceptability of assessment measures. Implementation data highlighted challenges with intervention uptake and attendance. Outcome measures generally had strong psychometric properties (range: α = 0.77 to α = 87), however did not demonstrate change over time in either group. CONCLUSIONS The EASE intervention and study procedures are acceptable and feasible for implementation with vulnerable adolescents in Lebanon, however several improvements are necessary prior to full-scale evaluation. TRIAL REGISTRATION #ISRCTN60799626, retrospectively registered on 04/10/2022.
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Affiliation(s)
- Felicity L Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands. .,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Karine Taha
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,War Child Lebanon, Beirut, Lebanon
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Jeremy Kane
- Mailman School of Public Health, Columbia University, New York, USA
| | | | - May Aoun
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,War Child Lebanon, Beirut, Lebanon
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Rabih El Chammay
- Ministry of Public Health, Beirut, Lebanon.,Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Mark J D Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands. .,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
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6
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Rose AL, Jack HE, Wan C, Toloza E, Bhattiprolu K, Ragunathan M, Schwartz KT, Magidson JF. Implementing Task-Shared Child and Adolescent Psychological Interventions in Low- and Middle-Income Countries: A Scoping Review. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-16. [PMID: 36507739 PMCID: PMC10258230 DOI: 10.1080/15374416.2022.2151450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Effective "task shared," or nonspecialist delivered, psychological interventions for children and adolescents have been developed or adapted in low- and middle-income countries with the aim of closing the global treatment gap for youth mental health care. Yet, delivery remains limited, in part due to the lack of knowledge of associated implementation, or process, outcomes. This scoping review aims to describe, examine the quality of, and synthesize findings on implementation outcomes of child and adolescent psychological interventions in low-and middle-income countries. METHODS PubMed, Web of Science, and PsycInfo were searched for studies on child and adolescent psychological interventions in low- and middle-income countries reporting on implementation outcomes. After abstract and full-text review, data were extracted and summarized on implementation outcomes and quality of implementation outcomes reporting. Implementation barriers and recommendations for addressing barriers were also charted and narratively synthesized. RESULTS Out of 5,207 manuscripts, 86 met inclusion criteria. Younger children were underrepresented. Studies largely reported feasibility and acceptability and did not state hypotheses or use conceptual models. Barriers primarily related to interventions being too complex, not an acceptable fit with participant cultures, and facilitators lacking time for or experiencing distress delivering interventions. Recommendations focused on increasing intervention fit and flexibility, training and support for facilitators, and linkages with existing systems. CONCLUSIONS Rigorous, broader implementation outcomes research is needed within child and adolescent psychological intervention research in low-and middle-income countries. Current evidence suggests the importance of the further developing strategies to increase acceptability to participants and better support facilitators.
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Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E. Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christine Wan
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Emilia Toloza
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kavya Bhattiprolu
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Meera Ragunathan
- Department of Psychology, University of Maryland, College Park, MD, USA
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7
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Mediavilla R, McGreevy KR, Felez-Nobrega M, Monistrol-Mula A, Bravo-Ortiz MF, Bayón C, Rodríguez-Vega B, Nicaise P, Delaire A, Sijbrandij M, Witteveen AB, Purgato M, Barbui C, Tedeschi F, Melchior M, van der Waerden J, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Haro JM, Ayuso-Mateos JL. Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial. Digit Health 2022; 8:20552076221129084. [PMID: 36211795 PMCID: PMC9537484 DOI: 10.1177/20552076221129084] [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: 01/17/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers' mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms. Methods We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire - Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness. Conclusions This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies. Registration details ClinicalTrials.gov Identifier: NCT04980326.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain
| | - Kerry R McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Kerry R. McGreevy, Department of
Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo, 4, 28029,
Madrid, Spain.
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - Anna Monistrol-Mula
- Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Clinical Psychology and Mental Health,
Hospital Univeristario La Paz, Madrid, Spain,Instituto de Investigación del Hospital
Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Pablo Nicaise
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Audrey Delaire
- Institute of Health & Society (IRSS), Université Catholique de
Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Anke B. Witteveen
- Clinical, Neuro- and Developmental Psychology, WHO Collaborating
Centre for Research and Dissemination of Psychological Interventions, Amsterdam
Public Health Institute, Vrije Universiteit
Amsterdam, Amsterdam, the Netherlands
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health
and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement
Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé
Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Faculté de
Médecine St Antoine, , Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political
Science, London, UK
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research
(LIR), Mainz, Germany,Neuroimaging Center (NIC), Focus Program Translational Neuroscience
(FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New
South Wales, Sydney, NSW, Australia
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Research and Development Unit, Parc Sanitari Sant Joan de
Déu, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid
(UAM), Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM),
Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, La Princesa University
Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa),
Madrid, Spain
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Michelson D, Hodgson E, Bernstein A, Chorpita BF, Patel V. Problem Solving as an Active Ingredient in Indicated Prevention and Treatment of Youth Depression and Anxiety: An Integrative Review. J Adolesc Health 2022; 71:390-405. [PMID: 35803863 DOI: 10.1016/j.jadohealth.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
Problem solving is a common focus of psychological interventions for young people. However, existing evidence syntheses are relatively limited in their scope and conclusions. Taking a transdiagnostic approach and incorporating diverse sources of evidence, we examined the role of problem solving as an active ingredient for the indicated prevention and treatment of depression and anxiety in 14-24-year-olds. Three information sources were integrated using framework synthesis: (1) a systematic review of randomized controlled trials of problem solving; (2) a metasynthesis of qualitative evidence on the therapeutic experience of problem solving; and (3) consultations with a Youth Advisory Group. Intervention protocols that included problem solving and no more than one other specific component appeared to be effective for depression but not anxiety. Larger multicomponent interventions with a problem-solving element achieved moderate effect sizes for both conditions. There was no clear evidence that effectiveness varied by population characteristics, intervention formats, or contextual factors. Qualitative evidence and youth consultations highlighted positive views about the practicality, simplicity, and flexibility of problem solving. Converging sources also suggested changes in problem orientation as a key transdiagnostic process contributing to positive outcomes. Problem solving is a widely applicable therapeutic approach that can help young people with emotional problems to resolve specific stressors and lead to a more hopeful mindset about managing future challenges. Implications for practice are discussed.
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Affiliation(s)
- Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom.
| | - Eleanor Hodgson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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9
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Bryant RA, Malik A, Aqel IS, Ghatasheh M, Habashneh R, Dawson KS, Watts S, Jordans MJD, Brown FL, van Ommeren M, Akhtar A. Effectiveness of a brief group behavioural intervention on psychological distress in young adolescent Syrian refugees: A randomised controlled trial. PLoS Med 2022; 19:e1004046. [PMID: 35960704 PMCID: PMC9374250 DOI: 10.1371/journal.pmed.1004046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Millions of young adolescents in low- and middle-income countries (LMICs) affected by humanitarian crises experience elevated rates of poor mental health. There is a need for scalable programs that can improve the mental health of young adolescents. This study evaluated the effectiveness of a nonspecialist delivered group-based intervention (Early Adolescent Skills for Emotions (EASE)) to improve young adolescents' mental health. METHODS AND FINDINGS In this single-blind, parallel, controlled trial, Syrian refugees aged 10 to 14 years in Jordan were identified through screening of psychological distress as defined by scores ≥15 on the Paediatric Symptom Scale. Participants were randomised to either EASE or enhanced usual care (EUC) involving referral to local psychosocial services (on a 1:1.6 ratio). Participants were aware of treatment allocation but assessors were blinded. Primary outcomes were scores on the Paediatric Symptom Checklist (PSC; internalising, externalising, and attentional difficulty scales) assessed at week 0, 9 weeks, and 3 months after treatment (primary outcome time point). It was hypothesised that EASE would result in greater reductions on internalising symptoms than EUC. Secondary outcomes were depression, posttraumatic stress, well-being, functioning, school belongingness, and caregivers' parenting and mental health. Between June 2019 and January 2020, 1,842 young adolescent refugees were screened for eligibility on the basis of psychological distress. There were 520 adolescents (28.2%) who screened positive, of whom 471 (90.6%) agreed to enter the trial. Overall, 185 were assigned to EASE and 286 to EUC, and 169 and 254 were retained at 3 months for EASE and EUC, respectively. Intent-to-treat analyses indicated that at 3 months, EASE resulted in greater reduction on the PSC-internalising scale than EUC (estimated mean difference 0.69, 95% CI 0.19 to 1.19; p = 0.007; effect size, 0.38) but there were no differences for PSC-externalising (estimated mean difference 0.24, 95% CI -0.43 to 0.91; p = 0.49; effect size, -0.10), PSC-attentional problem (estimated mean difference -0.01, 95% CI -0.51 to 0.54; p = 0.97; effect size, -0.01) scores, or on depression, posttraumatic stress, well-being, functioning, or school belongingness. Relative to EUC, caregivers in EASE had less psychological distress (estimated mean difference 1.95, 95% CI 0.71 to 3.19; p = 0.002) and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < 0.001). Secondary analyses that (a) focused on adolescents with probable internalising disorders; (b) completed the 3-month assessment; and (c) controlled for trauma exposure did not alter the primary results. Mediation analysis indicated that for caregivers in the EASE condition, reduction in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) and internalising (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) problems in their children. No adverse events were attributable to the intervention. A limitation was that EUC was not matched to EASE in terms of facilitator attention or group involvement. CONCLUSIONS EASE led to reduced internalising problems in young refugee adolescents and was associated with reduced distress and less inconsistent disciplinary parenting in caregivers. This intervention has the potential as a scalable intervention to mitigate young adolescents' emotional difficulties in LMIC. TRIAL REGISTRATION Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619000341123.
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Affiliation(s)
- Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, Australia
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | | | - Maha Ghatasheh
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | - Rand Habashneh
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | - Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sarah Watts
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark J. D. Jordans
- Research and Development Department, War Child Holland, Amsterdam, the Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Felicity L. Brown
- Research and Development Department, War Child Holland, Amsterdam, the Netherlands
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
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10
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Mediavilla R, Monistrol-Mula A, McGreevy KR, Felez-Nobrega M, Delaire A, Nicaise P, Palomo-Conti S, Bayón C, Bravo-Ortiz MF, Rodríguez-Vega B, Witteveen A, Sijbrandij M, Turrini G, Purgato M, Vuillermoz C, Melchior M, Petri-Romão P, Stoffers-Winterling J, Bryant RA, McDaid D, Park AL, Ayuso-Mateos JL. Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis. Front Public Health 2022; 10:956403. [PMID: 35968478 PMCID: PMC9363705 DOI: 10.3389/fpubh.2022.956403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs. Materials and methods Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their determinants and consequences, as well as the strategies considered useful to overcome these problems. We used a thematic analysis approach to analyze the interview outputs and framed our results into a five-level social-ecological model (intrapersonal, interpersonal, organizational, community, and public health). Results We recruited 75 FL and 22 KI interviewees, roughly balanced in age and gender. We detected 56 themes during the FL interviews and explored the following themes in the KI interviews: fear of infection, psychological distress, stress, moral distress, and interpersonal conflicts among coworkers. We found that interviewees reported perceived causes and consequences across problems at all levels (intrapersonal to public health). Although several mental health strategies were implemented (especially at an intrapersonal and interpersonal level), most mental health needs remained unmet, especially at the organizational, community, and public policy levels. Conclusions In keeping with available quantitative evidence, our findings show that mental health problems are still relevant for frontline HCWs 1 year after the COVID-19 pandemic and that many reported causes of these problems are modifiable. Based on this, we offer specific recommendations to design and implement mental health strategies and recommend using transdiagnostic, low-intensity, scalable psychological interventions contextually adapted and tailored for HCWs.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Anna Monistrol-Mula
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Kerry R. McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Audrey Delaire
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | | | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - Anke Witteveen
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Giulia Turrini
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Cécile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Research Team on Social Epidemiology, Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Research Team on Social Epidemiology, Paris, France
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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11
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Jannesari S, Lotito C, Turrini G, Oram S, Barbui C. How does context influence the delivery of mental health interventions for asylum seekers and refugees in low- and middle-income countries? A qualitative systematic review. Int J Ment Health Syst 2021; 15:80. [PMID: 34702334 PMCID: PMC8546788 DOI: 10.1186/s13033-021-00501-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) host the majority of the world’s refugees. Evidence suggests that refugees and asylum seekers have high mental health needs compared to the host country population. However, they face many social, economic and culture barriers to receiving mental health care and benefitting from mental health interventions. This paper examines how these contextual factors affect the implementation of mental health interventions for refugees and asylum seekers in LMICs. Methods We conducted a qualitative systematic review searching 11 databases and 24 relevant government and non-governmental organisation (NGO) websites. We spoke with academic experts and NGO professionals for recommendations, and conducted forwards and backwards citation tracking. Results From 2055 records in abstract and title screening, and then 99 in full-text screening, 18 eligible studies were identified. Qualitative thematic synthesis was conducted on eligible papers. Three main thematic clusters were identified around: (1) support during a time of pressure and insecurity, and the need for intervention flexibility through facilitator and participant autonomy; (2) different cultural conceptions of mental health, and how interventions negotiated these differences; and (3) the importance of facilitator skills, knowledge, characteristics and relationships to intervention implementation. Conclusion Evidence suggests that intervention coordinators and developers should continue to: (1) think broadly about the range of social influences on mental health, addressing structural issues where possible; (2) offer flexibility with intervention style, content and timings; and (3) encourage building research capacity in LMICs while acknowledging pre-existing mental health knowledge and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-021-00501-y.
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Affiliation(s)
- Sohail Jannesari
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King's College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Claudia Lotito
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Siân Oram
- Institute of Psychiatry, Psychology and Neuroscience, Department of Health Services and Population Research, King's College London, David Goldberg Building, Kings College London, De Crespigny Park, London, SE5 8AF, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
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12
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Farran N. Mental health in Lebanon: Tomorrow's silent epidemic. MENTAL HEALTH & PREVENTION 2021; 24:200218. [PMID: 34660191 PMCID: PMC8503814 DOI: 10.1016/j.mhp.2021.200218] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/05/2021] [Indexed: 12/14/2022]
Abstract
Lebanon is a middle-income country that has been recently crippled by several tragedies including the economic collapse, COVID-19, and the fourth of August Beirut port explosion, the world’s most powerful non-nuclear explosion of the twenty-first century. Recent data on mental health from Lebanon is summarised, and other topics such as the psychological impact of cumulative adversities and the role of international support in Lebanon are examined. Data from Lebanon shows severe levels of distress among the people, in a country with minimal resources. Given current adversities in Lebanon, recent data in the country, and the literature on adversity and mental health outcomes of man-made disasters, Lebanon is most likely going to face an epidemic in poor mental health. A call is made for the wider scientific community and international organizations to support the mental health field in the country and help prevent further negative mental health outcomes. Understanding how to better navigate mental health in places with extreme adversity and emergencies can be beneficial to other communities which might face similar challenges.
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Affiliation(s)
- Natali Farran
- Institute of Psychiatry, Psychology, and Neuroscience. King's College London, 16 De Crespigny Park, Camberwell, London SE5 8AB, UK
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13
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Perera C, Salamanca-Sanabria A, Caballero-Bernal J, Feldman L, Hansen M, Bird M, Hansen P, Dinesen C, Wiedemann N, Vallières F. No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings. Confl Health 2020; 14:46. [PMID: 32684948 PMCID: PMC7362525 DOI: 10.1186/s13031-020-00290-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/30/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. METHODS The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. RESULTS The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols. CONCLUSION The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.
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Affiliation(s)
- Camila Perera
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | | | | | - Lya Feldman
- Department of Behavioural Science and Technology, Simon Bolivar University, Caracas, Venezuela
| | - Maj Hansen
- ThRIVE, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Martha Bird
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Pernille Hansen
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Cecilie Dinesen
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Nana Wiedemann
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
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14
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Roupetz S, Bartels SA, Michael S, Najjarnejad N, Anderson K, Davison C. Displacement and Emotional Well-Being among Married and Unmarried Syrian Adolescent Girls in Lebanon: An Analysis of Narratives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124543. [PMID: 32599758 PMCID: PMC7345669 DOI: 10.3390/ijerph17124543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/20/2022]
Abstract
Lebanon hosts over one million refugees displaced from Syria as a result of the armed conflict—of whom, approximately 15% are adolescents aged between 12 and 17 years of age. Many female adolescent migrants report a decrease in quality of life and an increase in family tensions. This study sought to investigate the emotional well-being of adolescent Syrian girls in Lebanon. We hypothesized that married girls may experience additional hardships and thus greater feelings of dissatisfaction in daily life, given their young marriage and responsibilities at home. This study was part of a large mixed-methods study on the experiences of Syrian refugee girls in Lebanon (n = 1422). Using line-by-line coding and thematic analysis, 188 first-person narratives from Syrian girls were analysed. Our results highlight poor emotional well-being among married and unmarried girls, with sadness, fear and anger commonly mentioned. Some participants expressed feelings of hope, happiness, gratefulness and empowerment. Unmarried girls (n = 111) were more likely to associate their shared stories with negative feelings such as sadness (47% vs. 22%), disappointment (30% vs. 19%), and frustration (32% vs. 22%) than were married girls (n = 77). Four themes emerged as important determinants: access to education, perceived safety, peer support, and longing for life back in Syria. Continued efforts to improve emotional well-being for married and unmarried refugee girls are needed in Lebanon, in particular those that address the nuances for these groups.
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Affiliation(s)
- Sophie Roupetz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany; (S.R.); (K.A.)
| | - Susan A. Bartels
- Department of Emergency Medicine, Queen’s University, Kingston, ON K7L 4V7, Canada;
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Saja Michael
- ABAAD Resource Center for Gender Equality, Beirut, Lebanon; (S.M.); (N.N.)
| | - Negin Najjarnejad
- ABAAD Resource Center for Gender Equality, Beirut, Lebanon; (S.M.); (N.N.)
- Department of Social Sciences, York University, Toronto, ON M3J 1P3, Canada
| | - Kimberley Anderson
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany; (S.R.); (K.A.)
| | - Colleen Davison
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Department of Global Development Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
- Correspondence: ; Tel.: +1-613-533-6000 (ext. 79518)
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