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Deo AJ, Castro VM, Baker A, Carroll D, Gonzalez-Heydrich J, Henderson DC, Holt DJ, Hook K, Karmacharya R, Roffman JL, Madsen EM, Song E, Adams WG, Camacho L, Gasman S, Gibbs JS, Fortgang RG, Kennedy CJ, Lozinski G, Perez DC, Wilson M, Reis BY, Smoller JW. Validation of an ICD-code-based case definition for psychotic illness across three health systems. medRxiv 2024:2024.02.28.24303443. [PMID: 38464074 PMCID: PMC10925367 DOI: 10.1101/2024.02.28.24303443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background and Hypothesis Early detection of psychosis is critical for improving outcomes. Algorithms to predict or detect psychosis using electronic health record (EHR) data depend on the validity of the case definitions used, typically based on diagnostic codes. Data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis. Study Design Using EHRs at three health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into five higher-order groups. 1,133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings. Study Results PPVs across all diagnostic groups and hospital systems exceeded 70%: Massachusetts General Brigham 0.72 [95% CI 0.68-0.77], Boston Children's Hospital 0.80 [0.75-0.84], and Boston Medical Center 0.83 [0.79-0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80-0.92) and major depressive disorder with psychosis were the most variable (0.57-0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08-0.62). Conclusions We found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the development of risk prediction models designed to predict or detect undiagnosed psychosis.
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Sharma M, Backman A, Vesga-Lopez O, Zayas L, Harris B, Henderson DC, Koenen KC, Williams DR, Borba CPC. Trauma, risk, and resilience: A qualitative study of mental health in post-conflict Liberia. Transcult Psychiatry 2023:13634615231191992. [PMID: 37731360 DOI: 10.1177/13634615231191992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
The Liberian civil wars led to widespread destruction and devastation for its individuals, communities, and economy. However, individuals' subjective trauma experiences and long-term psychological impact remain relatively understudied. This study aims to explore context-specific traumatic events and examine how risk and protective factors combine with traumas to influence trajectories of suffering and recovery over time. We conducted 43 semi-structured interviews with Liberian adults who were present during the Liberian civil wars, and we used line-by-line open coding, thematic analysis, and axial coding to analyze and contextualize the data. Eight key trauma themes emerged: Abuse (emotional, physical, and sexual), Captivity, Combat, Killings, Physical Illness, Resource Loss, Family Separation, and War Environment. The risk and protective factors that were reported as salient were: Age, Biological Sex, Socioeconomic Status, and Community Support. Further, key patterns emerged across interviews that indicated greater risk for long-term suffering: 1) exposure to multiple traumatic events, 2) certain types of traumatic events (like killing of a close family member), and 3) the combination of specific traumatic events and risk and protective factors (like older women witnessing the killing of their children). This study provides culturally relevant information on trauma, suffering, and resilience in post-conflict Liberia, with the aim of guiding the development of screening tools and targeted psychological interventions that improve well-being over time.
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Affiliation(s)
- Manasi Sharma
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Lazaro Zayas
- Massachusettes General Hospital, Boston, MA, USA
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3
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Ghebrehiwet S, Ogundare T, Owusu M, Harris BL, Ojediran B, Touma M, Durham MP, Hook K, Borba CPC, Henderson DC. Building a postgraduate psychiatry training program in Liberia through cross-country collaborations: initiation stages, challenges, and opportunities. Front Public Health 2023; 11:1020723. [PMID: 37727607 PMCID: PMC10505824 DOI: 10.3389/fpubh.2023.1020723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Background About 80% of the nearly 2 billion people experiencing psychiatric conditions worldwide do not have access to quality, affordable mental health care. In Africa, there are 0.004 psychiatrists per 10,000 people, with the shortage exacerbated by a limited number of postgraduate psychiatry training opportunities. As of 2018, there were only two psychiatrists in Liberia. Methods This paper aims to offer a framework for developing postgraduate (i.e., residency) psychiatry training in resource-constrained settings to disseminate best practices and lessons learned. This article describes the approach to developing the formal global academic partnership that supported the initiation of Liberia's first postgraduate psychiatry training program in July 2019. Results Authors describe strengths, challenges, and opportunities for improvement in the planning and initiation stages of the postgraduate program. Key strengths of the program planning process include: (1) collaboration with a coalition of local and national stakeholders committed to improving mental health care in Liberia; (2) early procurement of quality video conferencing equipment and internet service to facilitate remote learning and broaden access to digital materials; and (3) leveraging of intra-continental partnerships for subspecialty training. Challenges experienced include: (1) navigating the intricacies of local political and administrative processes; (2) recruiting candidates to a medical specialty with historically lower salaries; and (3) the added burden placed on the limited number of local specialists. Identified opportunities include building a monitoring, evaluation, and learning (MEL) framework, further diversifying subspecialty areas of psychiatric and neurological training, and obtaining full accreditation of the postgraduate psychiatry program through the West African College of Physicians (WACP). Conclusion The successful launch of the postgraduate psychiatry training program in Liberia is attributed to several factors, including a long-standing academic collaboration of over 10 years and support for mental health capacity-building efforts at national and local levels.
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Affiliation(s)
- Senait Ghebrehiwet
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Micaela Owusu
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Babawale Ojediran
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Mia Touma
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Michelle P. Durham
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Kimberly Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Christina P. C. Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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4
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Korte KJ, Hook K, Levey EJ, Cooper-Vince CE, Denckla CA, Ghebrehiwet S, Hock RS, Harris BL, Menyongai J, Baul TD, Borba CPC, Fricchione GL, Henderson DC. A Global-Local Paradigm for Mental Health: A Model and Implications for Addressing Disparities Through Training and Research. Acad Psychiatry 2023; 47:196-200. [PMID: 35941340 PMCID: PMC9360676 DOI: 10.1007/s40596-022-01695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/27/2022] [Indexed: 05/25/2023]
Affiliation(s)
- Kristina J Korte
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Kimberly Hook
- Boston Medical Center, Boston, MA, USA.
- Massachusetts General Hospital, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Christina P C Borba
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | - David C Henderson
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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5
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Oblath R, Herrera CN, Were LPO, Syeda HS, Duncan A, Ferguson T, Kalesan B, Perez DC, Taglieri J, Borba CPC, Henderson DC. Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team. Community Ment Health J 2023; 59:370-380. [PMID: 36001197 PMCID: PMC9399566 DOI: 10.1007/s10597-022-01015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.
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Affiliation(s)
- Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, USA. .,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.
| | - Carolina N Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Lawrence P O Were
- Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.,Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Haniya Saleem Syeda
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tasha Ferguson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bindu Kalesan
- Department of Medicine, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Joan Taglieri
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Department of Psychiatry, Cambridge Health Alliance, Cambridge, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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6
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Levey EJ, Harris BL, Laird LD, Kekulah I, Borba CPC, Henderson DC, Becker AE. Orphans in post-conflict Liberia: Seeking care in fractured communities. Transcult Psychiatry 2022; 59:235-248. [PMID: 35021921 PMCID: PMC9250424 DOI: 10.1177/13634615211066696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital.,Department of Psychiatry, Harvard Medical School.,Department of Psychiatry, University of Illinois College of Medicine
| | | | - Lance D Laird
- Department of Family Medicine, 12259Boston University School of Medicine
| | - Isaac Kekulah
- Department of Psychiatry, University of Illinois College of Medicine
| | - Christina P C Borba
- Department of Psychiatry, 12259Boston University School of Medicine.,Department of Psychiatry, 1836Boston Medical Center
| | - David C Henderson
- Department of Psychiatry, 12259Boston University School of Medicine.,Department of Psychiatry, 1836Boston Medical Center
| | - Anne E Becker
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital.,Department of Psychiatry, Harvard Medical School.,Department of Global Health and Social Medicine, Harvard T.H. Chan School of Public Health
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Ng LC, Solomon JS, Ameresekere M, Bass J, Henderson DC, Chakravarty S. Development of the South Sudan Mental Health Assessment Scale. Transcult Psychiatry 2022; 59:274-291. [PMID: 34898333 PMCID: PMC9575559 DOI: 10.1177/13634615211059711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study developed and validated a measure that captures variation in common local idioms of distress and mental health problems experienced by women in South Sudan, a country which has experienced over 50 years of violence, displacement, and political, social, and economic insecurity. This measure was developed during a randomized controlled trial of the Adolescent Girls Initiative (AGI) and used qualitative Free Listing (n = 102) and Key Informant interviews (n = 27). Internal reliability and convergent validity were assessed using data from 3,137 randomly selected women (ages 14-47) in 100 communities in South Sudan. Test-retest and inter-rater reliability were assessed using responses from 180 women (ages 15-58) who completed the measure once, and 129 of whom repeated the measure an average of 12 days (SD = 8.3) later. Concurrent validity was assessed through the ratings of 22 AGI leaders about the presence or absence of mental health symptoms in the 180 women in the test-retest sample. The study resulted in the development of the South Sudan Mental Health Assessment Scale, a 24-item measure assessing six idioms of distress. The scale consisted of one factor and had excellent internal, test-retest, and interrater reliability. The scale also demonstrated good convergent and concurrent validity and performed well psychometrically. Moreover, its development provides an example for other organizations, working in environments where mental health measures have not yet been developed and validated, to create and validate measures relevant to their populations. In this way, the role of mental health in development settings can be more rapidly assessed.
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Affiliation(s)
- Lauren C Ng
- 8785University of California, Los Angeles Boston University School of Medicine and Boston Medical Center
| | | | | | - Judith Bass
- 25802Johns Hopkins Bloomberg School of Public Health
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8
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Curren LC, Borba CPC, Henderson DC, Tompson MC. "Making Room": A Thematic Analysis Study of the Process of Postpartum Maternal Adjustment. Matern Child Health J 2022; 26:1142-1152. [PMID: 35298743 DOI: 10.1007/s10995-022-03393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Mothers are especially vulnerable to the onset or recurrence of psychological symptoms during the postpartum period. However, protective psychosocial factors may provide a stress buffering effect and promote a positive adjustment trajectory. Previous research has demonstrated the importance of positive maternal adjustment for maternal mental health and child outcome. However, research is needed that explores (1) the psychosocial components of maternal adjustment, (2) the process of maternal adjustment as subjectively experienced by mothers, and (3) clinical targets that can help postpartum healthcare teams to facilitate positive adjustment during the perinatal period. METHODS This qualitative study utilized thematic analysis in order to understand the dimensions and properties of themes related to maternal adjustment. Through narrative interviews, this study investigated processes associated with maternal adjustment in a sample of n = 23 mothers receiving obstetric care. RESULTS Thematic analysis uncovered three key developmental processes: (1) "Stretching Identity; Transitioning Roles", (2) "Navigating Stressors; Approaching Self-Efficacy", and (3) "Changing Relationships; Strengthening Support." Negative maternal self-attributions emerged as a key target for supportive intervention. Each process is complex and susceptible to both downward and upward spirals, consistent with the broaden-and-build theory of positive emotion. CONCLUSIONS FOR PRACTICE Negative maternal attributions of self are discussed as a key target precipitating postpartum adjustment trajectories. Given this, parenting interventions that teach cognitive reappraisal or mindfulness strategies may be especially beneficial for mothers in the perinatal period.
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Affiliation(s)
- Laura C Curren
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Martha C Tompson
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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9
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Chemali Z, Henderson DC, Fricchione G. Developing a Dual Residency Program in Psychiatry and Neurology in an Area of Regional Conflict: The University of Hargeisa-Massachusetts General Hospital-Boston Medical Center Experience. J Neuropsychiatry Clin Neurosci 2022; 34:77-83. [PMID: 34711068 DOI: 10.1176/appi.neuropsych.21010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noncommunicable diseases are the leading cause of worldwide death and disability and continue to increase in both developed and developing countries. There is a need to address and treat neuropsychiatric disorders in low-income countries, especially in the Horn of Africa. Capacity building by training local doctors and health care workers is a laborious endeavor, with challenges piling up along the way. Nevertheless, the rewards are great when brain specialists who are able to address the needs in their country and treat their fellow citizens receive the training needed to do so effectively. The present article describes a coordinated administrative, educational, and clinical effort to develop and implement a dual residency program in psychiatry and neurology at the University of Hargeisa in Somaliland. The authors highlight the foundations of the program and the challenges faced during its development and implementation in an area of regional conflict. The program provides evidence that this aim is achievable and serves as a model for others seeking to replicate it in other low- and middle-income countries.
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Affiliation(s)
- Zeina Chemali
- Departments of Neurology (Chemali) and Psychiatry (Chemali, Fricchione), Massachusetts General Hospital, Boston; and Department of Psychiatry, Boston Medical Center (Henderson)
| | - David C Henderson
- Departments of Neurology (Chemali) and Psychiatry (Chemali, Fricchione), Massachusetts General Hospital, Boston; and Department of Psychiatry, Boston Medical Center (Henderson)
| | - Gregory Fricchione
- Departments of Neurology (Chemali) and Psychiatry (Chemali, Fricchione), Massachusetts General Hospital, Boston; and Department of Psychiatry, Boston Medical Center (Henderson)
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10
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Adedeji IA, Ogunniyi A, Henderson DC, Sam-Agudu NA. Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review. Dementia (London) 2022; 21:995-1011. [PMID: 34978956 DOI: 10.1177/14713012211065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa. METHODS A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software. RESULTS All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress. CONCLUSION In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.
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Affiliation(s)
- Isaac A Adedeji
- Department of Sociology, 107991Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, 58987University College Hospital, Ibadan, Nigeria
| | - David C Henderson
- Department of Psychiatry, 1846Boston University School of Medicine, USA
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, 12264Institute of Human Virology Nigeria, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.,Division of Epidemiology and Prevention, Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, USA
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11
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Challa F, Getahun T, Sileshi M, Geto Z, Kelkile TS, Gurmessa S, Medhin G, Mesfin M, Alemayehu M, Shumet T, Mulugeta A, Bekele D, Borba CPC, Oppenheim CE, Henderson DC, Fekadu A, Carobene A, Teferra S. Prevalence of metabolic syndrome among patients with schizophrenia in Ethiopia. BMC Psychiatry 2021; 21:620. [PMID: 34895175 PMCID: PMC8665491 DOI: 10.1186/s12888-021-03631-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Globally, the prevalence of metabolic syndrome (MetS) is higher among patients with schizophrenia than the general population, and this leads to higher morbidity and mortality in this population. The aim of this study was to investigate the MetS prevalence among patients with schizophrenia in Ethiopia. METHODS We conducted a cross-sectional analysis of baseline data of 200 patients with schizophrenia recruited from Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Lipid profile and blood glucose levels were measured using Roche Cobas 6000 clinical chemistry analyzer. The prevalence of MetS was assessed based on National Cholesterol Education Program Adult Treatment Panel III criteria. Patients' demographic information, clinical and laboratory data, lifestyle habits, particularly smoking and Khat chewing, were evaluated vis-à-vis MetS. RESULTS The overall prevalence of MetS in patients with schizophrenia was 21.5% (17.1% male, 29.6% female) where Low HDL-cholesterol value was the most common metabolic disorders components in both males and females subgroups. In the multivariate analysis, the positive and negative symptoms score (PANSS, AOR = 1.03, 95% CI 1.001-1.054) was associated factors with MetS. CONCLUSION In Ethiopia, patients with schizophrenia were found to have higher prevalence of MetS than the general population. Physicians/health care providers should routinely screen patients with schizophrenia for MetS and initiate timely management of those who develop the syndrome to reduce the health cost from caring for NCDs, improve the patients' quality of life, and prevent premature mortality.
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Affiliation(s)
- Feyissa Challa
- National References Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Gulelle Arbegnoch Street (the former Pasteur Institute): Gulele Sub City, Addis Ababa, Ethiopia.
| | - Tigist Getahun
- grid.452387.f0000 0001 0508 7211National References Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Gulelle Arbegnoch Street (the former Pasteur Institute): Gulele Sub City, Addis Ababa, Ethiopia
| | - Meron Sileshi
- grid.452387.f0000 0001 0508 7211National References Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Gulelle Arbegnoch Street (the former Pasteur Institute): Gulele Sub City, Addis Ababa, Ethiopia
| | - Zeleke Geto
- grid.467130.70000 0004 0515 5212Department of Biomedical Science, College of Medicine and Health Science, Wollo University, Dessie, Wollo Ethiopia
| | - Teshome S. Kelkile
- grid.428748.50000 0000 8052 6109Horizon Health Network, Fredericton, NB Canada
| | - Sintayehu Gurmessa
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- grid.7123.70000 0001 1250 5688Aklilu Lemma Institute of Pathobiology Addis Ababa University, Addis Ababa, Ethiopia
| | - Miraf Mesfin
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkam Alemayehu
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tigist Shumet
- grid.452387.f0000 0001 0508 7211National References Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Gulelle Arbegnoch Street (the former Pasteur Institute): Gulele Sub City, Addis Ababa, Ethiopia
| | - Anwar Mulugeta
- grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Desalegn Bekele
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Christina P. C. Borba
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA ,grid.239424.a0000 0001 2183 6745Boston Medical Center, Boston, MA USA
| | - Claire E. Oppenheim
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - David C. Henderson
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA ,grid.239424.a0000 0001 2183 6745Boston Medical Center, Boston, MA USA
| | - Abebaw Fekadu
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.414601.60000 0000 8853 076XGlobal Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK ,grid.13097.3c0000 0001 2322 6764King’s College London, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anna Carobene
- grid.18887.3e0000000417581884Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Solomon Teferra
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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12
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Hook K, Ametaj A, Cheng Y, Serba EG, Henderson DC, Hanlon C, Ng LC. Psychotherapy in a resource-constrained setting: Understanding context for adapting and integrating a brief psychological intervention into primary care. Psychotherapy (Chic) 2021; 58:557-575. [PMID: 34410763 PMCID: PMC8664957 DOI: 10.1037/pst0000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Low- and middle-income countries have few mental health professionals, and efforts to increase access to treatment are a global priority. A key gap is the lack of integration of psychotherapy interventions as a part of accessible evidence-based care. Current recommendations suggest that the integration of mental health treatments, including psychotherapy, into existing primary care pathways may serve as a means to address this disparity. Understanding the cultural and contextual factors that affect this process is a critical step in identifying necessary adaptations. The aim of this qualitative study was to identify contextual factors associated with integrating psychotherapy in primary care in a predominantly rural district in south-central Ethiopia. Purposive sampling was used to recruit 48 mental health service users, caregivers, health care providers, and community leaders. Semistructured interviews were conducted, recorded, and transcribed in Amharic and translated into English. Although challenges (e.g., stigma, job strain, lack of belief in formal treatments) are present, other existing strengths (e.g., openness to seeking treatment, increasing knowledge about mental health treatment, familiarity with practices similar to therapy) support subsequent psychotherapy adaptation and implementation. These findings suggest possible mechanisms to improve delivery and adaptation in the effort to lower the existing global treatment gap. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kimberly Hook
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Amantia Ametaj
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | | | - Eyerusalem G. Serba
- Addis Ababa University, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
| | - David C. Henderson
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Charlotte Hanlon
- Addis Ababa University, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- King’s College London, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren C. Ng
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
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13
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Lim Y, Beane-Ebel JE, Tanaka Y, Ning B, Husted CR, Henderson DC, Xiang Y, Park IH, Farrer LA, Zhang H. Exploration of alcohol use disorder-associated brain miRNA-mRNA regulatory networks. Transl Psychiatry 2021; 11:504. [PMID: 34601489 PMCID: PMC8487426 DOI: 10.1038/s41398-021-01635-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 02/08/2023] Open
Abstract
Transcriptomic changes in specific brain regions can influence the risk of alcohol use disorder (AUD), but the underlying mechanism is not fully understood. We investigated AUD-associated miRNA-mRNA regulatory networks in multiple brain regions by analyzing transcriptomic changes in two sets of postmortem brain tissue samples and ethanol-exposed human embryonic stem cell (hESC)-derived cortical interneurons. miRNA and mRNA transcriptomes were profiled in 192 tissue samples (Set 1) from eight brain regions (amygdala, caudate nucleus, cerebellum, hippocampus, nucleus accumbens, prefrontal cortex, putamen, and ventral tegmental area) of 12 AUD and 12 control European Australians. Nineteen differentially expressed miRNAs (fold-change>2.0 & P < 0.05) and 97 differentially expressed mRNAs (fold-change>2.0 & P < 0.001) were identified in one or multiple brain regions of AUD subjects. AUD-associated miRNA-mRNA regulatory networks in each brain region were constructed using differentially expressed and negatively correlated miRNA-mRNA pairs. AUD-relevant pathways (including CREB Signaling, IL-8 Signaling, and Axonal Guidance Signaling) were potentially regulated by AUD-associated brain miRNA-mRNA pairs. Moreover, miRNA and mRNA transcriptomes were mapped in additional 96 tissue samples (Set 2) from six of the above eight brain regions of eight AUD and eight control European Australians. Some of the AUD-associated miRNA-mRNA regulatory networks were confirmed. In addition, miRNA and mRNA transcriptomes were analyzed in hESC-derived cortical interneurons with or without ethanol exposure, and ethanol-influenced miRNA-mRNA regulatory networks were constructed. This study provided evidence that alcohol could induce concerted miRNA and mRNA expression changes in reward-related or alcohol-responsive brain regions. We concluded that altered brain miRNA-mRNA regulatory networks might contribute to AUD development.
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Affiliation(s)
- Yolpanhchana Lim
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- The Bioinformatics Program, Boston University Graduate School of Arts and Sciences, Boston, MA, USA
| | - Jennifer E Beane-Ebel
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Yoshiaki Tanaka
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, QC, H1T 2M4, Canada
| | - Boting Ning
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christopher R Husted
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Yangfei Xiang
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
- School of Life Science and Technology, ShanghaiTech University, Shanghai, 201210, China
| | - In-Hyun Park
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Lindsay A Farrer
- Section of Biomedical Genetics, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Departments of Neurology and Ophthalmology, Boston University School of Medicine, Boston, MA, USA
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Huiping Zhang
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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14
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Pullen SJ, Herman AR, Lange BC, Christian-Brathwaite N, Ulloa M, Kempeh MP, Karnga DG, Fallah MP, Menyongai J, Harris B, Alonso Y, Henderson DC, Borba CP. Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation. Afr Health Sci 2021; 21:1396-1409. [PMID: 35222605 PMCID: PMC8843300 DOI: 10.4314/ahs.v21i3.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background A better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war. Methods A qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis. Results Mental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depression and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern healthcare. Conclusion Traditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Westernized nosology and social factors. Traditional healer's attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with ‘modern’ health care providers, but this will require reciprocal trust-building.
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Affiliation(s)
- Samuel J Pullen
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Family Mental Health and Community Psychiatry, Durham, NC.,Johns Hopkins Bloomberg School of Public Health, Baltimore
| | | | - Brittany Cl Lange
- University of Oxford - Department of Social Policy and Intervention, Oxford, England
| | | | - Melissa Ulloa
- New York University Steinhardt School of Culture, Education, and Human Development, 82 Washington Square E, New York, NY 10003
| | - Michael P Kempeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa
| | - Dyujay G Karnga
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa
| | - Mosoka P Fallah
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa.,National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Benjamin Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine University of Liberia, Monrovia, Liberia, West Africa
| | - Yadira Alonso
- Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA
| | - David C Henderson
- Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA
| | - Christina Pc Borba
- Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA
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15
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Bell Lynum KS, Henderson DC, Wright HJ, Gogate JP, Kim E. Treatment Effect With Paliperidone Palmitate Compared With Oral Antipsychotics in Black/African American Patients With Schizophrenia and a History of Criminal Justice System Involvement: A Post Hoc Analysis of the PRIDE Study. J Clin Psychiatry 2021; 82. [PMID: 33988924 DOI: 10.4088/jcp.20m13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the efficacy and safety of paliperidone palmitate once-monthly (PP1M) versus oral antipsychotics (OAPs) in Black/African American patients with schizophrenia and a history of criminal justice system involvement. METHODS This was a post hoc analysis of a 15-month prospective, randomized, open-label, parallel-group, multicenter US study conducted from May 2010 to December 2013 that examined a subpopulation of Black/African American patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The primary objective was to compare time to first treatment failure in patients treated with PP1M versus OAPs. Secondary objectives were to compare time to first institutionalization (psychiatric hospitalization or arrest/incarceration) and mean number of treatment failure events and institutionalizations over 15 months in PP1M-treated and OAP-treated patients. RESULTS The intention-to-treat population included 275 Black/African American patients (PP1M, n = 145; OAPs, n = 130). Median time to first treatment failure was not reached for PP1M-treated patients and was 270 days for OAP-treated patients; hazard ratio (HR) was 1.39 (95% CI, 0.97-1.99; P = .075). Median time to first institutionalization was not reached for PP1M-treated patients and was 304 days for OAP-treated patients; HR was 1.49 (95% CI, 1.01-2.19; P = .043). Mean numbers of treatment failure events and institutionalizations were lower with PP1M than OAPs. The safety profile of PP1M was consistent with that of previous PP1M studies. CONCLUSIONS In a Black/African American subpopulation of patients with schizophrenia and prior criminal justice system involvement, PP1M reduced the number of treatment failures, thereby reducing the number of psychiatric hospitalizations and/or arrests/incarcerations compared with daily OAPs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01157351.
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Affiliation(s)
- Karimah S Bell Lynum
- Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Corresponding author: Karimah S. Bell Lynum, PharmD, MBA, BCPP, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | | | - Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Affiliation at the time the analysis was conducted
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16
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Ogundare T, Onifade PO, Ogundapo 'D, Ghebrehiwet S, Borba CPC, Henderson DC. Relationship between quality of life and social integration among patients with schizophrenia attending a Nigerian tertiary hospital. Qual Life Res 2021; 30:1665-1674. [PMID: 33523402 DOI: 10.1007/s11136-021-02764-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite decades of de-institutionalization and the best efforts of community mental health services, individuals with schizophrenia living outside the hospital may be described as in the community but not of the community, and remain in a very real sense socially excluded. AIM AND OBJECTIVES To determine the relationship between social integration and quality of life among patients with schizophrenia attending the outpatient clinic of the Neuropsychiatric Hospital Abeokuta in Nigeria. METHODS One hundred and fifty-one patients were recruited. Sociodemographic questionnaire, MINI-PLUS, WHOQOL-BREF, Social Integration Scale and PANSS were administered. Multivariable regression analyses were performed to identify the determinants of quality of life and the relationship with social integration. RESULTS The mean (± SD) age of the respondents was 40.00 (± 10.23), 56.3% were males, 37.1% were single. Independent predictors of lower quality of life were: (1) more severe psychopathology for the domains of general health (p = 0.003), social relationship (p = 0.019) and environment (p = 0.008); (2) longer duration of illness for the social relationship (p = 0.028) and environment (p = 0.015) domains; and (3) negative symptoms (p = 0.034) for the physical domain. CONCLUSION There is a need to pay closer attention to social outcome measures such as quality of life and level of social integration among patients with schizophrenia who come in contact with psychiatry services, and not just on symptom remission only.
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Affiliation(s)
- Temitope Ogundare
- Neuropsychiatric Hospital, PMB 2002, Aro, Abeokuta, Ogun State, Nigeria. .,School of Public Health, Boston University, Boston, MA, 02118, USA.
| | - Peter O Onifade
- Neuropsychiatric Hospital, PMB 2002, Aro, Abeokuta, Ogun State, Nigeria
| | - 'Deji Ogundapo
- Neuropsychiatric Hospital, PMB 2002, Aro, Abeokuta, Ogun State, Nigeria
| | | | - Christina P C Borba
- Boston University School of Medicine, Boston, MA, 02118, USA.,Department of Psychiatry, Boston Medical Center, Boston, MA, 02118, USA
| | - David C Henderson
- Boston University School of Medicine, Boston, MA, 02118, USA.,Department of Psychiatry, Boston Medical Center, Boston, MA, 02118, USA
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17
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Ghebrehiwet S, Harris BL, Ojediran B, Owusu M, Augello LP, Durham MP, Henderson DC, Borba CP. Using local terminology to measure substance use behaviours among youth in post-conflict Liberia: a mixed methods study. Vulnerable Child Youth Stud 2020; 16:279-291. [PMID: 35003316 PMCID: PMC8734640 DOI: 10.1080/17450128.2020.1838681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/13/2020] [Indexed: 06/14/2023]
Abstract
This mixed methods study aimed to use local terminology to accurately characterize the prevalence and risk factors associated with substance use and risky health behaviors among school-based youth in Monrovia, Liberia. An 86-question survey was validated using qualitative data obtained from focus groups at two secondary schools in central and greater Monrovia. The revised survey was then administered to 400 students from eight different secondary schools in this region. The observed prevalence estimates for lifetime and current substance use were considerably higher than previously reported among adolescents in the West African region. Among students who were former child soldiers, the rates of current substance use were 5.8-33.8% higher compared to the overall study sample. Male gender, academic seniority, and peer approval of substance use were all found to be strong predictors of current substance use among secondary students. Results suggest the need for targeted, trauma-informed interventions to reduce rates of substance use and risky health behaviors among youth in Liberia and similar post-conflict settings.
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Affiliation(s)
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Babawale Ojediran
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Micaela Owusu
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Lauren P. Augello
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Michelle P. Durham
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Christina P.C. Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
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18
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Carroll HA, Hook K, Perez OFR, Denckla C, Vince CC, Ghebrehiwet S, Ando K, Touma M, Borba CPC, Fricchione GL, Henderson DC. Establishing reliability and validity for mental health screening instruments in resource-constrained settings: Systematic review of the PHQ-9 and key recommendations. Psychiatry Res 2020; 291:113236. [PMID: 32593853 PMCID: PMC7484202 DOI: 10.1016/j.psychres.2020.113236] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 01/28/2023]
Abstract
Mental illness is one of the largest contributors to the global disease burden. The importance of valid and reliable mental health measures is crucial in order to accurately measure said burden, to capture symptom improvement, and to ensure that symptoms are appropriately identified and quantified. This is of particular importance in low and middle-income countries (LMICs), where the burden of mental illness is relatively high, and there is heterogeneity in linguistic, racial, and ethnic groups. Using the PHQ-9 as an illustrative example, this systematic review aims to provide an overview of existing work and highlight common validation and reporting practices. A systematic review of published literature validating the use of the PHQ-9 in LMICs as indexed in the PubMed and PsychInfo databases was conducted. The review included n = 49 articles (reduced from n = 2,349). This manuscript summarizes these results in terms of the frequency of reporting on important procedures and in regards to the types of reliability and validity measured. Then, building off of the existing literature, we provide key recommendations for measure validation in LMICs, which can be generalized for any type of measure used in a setting in which it was not initially developed.
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Affiliation(s)
- Haley A Carroll
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States
| | - Kimberly Hook
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States.
| | - Oscar F Rojas Perez
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States
| | - Christy Denckla
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Senait Ghebrehiwet
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States
| | - Kanako Ando
- Northeastern University, Boston, MA, United States
| | - Mia Touma
- Boston University, Boston, MA, United States
| | - Christina P C Borba
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States
| | - Gregory L Fricchione
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Harvard Medical School, Boston, USA
| | - David C Henderson
- Boston Medical Center, Department of Psychiatry, Boston, MA, United States; Boston University School of Medicine, Department of Psychiatry, Boston, MA, United States; Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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19
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Affiliation(s)
- Hannah E Brown
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sydney Feinstein
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - David C Henderson
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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20
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Lin H, Wang F, Rosato AJ, Farrer LA, Henderson DC, Zhang H. Prefrontal cortex eQTLs/mQTLs enriched in genetic variants associated with alcohol use disorder and other diseases. Epigenomics 2020; 12:789-800. [PMID: 32496132 DOI: 10.2217/epi-2019-0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: This study aimed to investigate the function of genome-wide association study (GWAS)-identified variants associated with alcohol use disorder (AUD)/comorbid psychiatric disorders. Materials & methods: Genome-wide genotype, transcriptome and DNA methylome data were obtained from postmortem prefrontal cortex (PFC) of 48 Caucasians (24 AUD cases/24 controls). Expression/methylation quantitative trait loci (eQTL/mQTL) were identified and their enrichment in GWAS signals for the above disorders were analyzed. Results: PFC cis-eQTLs (923 from cases+controls, 27 from cases and 98 from controls) and cis-mQTLs (9,932 from cases+controls, 264 from cases and 695 from controls) were enriched in GWAS-identified genetic variants for the above disorders. Cis-eQTLs from AUD cases were mapped to morphine addiction-related genes. Conclusion: PFC cis-eQTLs/cis-mQTLs influence gene expression/DNA methylation patterns, thus increasing the disease risk.
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Affiliation(s)
- Honghuang Lin
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, MA, USA.,Boston University's & National Heart, Lung & Blood Institute's Framingham Heart Study, MA, USA
| | - Fan Wang
- Department of Cardiovascular & Metabolic Sciences, Cleveland Clinic Lerner Research Institute, OH, USA
| | - Andrew J Rosato
- Department of Psychiatry, Boston University School of Medicine, MA, USA
| | - Lindsay A Farrer
- Section of Biomedical Genetics, Department of Medicine, Boston University School of Medicine, MA, USA
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, MA, USA
| | - Huiping Zhang
- Department of Psychiatry, Boston University School of Medicine, MA, USA.,Section of Biomedical Genetics, Department of Medicine, Boston University School of Medicine, MA, USA
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21
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Ogundare T, Adebowale TO, Borba CPC, Henderson DC. Correlates of depression and quality of life among patients with epilepsy in Nigeria. Epilepsy Res 2020; 164:106344. [PMID: 32361406 DOI: 10.1016/j.eplepsyres.2020.106344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine the prevalence of Major Depressive Disorders (MDD) and its relationship to Quality of life. DESIGN A cross-sectional observational study. SETTING Out-Patient Clinic of the Neuropsychiatric Hospital, Abeokuta, Nigeria. SUBJECTS Patients with diagnosis of Epilepsy with Electroencephalogram (EEG) confirmation. OUTCOME MEASURES Depression and Quality of life. RESULTS The prevalence of current MDD was 11.9 %, and patients having at least 1 seizure per week were 5 times more likely to develop MDD (OR = 5.104, p = 0.014). The mean (SD) QOLIE-31 scores was 77.98 (13.32), with presence of MDD (β = -11.101, p = 0.0001); having at least 1 seizure/week (β = -6.653, p = 0.037) being independent predictors. CONCLUSION Depression is a common comorbidity in patients with epilepsy and is associated with a lower quality of life.
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Affiliation(s)
- Temitope Ogundare
- Neuropsychiatric Hospital Aro, PMB 2002, Abeokuta, Ogun State, Nigeria; Boston University School of Public Health, Boston, MA, 02118, USA.
| | | | - Christina P C Borba
- Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
| | - David C Henderson
- Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
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Oppenheim CE, Axelrod K, Menyongai J, Chukwuezi B, Tam A, Henderson DC, Borba CPC. The HEAAL Project: Applying Community-Based Participatory Research (CBPR) Methodology in a Health and Mental Health Needs Assessment With an African Immigrant and Refugee Faith Community in Lowell, Massachusetts. J Public Health Manag Pract 2020; 25:E1-E6. [PMID: 30507809 DOI: 10.1097/phh.0000000000000707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community-based participatory research methodology is driven by community interests and rooted in community involvement throughout the research process. This article describes the use of community-based participatory research methodology in the HEAAL project (Health and Mental Health Education and Awareness for Africans in Lowell), a research collaboration between Christ Jubilee International Ministries-a nondenominational Christian church in Lowell, Massachusetts, that serves an African immigrant and refugee congregation-and the Massachusetts General Hospital Department of Psychiatry. The objective of the HEAAL project was to better understand the nature, characteristics, scope, and magnitude of health and mental health issues in this faith community. The experience of using community-based participatory research in the HEAAL project has implications for research practice and policy as it ensured that research questions were relevant and meaningful to the community; facilitated successful recruitment and navigation through challenges; and can expedite the translation of data to practice and improved care.
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Affiliation(s)
- Claire E Oppenheim
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (Ms Oppenheim and Drs Tam, Henderson, and Borba); Department of Psychiatry, Boston Medical Center, Boston, Massachusetts (Ms Oppenheim and Drs Tam, Henderson, and Borba); Innovations in Healthcare, Duke University, Durham, North Carolina (Ms Axelrod); and Christ Jubilee International Ministries, Lowell, Massachusetts (Mr Menyongai and Ms Chukwuezi)
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Hailemariam M, Ghebrehiwet S, Baul T, Restivo JL, Shibre T, Henderson DC, Girma E, Fekadu A, Teferra S, Hanlon C, Johnson JE, Borba CPC. "He can send her to her parents": The interaction between marriageability, gender and serious mental illness in rural Ethiopia. BMC Psychiatry 2019; 19:315. [PMID: 31655561 PMCID: PMC6815356 DOI: 10.1186/s12888-019-2290-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For women in most low- and middle-income countries, the diagnosis with serious mental illness (SMI) leads to stigma and challenges related to starting or maintaining marriages. The purpose of this qualitative study was to explore perspectives on marriage, divorce and family roles of women with SMI in rural Ethiopia. METHODS A qualitative study was conducted in a rural setting of Butajira, South Central Ethiopia. A total of 39 in-depth interviews were carried out with service users (n = 11), caregivers (n = 12), religious leaders (n = 6), health extension workers (n = 4), police officers (n = 2), teachers (n = 2) and government officials (n = 2). Data were analyzed using a thematic approach. RESULTS Three themes emerged. (1) Marriage and SMI: Chances of getting married for individuals with SMI in general was perceived to be lower: Individuals with SMI experienced various challenges including difficulty finding romantic partner, starting family and getting into a long-term relationship due to perceived dangerousness and the widespread stigma of mental illness. (2) Gendered experiences of marriageability: Compared to men, women with SMI experienced disproportionate levels of stigma which often continued after recovery. SMI affects marriageability for men with SMI, but mens' chances of finding a marital partner increases following treatment. For women in particular, impaired functioning negatively affects marriageability as ability to cook, care and clean was taken as the measure of suitability. (3) Acceptability of divorce and separation from a partner with SMI: Divorce or separation from a partner with SMI was considered mostly acceptable for men while women were mostly expected to stay married and care for a partner with SMI. For men, the transition from provider to dependent was often acceptable. However, women who fail to execute their domestic roles successfully were considered inept and would be sent back to their family of origin. CONCLUSION Women with SMI or those married to partners with SMI are at greater disadvantage. Reducing vulnerabilities through stigma reduction efforts such as community outreach and mental health awareness raising programs might contribute for better social outcomes for women with SMI.
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Affiliation(s)
- Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA. .,College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Senait Ghebrehiwet
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA
| | - Tithi Baul
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA
| | | | - Teshome Shibre
- 0000 0000 8052 6109grid.428748.5Horizon Health Network, Fredericton, NB Canada
| | - David C. Henderson
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Eshetu Girma
- 0000 0001 1250 5688grid.7123.7School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- 0000 0001 2150 1785grid.17088.36Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI USA ,0000 0001 1250 5688grid.7123.7Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,0000 0000 8853 076Xgrid.414601.6Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Solomon Teferra
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia ,King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, London, UK
| | - Jennifer E. Johnson
- 0000 0001 2150 1785grid.17088.36Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI USA
| | - Christina P. C. Borba
- 0000 0001 2183 6745grid.239424.aDepartment of Psychiatry, Boston Medical Center, Boston, MA USA ,0000 0004 0367 5222grid.475010.7Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
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Ghebrehiwet S, Baul T, Restivo JL, Kelkile TS, Stevenson A, Gelaye B, Fekadu A, Hailemariam M, Girma E, Teferra S, Canelos V, Henderson DC, Borba CPC. Gender-specific experiences of serious mental illness in rural Ethiopia: A qualitative study. Glob Public Health 2019; 15:185-199. [PMID: 31630624 DOI: 10.1080/17441692.2019.1680723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considerable variation in the gender-specific prevalence of serious mental illness (SMI) has been reported in low- and middle-income countries (LMICs). In the rural setting of Butajira, Ethiopia, the male-to-female prevalence ratio of schizophrenia was reported to be 5:1. This qualitative study explores gender-specific experiences of SMI and the extent to which sociocultural factors may explain the observed difference in prevalence estimates. Using purposive sampling, 39 in-depth interviews were conducted with community members from Butajira, a rural district in South Central Ethiopia. Transcripts were analysed using thematic analysis to elicit community perspectives on cultural explanatory models of SMI and experiences in this region. Gender-specific experiences were reported to differ due to visibility of symptoms, community responses, and varying levels of family support towards individuals with SMI. Overall, respondents described how various sociocultural factors subject women with SMI to higher levels of physical and social isolation compared to men, greatly affecting community health workers' ability to identify and provide care to women with mental illness. Future case detection methods should involve family members as they interact with women with SMI early on in the development of their symptoms and play an essential role in their path to mental health care.
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Affiliation(s)
| | - Tithi Baul
- Department of Psychiatry, Boston Medical Center, Boston, USA
| | - Juliana L Restivo
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | | | - Anne Stevenson
- Broad Institute, Stanley Center for Psychiatric Research, Cambridge, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Abebaw Fekadu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, Institute of Psychiatry, London, UK
| | - Maji Hailemariam
- College of Human Medicine, Division of Public Health, Michigan State University, Flint, USA
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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Denckla CA, Ongeri L, Ouma L, Singa B, Maingi C, Bosire R, Otieno P, Omolo D, Henderson DC, Chibnik LB, Koenen KC, Manduku V. Prevalence of parental bereavement among female sex workers (FSW) in Kibra, Kenya. J Loss Trauma 2019; 24:129-142. [PMID: 31598099 DOI: 10.1080/15325024.2018.1560692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Female sex workers (FSW) residing in Kibra, Kenya experience elevated exposure to adverse events, yet the prevalence of parental bereavement is not well characterized. This cross-sectional pilot study on 301 FSWs residing in Kibra, Kenya found that 67.7% of these women were parentally bereaved. Significantly fewer parentally bereaved women reported historical use of condoms and emergency contraception compared to non-bereaved women, and older age of paternal bereavement was significantly associated with current contraceptive use. Prevalence rates of bereavement among this cohort are well over the national Kenyan average, and further research on the specific impact of bereavement is warranted.
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Affiliation(s)
- Christy A Denckla
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Linnet Ongeri
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
| | - Linet Ouma
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
| | - Charity Maingi
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
| | - Rose Bosire
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
| | - Phelgona Otieno
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
| | - Danvers Omolo
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya.,United Nations Food and Agriculture Organization, Southern Sudan
| | - David C Henderson
- Boston Medical Center, Boston University, 720 Harrison Ave., Boston, MA, 02118 USA
| | - Lori B Chibnik
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Karestan C Koenen
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Veronica Manduku
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840 00200, Nairobi, Kenya
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Irwin KE, Steffens EB, Yoon Y, Flores EJ, Knight HP, Pirl WF, Freudenreich O, Henderson DC, Park ER. Lung Cancer Screening Eligibility, Risk Perceptions, and Clinician Delivery of Tobacco Cessation Among Patients With Schizophrenia. Psychiatr Serv 2019; 70:927-934. [PMID: 31357921 PMCID: PMC8386131 DOI: 10.1176/appi.ps.201900044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, and receipt of tobacco cessation interventions from psychiatry and primary care. METHODS The authors performed a cross-sectional survey and medical record review with 112 adults with schizophrenia treated with clozapine in a community mental health clinic (CMHC). RESULTS Among older participants (ages 55-77 years) with schizophrenia, 34% met the criteria for lung screening on the basis of smoking history (heavy current or former smokers), and more than half believed they had a low risk of developing lung cancer. Of all participants, 88% had visited their primary care provider (PCP) in the past year; PCPs represented 35 different practices. Only one in three current smokers reported that their PCP or psychiatrist assisted them in obtaining medications for tobacco cessation. CONCLUSIONS Given smoking history, many older adults with schizophrenia have potential to benefit from lung screening, yet most older participants underestimated their lung cancer risk. Although participants regularly accessed care, PCP and psychiatric visits may be missed opportunities to engage patients with schizophrenia in tobacco cessation and decrease preventable premature mortality. Embedding interventions in a CMHC, a centralized access point of care delivery for patients with schizophrenia, may have unique potential to increase uptake of cancer screening and tobacco cessation interventions.
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Affiliation(s)
- Kelly E Irwin
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Eleanor B Steffens
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - YooJin Yoon
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Efren J Flores
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Helen P Knight
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Oliver Freudenreich
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - David C Henderson
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
| | - Elyse R Park
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston (Irwin, Yoon); Schizophrenia Clinical and Research Program (Irwin, Freudenreich), Mongan Institute Health Policy Center (Steffens, Park), Tobacco Research and Treatment Center (Park), and Department of Radiology (Flores), Massachusetts General Hospital, Boston; Erich Lindemann Mental Health Center, Boston (Freudenreich); Department of Medicine, Brigham and Women's Hospital, Boston (Knight); Dana-Farber Cancer Institute, Boston (Pirl); Department of Psychiatry, Boston Medical Center and Boston University, Boston (Henderson)
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Fan X, Copeland P, Nawras S, Harrington A, Freudenreich O, Goff DC, Henderson DC. Adjunctive telmisartan treatment on body metabolism in clozapine or olanzapine treated patients with schizophrenia: a randomized, double blind, placebo controlled trial. Psychopharmacology (Berl) 2019; 236:1949-1957. [PMID: 30747254 DOI: 10.1007/s00213-019-5181-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/28/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study examined the effect of adjunctive telmisartan on body metabolism in clozapine- or olanzapine-treated patients with schizophrenia. METHOD Each subject had been on stable dose of olanzapine or clozapine for at least 1 month. In a 12-week randomized, double-blind, placebo-controlled study, subjects received either telmisartan (80 mg once per day) or placebo. The homeostasis model of assessment of insulin resistance (HOMA-IR) was calculated based on fasting blood levels of insulin and glucose. Fasting blood levels of triglycerides and cholesterols, as well as serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) were measured. The whole-body dual-energy X-ray absorptiometry (DXA) was used to assess body composition. Lipid particles were assessed using nuclear magnetic resonance (NMR) spectroscopy. All assessments were conducted at baseline and repeated at week 12. RESULTS Fifty-four subjects were randomized and 43 completed the study (22 in the telmisartan group, 21 in the placebo group). There were no significant differences between the two groups in week 12 changes for HOMA-IR or fasting triglycerides (- 0.18 ± 1.24 vs 0.39 ± 1.39, p = 0.181; - 26 ± 76 vs - 10 ± 81 mg/dL, p = 0.679, respectively) (telmisartan vs placebo). Further, there were no significant between group differences in week 12 changes for other fasting lipids, body weight, body mass index, waist circumference, as well as various measures of lipid particles (p's > 0.100). The DXA assessment showed no significant differences between the two groups in week 12 changes for fat mass, lean mass, or total mass (p's > 0.100). CONCLUSION In the present study, adjunctive treatment of telmisartan did not seem to improve body metabolism in schizophrenia patients receiving olanzapine or clozapine. The implications for future studies were discussed. CLINICALTRIALS. GOV IDENTIFIER NCT00981526.
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Affiliation(s)
- Xiaoduo Fan
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, 01605, USA.
| | - Paul Copeland
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Shukair Nawras
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, 01605, USA
| | - Amy Harrington
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, 01605, USA
| | - Oliver Freudenreich
- Schizophrenia Program, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Donald C Goff
- Department of Psychiatry, New York University Medical School and Nathan Kline Institute, New York, NY, USA
| | - David C Henderson
- Department of Psychiatry, Boston University/Boston Medical Center, Boston, MA, USA
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28
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Rosato AJ, Chen X, Tanaka Y, Farrer LA, Kranzler HR, Nunez YZ, Henderson DC, Gelernter J, Zhang H. Salivary microRNAs identified by small RNA sequencing and machine learning as potential biomarkers of alcohol dependence. Epigenomics 2019; 11:739-749. [PMID: 31140863 DOI: 10.2217/epi-2018-0177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: Salivary miRNA can be easily accessible biomarkers of alcohol dependence (AD). Materials & methods: The miRNA transcriptome in the saliva of 56 African-Americans (AAs; 28 AD patients/28 controls) and 64 European-Americans (EAs; 32 AD patients/32 controls) was profiled using small RNA sequencing. Differentially expressed miRNAs were identified. Salivary miRNAs were used to predict the AD presence using machine learning with Random Forests. Results: Seven miRNAs were differentially expressed in AA AD patients, and five miRNAs were differentially expressed in EA AD patients. The AD prediction accuracy based on top five miRNAs (ranked by Gini index) was 79.1 and 72.2% in AAs and EAs, respectively. Conclusion: This study provided the first evidence that salivary miRNAs are AD biomarkers.
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Affiliation(s)
- Andrew J Rosato
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Xiaochun Chen
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Yoshiaki Tanaka
- Department of Genetics, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Lindsay A Farrer
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA 02118, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Ophthalmology, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Epidemiology & Boston University School of Public Health, Boston, MA 02118, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania & VISN4 MIRECC, Crescenz VAMC, Philadelphia, PA 19104, USA
| | - Yaira Z Nunez
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Joel Gelernter
- Department of Genetics, Yale University School of Medicine, New Haven, CT 06520, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.,VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Huiping Zhang
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA 02118, USA
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Montalvo C, Stankiewicz B, Brochier A, Henderson DC, Borba CPC. Long-Term Retention in an Outpatient Behavioral Health Clinic With Buprenorphine. Am J Addict 2019; 28:339-346. [PMID: 31066985 DOI: 10.1111/ajad.12896] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite high comorbidity between substance use disorders and other mental health diagnoses, there is a paucity of literature on buprenorphine treatment outcomes in outpatient mental health settings. This study aimed to identify rates and predictors of outpatient buprenorphine treatment retention in a Behavioral Health Clinic (BHC). METHODS This retrospective cohort study of adults on buprenorphine used multiple logistic regression to identify clinical and demographic factors associated with 1- and 2-year treatment retention and buprenorphine adherence. RESULTS Of 321 subjects, 169 (52.6%) were retained in treatment for at least 1 year; 114 (35.5%) were retained for 2 years or more. Buprenorphine adherence was 95.8% and 97.3% for 1- and 2-year retention groups, respectively. Predictors of 1-year retention included benzodiazepine co-prescription (adjusted odds ratio [AOR] = 2.4; 95% CI [1.30, 4.55]), having a diagnosis of other mood disorder (AOR = 3.4; [1.95, 5.98]), or nicotine use disorder (AOR = 2.4; [1.35, 4.27]). Predictors of 2-year retention included female gender (AOR = 2.1; [1.16, 3.73]), having a diagnosis of depressive disorder (AOR = 4.6; [1.49, 14.29]), other mood disorder (AOR = 3.6; [1.88, 6.88]), or nicotine use disorder (AOR = 2.0; [1.13, 3.52]). DISCUSSION AND CONCLUSION During the study period, 52.7% and 35.5% of BHC patients treated with buprenorphine were retained for 1 and 2 years, respectively, comparable to the studies performed within primary care. Providing buprenorphine treatment within mental health clinics may serve patients who are already engaged with mental health providers but are reluctant to start new treatment within another treatment setting. SCIENTIFIC SIGNIFICANCE Identifying common predictors of retention can help determine which patients require additional substance use treatment support. (Am J Addict 2019;28:339-346).
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Affiliation(s)
- Cristina Montalvo
- Department of Psychiatry, VA Boston Healthcare System, West Roxbury, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Brad Stankiewicz
- Department of Psychiatry, Bournewood Health Systems, Brookline, Massachusetts
| | - Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Christina P C Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
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Pino EC, Zuo Y, Schor SH, Zatwarnicki S, Henderson DC, Borba CP, Milanovic SM, Kalesan B. Temporal trends of co-diagnosis of depression and/or anxiety among female maternal and non-maternal hospitalizations: Results from Nationwide Inpatient Sample 2004-2013. Psychiatry Res 2019; 272:42-50. [PMID: 30579180 DOI: 10.1016/j.psychres.2018.12.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 01/23/2023]
Abstract
Perinatal depression/anxiety is considered the most underdiagnosed pregnancy complication in the US and is associated with poor maternal and fetal outcomes. However, despite its prevalence, most women who present with depressive symptoms are not screened and do not receive adequate treatment. We examined the clinical co-diagnosis of depression and/or anxiety among maternal and non-maternal hospitalizations among females aged 14-49 from the Nationwide Inpatient Sample (NIS) between 2004 and 2013 (n = 83,472,775). Meta-regression was used to determine annual change and presence of temporal trends. Survey logistic regression was used to examine the association with sociodemographic factors. Rates of diagnosis of depression and/or anxiety disorders demonstrated a temporal increase from 2004-2013, and this increase was mainly driven by non-maternal hospitalizations compared to maternal. Furthermore, non-maternal hospitalizations demonstrated a greater prevalence of depression and/or anxiety diagnoses compared to maternal hospitalizations over the same time period (21•7% versus 2•8%). Among all female hospitalizations, whites were roughly twice as likely as minorities to have a diagnosis of depression and/or anxiety. These results add to the evidence suggestive of the underdiagnosed depression/anxiety present among women of reproductive age, particularly pregnant women and minorities, and underscore the critical role of obstetricians in treating both physical and mental health.
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Affiliation(s)
- Elizabeth C Pino
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA, USA
| | - Yi Zuo
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA, USA
| | - Shayna H Schor
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Stephanie Zatwarnicki
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - David C Henderson
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Christina Pc Borba
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Snezana M Milanovic
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Bindu Kalesan
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA, USA.
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Denckla CA, Spies G, Heaton R, Vasterling J, Franklin D, Korte KJ, Colgan C, Henderson DC, Koenen KC, Seedat S. Generalizability of demographically corrected Zambian neuropsychological norms to South African women. Clin Neuropsychol 2019; 33:40-57. [PMID: 30950749 PMCID: PMC6778499 DOI: 10.1080/13854046.2019.1588995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Objective: Demographically corrected norms typically account for the effects of age, education, and in some cases, sex and other factors (e.g. race/ethnicity). However, generalizability of normative standards to different countries and ethnic groups is not universal. This study sought to determine whether demographically specific Zambian neuropsychological norms would generalize to a group of South African women.Method: 212 English-Xhosa bilingual, South African (SA) women were administered a comprehensive neuropsychological (NP) test battery in either English or Xhosa. We examined rates of "impairment" using Global Deficit Scores (GDS) based upon published, demographically corrected norms from a nearby African country (Zambia). Using multiple regression, we examined the extent to which Zambian norms "corrected" for the effects of age and education in this SA sample.Results: Compared to the normative standards from Zambia, the South African women performed somewhat worse than expected on a few test measures and better than expected on others, but their GDS and associated "impairment" rates were close to what was seen in Zambia. Demographically corrected Zambian norms adequately adjusted for the effects of age and years of education in this sample of SA women, with the exception that Zambian norms appeared to "under correct" for the positive effects of years of education on tests of information processing speed.Conclusions: Demographically corrected norms developed for Zambia may adequately adjust for the effects of age in SA women. Further research is needed to determine whether additional corrections for education are needed in SA, especially for tests of information processing speed.
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Affiliation(s)
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | - Robert Heaton
- HIV Neurobehavioral Research Center at the University of California, La Jolla, CA, USA
| | - Jennifer Vasterling
- VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Center at the University of California, La Jolla, CA, USA
| | - Kristina J. Korte
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Courtney Colgan
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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32
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Pino EC, Zuo Y, Borba CP, Henderson DC, Kalesan B. Reply to psychiatric disorders' paradoxical protective effect on cardiovascular procedures and mortality. Psychiatry Res 2018; 270:1181-1183. [PMID: 30470578 DOI: 10.1016/j.psychres.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Elizabeth C Pino
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, 801 Massachusetts Ave, Room 475, Boston, MA, United States
| | - Yi Zuo
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, 801 Massachusetts Ave, Room 475, Boston, MA, United States
| | - Christina Pc Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Bindu Kalesan
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, 801 Massachusetts Ave, Room 475, Boston, MA, United States.
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Pino EC, Zuo Y, Borba CP, Henderson DC, Kalesan B. Clinical depression and anxiety among ST-elevation myocardial infarction hospitalizations: Results from Nationwide Inpatient Sample 2004-2013. Psychiatry Res 2018; 266:291-300. [PMID: 29615266 DOI: 10.1016/j.psychres.2018.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/13/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
Depression and anxiety are common among patients who have a major cardiovascular event. However, despite their frequency, there is a lack of evidence regarding the relationship between depression and/or anxiety and receiving revascularization in ST-elevation myocardial infarction (STEMI) hospitalizations. Using data from the Nationwide Inpatient Sample (NIS) from the years 2004 to 2013, we assessed whether a clinical co-diagnosis of depression and/or anxiety decreases the likelihood of revascularization among STEMI hospitalizations. Our central finding is that, paradoxically, the odds of in-hospital mortality were lower among STEMI hospitalizations with a clinical co-diagnosis of depression and/or anxiety as compared to those without. We further discovered that clinical diagnoses of depression and/or anxiety were less prevalent among revascularized as compared to non-revascularized STEMI hospitalizations. However, the percentage of clinical diagnoses of depression and/or anxiety among STEMI hospitalizations increased at a similar rate over a 10-year period irrespective of revascularization status. In conclusion, these results are suggestive of the potentially underdiagnosed mental health issues surrounding major cardiovascular events, and indeed, chronic disease as a whole. To our knowledge, this is the first study to document and examine the "depression paradox" among a population of cardiac patients.
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Affiliation(s)
- Elizabeth C Pino
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Yi Zuo
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Christina Pc Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Bindu Kalesan
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
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Levey EJ, Gelaye B, Koenen K, Zhong QY, Basu A, Rondon MB, Sanchez S, Henderson DC, Williams MA. Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women. Arch Womens Ment Health 2018; 21:193-202. [PMID: 28905129 PMCID: PMC5849493 DOI: 10.1007/s00737-017-0776-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/04/2017] [Indexed: 11/28/2022]
Abstract
Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
- Institute for Juvenile Research, University of Illinois College of Medicine, Chicago, IL, 60608, USA.
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Karestan Koenen
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Qiu-Yue Zhong
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Archana Basu
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Sixto Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, 02118, USA
- Boston University School of Medicine, Boston, MA, 02118, USA
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Herman AR, Pullen SJ, Lange BCL, Christian-Brathwaite N, Ulloa M, Kempeh M, Karnga D, Johnson D, Harris B, Henderson DC, Borba CPC. Closing the Mental Health Treatment Gap through the Collaboration of Traditional and Western Medicine in Liberia. Int J Cult Ment Health 2018; 11:693-704. [PMID: 31467591 DOI: 10.1080/17542863.2018.1556715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Liberians have experienced significant psychological trauma following fourteen years of violent civil war and the 2014-2015 Ebola epidemic, but there are only two psychiatrists for the entire population. However, many traditional healers commonly treat mental health-related illnesses throughout the country. This paper examines the potential for collaboration between traditional and Western medicine to close the mental health treatment gap in Liberia. We conducted 35 semi-structured qualitative interviews with Liberian traditional healers and utilizers of traditional medicine asking questions about common health problems, treatments, beliefs, and personal preferences. Participants discussed cultural attitudes, beliefs, and structural factors that may influence collaboration between traditional and Western medicine. Healers expressed willingness to collaborate in order to strengthen their skills, though realized Western physicians were hesitant to collaborate. Additionally, Liberians believed in both medical traditions, though preferred Western medicine. Finally, structural factors such as geographic distance and financial barriers made traditional medicine more accessible than Western medicine. Traditional healers and utilizers support collaboration as evidenced by their perceptions of cultural attitudes, beliefs, and structural factors within the Liberian context. With Liberia's overwhelming mental illness burden, collaboration between traditional healers and Western medicine physicians offers a solution to the treatment gap in Liberian mental health care.
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Affiliation(s)
- Augusta R Herman
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118, (617) 638-4640
| | - Samuel J Pullen
- Department of Psychiatry and Behavioral Health, St. Luke's Health System, 190 E Bannock St, Boise, ID 83712, (208) 381-2222
| | - Brittany C L Lange
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118, (617) 638-4640
| | | | - Melissa Ulloa
- New York University Steinhardt School of Culture, Education and Human Development, 82 Washington Square E, New York, NY 10003, (212) 998-4500
| | - Michael Kempeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine, University of Liberia, Monrovia, Liberia, West Africa, +231 88 639 8593
| | - Dyujay Karnga
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine, University of Liberia, Monrovia, Liberia, West Africa, +231 88 639 8593
| | - Dorothy Johnson
- Christ Jubilee International Ministries, 101 Smith St, Lowell, MA 01851, (978) 452-9976
| | - Benjamin Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia, College of Medicine, University of Liberia, Monrovia, Liberia, West Africa, +231 88 639 8593
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, 720 Harrison Avenue, Suite #1150 Boston, MA 02118, (617) 414-1915
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, 720 Harrison Avenue, Suite #1150 Boston, MA 02118, (617) 414-1915
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Jackson JW, Fulchino L, Rogers J, Mogun H, Polinski J, Henderson DC, Schneeweiss S, Fischer MA. "Impact of drug-reimbursement policies on prescribing: A case-study of a newly marketed long-acting injectable antipsychotic among relapsed schizophrenia patients". Pharmacoepidemiol Drug Saf 2017; 27:95-104. [PMID: 29168261 DOI: 10.1002/pds.4354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To quantify and explain variation in use of long-acting injectable antipsychotics (LAIs) in the United States, and understand the relationship between patient characteristics, drug reimbursement policies, and LAI prescribing after relapse. METHODS A cohort of recently relapsed patients with schizophrenia ages 18 to 64, were identified immediately after discharge from a related inpatient hospitalization, partial hospitalization, or emergency room visit, drawn from 2004 to 2006 Medicaid claims, and followed for 90 days until LAI initiation. Data on state-level Medicaid prior authorization (PA) policies for LAIs were collected. Sequential longitudinal Poisson regression models were developed to understand the relationship between patient and PA policy variables and LAI prescribing, including prior adherence to oral antipsychotics, demographics, clinical variables, and presence of PA policy for LAI. RESULTS Among 36 282 patients, 3.1% received risperidone LAI, and 3.8% received a first-generation (FGA) LAI with wide variation across states. Prior adherence ranged from 29% to 89% but was marginally associated with initiation and did not explain variation for LAI prescribing. FGA initiation was associated with geography and race/ethnicity but not PA policy. For risperidone LAI initiation, demographics and clinical factors explained, respectively, 5.0% and 3.0% of the variation; PA policy had a large negative association with initiation (RR = 0.41; 95%CI 0.20-0.87) and explained 8.4% of the variation. CONCLUSIONS PA policies may represent a major treatment barrier for risperidone LAI among relapsed patients. Non-adherence plays a little role in predicting which patients receive LAIs. Policy makers and health insurers will need to consider these findings when guiding the use of LAIs. KEY POINTS Among a nationwide cohort of relapsed schizophrenia patients enrolled in US Medicaid, 3.1% received Risperdal Consta, a long-acting injectable antipsychotic (LAI), and 3.8% initiated a first-generation first-generation LAI within 90 days after discharge. During 2004 to 2006, there was marked variation in 90 day post-relapse initiation of Risperdal-Consta-a newly marketed medication during this period-and also marked variation in 90 day post-relapse initiation of any first-generation LAI, which appeared to be associated with race/ethnicity and geography. Prior authorization policies were associated with substantially lower initiation of Risperdal Consta in this cohort of relapsed patients even after accounting for clinical indication (non-adherence), relapse history, demographics, adjunctive medication, and mental health service use.
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Affiliation(s)
- John W Jackson
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Schizophrenia Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Lisa Fulchino
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - James Rogers
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Polinski
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,CVS Caremark Corporation, Woonsocket, RI, USA
| | - David C Henderson
- Schizophrenia Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Nemani KL, Greene MC, Ulloa M, Vincenzi B, Copeland PM, Al-Khadari S, Henderson DC. Clozapine, Diabetes Mellitus, Cardiovascular Risk and Mortality: Results of a 21-Year Naturalistic Study in Patients with Schizophrenia and Schizoaffective Disorder. ACTA ACUST UNITED AC 2017; 12:168-176. [PMID: 29164928 DOI: 10.3371/csrp.knmg.111717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The goal of this 21-year naturalistic study of clozapine-treated patients was to examine the cardiovascular risk factors following clozapine initiation and resultant mortality estimates from cardiovascular disease. Data were collected from January 1992 to February 2012 medical records from clozapine-treated patients with schizophrenia or schizoaffective disorder. Demographics, clozapine dosage and laboratory results were extracted at 12-month intervals. At clozapine initiation, the mean age of the 96 patients was 36.4 years±7.6 years; n=27 (28%) were women. The mean duration of clozapine use was 13 years. The Kaplan-Meier estimate for 21-year cardiovascular events was 29%, while the Kaplan-Meier estimate for 21-year mortality from cardiovascular disease was 10%. The mean cardiovascular risk increased during the first ten years (p<.01), while a slight decrease occurred beyond ten years (p<.01). Patients involved in cardiometabolic research showed a greater decrease in cardiovascular risk factors over 21 years (p=.05). The Kaplan-Meier estimate for 21-year all-cause mortality was 22%. Forty-one patients were diagnosed with diabetes (42.7%), compared to a nationwide prevalence of 13.7% in a similar age group. These results support the hypothesis that clozapine-treated patients are at risk for cardiovascular events and death secondary to an increased risk of medical disorders. Interventions that target weight loss, smoking cessation, and lipid profile improvement may alleviate the increased risk of cardiovascular mortality.
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Fan X, Song X, Zhao M, Jarskog LF, Natarajan R, Shukair N, Freudenreich O, Henderson DC, Goff DC. The effect of adjunctive telmisartan treatment on psychopathology and cognition in patients with schizophrenia. Acta Psychiatr Scand 2017; 136:465-472. [PMID: 28851055 PMCID: PMC5630515 DOI: 10.1111/acps.12799] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examined the effect of adjunctive telmisartan on psychopathology and cognition in olanzapine- or clozapine-treated patients with schizophrenia. METHOD In a 12-week randomized, double-blind, placebo-controlled study, patients diagnosed with schizophrenia or schizoaffective disorder received either telmisartan (80 mg once per day) or placebo. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Scale for Assessment of Negative Symptoms (SANS), and a neuropsychological battery was used to assess cognitive performance. Assessments for psychopathology and cognition were conducted at baseline and week 12. RESULTS Fifty-four subjects were randomized, and 43 completed the study (22 in the telmisartan group, 21 in the placebo group). After 12-weeks of treatment, the telmisartan group had a significant decrease in PANSS total score compared withthe placebo group (mean ± SD: - 4.1 ± 8.1 vs. 0.4 ± 7.5, P = 0.038, SCohen's d = 0.57). There were no significant differences between the two groups in change from baseline to week 12 in PANSS subscale scores, SANS total score, or any cognitive measures (P > 0.100). CONCLUSION The present study suggests that adjunctive treatment with telmisartan may improve schizophrenia symptoms. Future trials with larger sample sizes and longer treatment durations are warranted.
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Affiliation(s)
- Xiaoduo Fan
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA,Corresponding Author: Xiaoduo Fan, M.D., M.P.H., M.S., University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA 01605, ; Phone: (508) 856-3881. Xueqin Song, MD, PhD, The 1 Affiliated Hospital of Zhengzhou University,
| | - Xueqin Song
- Department of Psychiatry, The1 Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Corresponding Author: Xiaoduo Fan, M.D., M.P.H., M.S., University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA 01605, ; Phone: (508) 856-3881. Xueqin Song, MD, PhD, The 1 Affiliated Hospital of Zhengzhou University,
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai, China
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Radhika Natarajan
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA
| | - Nawras Shukair
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA
| | - Oliver Freudenreich
- Schizophrenia Program, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - David C. Henderson
- Department of Psychiatry, Boston University/Boston Medical Center, Boston, MA
| | - Donald C. Goff
- Department of Psychiatry, New York University Medical School and Nathan Kline Institute, New York, NY
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Mehralizade A, Schor S, Coleman CM, Oppenheim CE, Denckla CA, Borba CP, Henderson DC, Wolff J, Crane S, Nettles-Gomez P, Pal A, Milanovic S. Mobile Health Apps in OB-GYN-Embedded Psychiatric Care: Commentary. JMIR Mhealth Uhealth 2017; 5:e152. [PMID: 28986335 PMCID: PMC5650672 DOI: 10.2196/mhealth.7988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
This paper explores the potential benefits of the use of mobile health (mHealth) apps in obstetrician-gynecologist (OB-GYN)-embedded psychiatric clinics in the United States. First, we highlight the increasing trend of integrating mental health care within the OB-GYN context. Second, we provide examples of successful uses of mHealth in the global health context and highlight the dearth of available research in the United States. Finally, we provide a summary of the shortcomings of currently available apps and describe the upcoming trial of a novel app currently underway at the Mother-Child Wellness Clinical and Research Center at Boston Medical Center.
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Affiliation(s)
| | - Shayna Schor
- Boston Medical Center, Boston, MA, United States
| | | | | | - Christy A Denckla
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | | | | | - James Wolff
- Boston University School of Public Health, Boston, MA, United States
| | - Sarah Crane
- Boston Medical Center, Boston, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Pamela Nettles-Gomez
- Boston Medical Center, Boston, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Avik Pal
- CliniOps, Fremont, CA, United States
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Hock RS, Bryce CP, Waber DP, McCuskee S, Fitzmaurice GM, Henderson DC, Galler JR. Relationship between infant malnutrition and childhood maltreatment in a Barbados lifespan cohort. Vulnerable Child Youth Stud 2017; 12:304-313. [PMID: 30034507 PMCID: PMC6051436 DOI: 10.1080/17450128.2017.1371817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Childhood malnutrition and maltreatment (abuse, neglect) are both prevalent, particularly in resource-limited settings. Despite their known negative impact on child development, there is surprisingly little research documenting their interrelationships. To address this gap, we administered the Childhood Trauma Questionnaire-Short Form (CTQ-SF), a retrospective structured self-report of childhood abuse and neglect, in a Barbadian cohort of 77 adult survivors of infant malnutrition, limited to the first year of life, and 62 healthy controls from the same classrooms and neighborhoods (mean age ± SD = 43.8±2.3 years). This cohort has been followed since birth. Using factor analysis and comparison with archival data addressing similar constructs, we found evidence for reliability and validity of the CTQ-SF in this population. Linear regression analyses, with and without adjusting for childhood household standard of living at three childhood ages, revealed that a history of infant malnutrition was significantly associated with increased levels of self-reported physical neglect in childhood, and, to a somewhat lesser degree, emotional neglect. This study highlights the co-occurrence of infant malnutrition and self-reported maltreatment in childhood in Barbados, with potential public health implications.
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Affiliation(s)
- Rebecca S. Hock
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cyralene P. Bryce
- Harvard Medical School, Boston, MA, USA
- Barbados Nutrition Study, Bridgetown, Barbados
| | - Deborah P. Waber
- Harvard Medical School, Boston, MA, USA
- Children’s Hospital Boston, Boston, MA, USA
| | - Sarah McCuskee
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Garrett M. Fitzmaurice
- McLean Hospital, Belmont, MA, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - David C. Henderson
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Janina R. Galler
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center on the Developing Child, Harvard University, Cambridge, MA, USA
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Musyimi CW, Mutiso VN, Ndetei DM, Unanue I, Desai D, Patel SG, Musau AM, Henderson DC, Nandoya ES, Bunders J. Mental health treatment in Kenya: task-sharing challenges and opportunities among informal health providers. Int J Ment Health Syst 2017; 11:45. [PMID: 28775764 PMCID: PMC5540195 DOI: 10.1186/s13033-017-0152-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background The study was conducted to explore challenges faced by trained informal health providers referring individuals with suspected mental disorders for treatment, and potential opportunities to counter these challenges. Methods The study used a qualitative focus group approach. It involved community health workers, traditional and faith healers from Makueni County in Kenya. Ten Focus Group Discussions were conducted in the local language, recorded and transcribed verbatim and translated. Using a thematic analysis approach, data were entered into NVivo 7 for analysis and coding. Results Results demonstrate that during the initial intake phase, challenges included patients’ mistrust of informal health providers and cultural misunderstanding and stigma related to mental illness. Between initial intake and treatment, challenges related to resource barriers, resistance to treatment and limitations of the referral system. Treatment infrastructure issues were reported during the treatment phase. Various suggestions for solving these challenges were made at each phase. Conclusions These findings illustrate the commitment of informal health providers who have limited training to a task-sharing model under difficult situations to increase patients’ access to mental health services and quality care. With the identified opportunities, the expansion of this type of research has promising implications for rural communities.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | - Victoria N Mutiso
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David M Ndetei
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,University of Nairobi, P.O Box 30197, Nairobi, 00100 Kenya
| | - Isabel Unanue
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Dhru Desai
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Sita G Patel
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Abednego M Musau
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David C Henderson
- Boston University School of Medicine, 72 E. Concord St, Boston, MA 02118 USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Erick S Nandoya
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - Joske Bunders
- Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
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42
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Welch LC, Trudeau JJ, Silverstein SM, Sand M, Henderson DC, Rosen RC. Initial development of a patient-reported outcome measure of experience with cognitive impairment associated with schizophrenia. Patient Relat Outcome Meas 2017; 8:71-81. [PMID: 28652836 PMCID: PMC5476762 DOI: 10.2147/prom.s123266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive impairment is a serious, often distressing aspect of schizophrenia that affects patients' day-to-day lives. Although several interview-based instruments exist to assess cognitive functioning, a reliable measure developed based on the experiences of patients facing cognitive difficulties is needed to complement the objective performance-based assessments. The present article describes the initial development of a patient-reported outcome (PRO) measure to assess the subjective experience of cognitive impairment among patients with schizophrenia, the Patient-Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS). The phases of development included the construction of a conceptual model based on the existing knowledge and two sets of qualitative interviews with patients: 1) concept elicitation interviews to ensure face and content validity from the perspective of people with schizophrenia and 2) cognitive debriefing of the initial item pool. Input from experts was elicited throughout the process. The initial conceptual model included seven domains. The results from concept elicitation interviews (n=80) supported these domains but yielded substantive changes to concepts within domains and to terminology. Based on these results, an initial pool of 53 items was developed to reflect the most common descriptions and languages used by the study participants. Cognitive debriefing interviews (n=22) resulted in the removal of 18 items and modification of 22 other items. The remaining 35 items represented 23 concepts within six domains plus two items assessing bother. The draft PRO measure is currently undergoing psychometric testing as a precursor to broad-based clinical and research use.
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Affiliation(s)
- Lisa C Welch
- Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA
| | - Jeremiah J Trudeau
- Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT
| | - Steven M Silverstein
- University Behavioral Health Care, Department of Psychiatry, Rutgers University, Piscataway, NJ
| | - Michael Sand
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT
| | - David C Henderson
- Boston Medical Center, School of Medicine, Boston Univeristy, Boston
| | - Raymond C Rosen
- Epidemiology, New England Research Institutes, Watertown, MA, USA
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Chemali Z, Borba CPC, Johnson K, Hock RS, Parnarouskis L, Henderson DC, Fricchione GL. Humanitarian space and well-being: effectiveness of training on a psychosocial intervention for host community-refugee interaction. Med Confl Surviv 2017; 33:141-161. [PMID: 28497699 DOI: 10.1080/13623699.2017.1323303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Social and fieldworkers face enormous challenges in assisting millions of Syrian refugees in Lebanon since the Syrian war in 2011. We sought to assess the feasibility and acceptability of an adapted version of the SMART-3RP (Stress Management Relaxation Response Resilience Training) training to address the emotional and physical burden on the humanitarian field. Data were collected using the Symptom Checklist-90 (SCL-90), blood pressure, pulse and a brief qualitative survey at months 0, 3, 6 and 9. We compared mean SCL-90 scores and physiological measures from these time points and subjected qualitative data to a thematic analysis. Mean values of all measures decreased from months 0 to 9, with significance in SCL-90 changes increasing at each visit. Qualitative themes included decreased stress, increased positivity and problem-solving skills, interpersonal and personal benefits of mindfulness practice and the need to continue and expand the programme. Qualitative and quantitative analyses showed a decrease in stress perception and blood pressure, demonstrating the physiological benefits of mind body approaches. We highlight the importance of self-care for humanitarian workers as the basis for the mission's success. We invite additional research to confirm these findings and their implications for the humanitarian field.
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Affiliation(s)
- Zeina Chemali
- a The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital , Boston , MA USA.,b Benson Henry Institute for Mind Body Medicine , Harvard Medical School , Boston , MA , USA
| | - Christina P C Borba
- c Department of Psychiatry , Boston Medical Center , Boston , MA , USA.,d Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Kelsey Johnson
- c Department of Psychiatry , Boston Medical Center , Boston , MA , USA
| | - Rebecca S Hock
- a The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital , Boston , MA USA
| | - Lindsey Parnarouskis
- a The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital , Boston , MA USA
| | - David C Henderson
- c Department of Psychiatry , Boston Medical Center , Boston , MA , USA.,d Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Gregory L Fricchione
- a The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital , Boston , MA USA.,b Benson Henry Institute for Mind Body Medicine , Harvard Medical School , Boston , MA , USA
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Musyimi CW, Mutiso VN, Nayak SS, Ndetei DM, Henderson DC, Bunders J. Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya. Health Qual Life Outcomes 2017; 15:95. [PMID: 28482849 PMCID: PMC5422872 DOI: 10.1186/s12955-017-0657-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population. Method This was a cross-sectional epidemiological survey (n = 443) conducted over a period of 3 months among adult patients seeking care from traditional and faith healers in rural Kenya. Data were collected using the Beck Depression Inventory II (BDI-II), Beck Scale for Suicide Ideation (BSS) and WHO Quality of Life Survey- BREF (WHOQOL-BREF), and analyzed using correlation analyses, parametric tests, and regression analyses. Results Increasing levels of depression were associated with lower QoL among patients seeking care from traditional and faith healers. BSS scores were significantly negatively correlated with overall, physical, psychological, and environmental QoL, p < .05. There was a statistically significant difference between mean scores for overall QoL between depressed (M = 2.35, SD = 0.76) and non-depressed participants (M = 3.03, SD = 0.67), t(441) = 8.899, p < .001. Overall life satisfaction for depressed participants (M = 2.23, SD = 0.69) was significantly lower than non-depressed participants. Regression analyses indicated that depression, suicidal ideation, and being married predicted lower overall QoL controlling for other variables. Post hoc tests and subgroup analysis by gender revealed significant differences for females only. Depression, and older age predicted lower life satisfaction whereas being self-employed predicted higher life satisfaction, when controlling for other variables. Conclusion This study sheds light on correlates of QoL in depressed and non-depressed patients in rural Kenya. Evidence suggests that traditional and faith healers treat patients with a variety of QoL issues. Further research should focus on understanding how these issues tie into QoL, and how these healers can target these to improve care.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
| | - David C Henderson
- Boston University School of Medicine, Boston, USA.,Harvard Medical School, Boston, USA
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45
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Parnarouskis L, Stevenson A, Lange BC, Pullen SJ, Petruzzi LJ, Dominguez S, Quiterio N, Harris B, Lekpeh GG, Manobah B, Henderson DC, Borba CP. The impact of transactional sex with teachers on public school students in Monrovia, Liberia - a brief report. Vulnerable Child Youth Stud 2017; 12:328-333. [PMID: 29354188 PMCID: PMC5773053 DOI: 10.1080/17450128.2017.1300721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Access to education has been shown to strongly influence adolescent health across the world, and strong relationships with teachers has been found to lead to better academic and psychosocial outcomes for students. In many low-income countries where adolescents have less access to education and are more likely to experience poor health outcomes, risky sexual behaviors can exacerbate these challenges by increasing the risk of unintended pregnancy and sexually transmitted infections. This study sought to examine risky behaviors, such as substance use and risky sexual practices, of in-school youth in Liberia, a country in West Africa. Nine focus groups were conducted with public school students in Monrovia, Liberia in April 2012 using a semi-structured guide. The sessions took place in three public schools with n = 72 participants aged 12-20 years old. Following thematic content analysis, a pattern emerged of transactional sex between female students and male teachers, which often led to contrived and coercive relationships for the students. Conversely, participants reported that educators were not disciplined for having sex with students. Interventions to reduce the prevalence of transactional sex within the academic environment would likely protect the well being of school-going youth, particularly female youth, and support students' academic pursuits in Liberia.
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Affiliation(s)
- Lindsey Parnarouskis
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Anne Stevenson
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brittany C.L. Lange
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel J. Pullen
- Behavioral Health Services, St. Luke‘s Magic Valley Regional Medical Center, Twin Falls, ID, USA
| | - Liana J. Petruzzi
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Silvia Dominguez
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Nicole Quiterio
- Oakland Clinic, Bay Area Children’s Association, Oakland, CA, USA
| | - Benjamin Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - G. Gondah Lekpeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Burgess Manobah
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - David C. Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina P.C. Borba
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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46
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Levey EJ, Gelaye B, Bain P, Rondon MB, Borba CPC, Henderson DC, Williams MA. A systematic review of randomized controlled trials of interventions designed to decrease child abuse in high-risk families. Child Abuse Negl 2017; 65:48-57. [PMID: 28110205 PMCID: PMC5346446 DOI: 10.1016/j.chiabu.2017.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/18/2016] [Accepted: 01/05/2017] [Indexed: 05/24/2023]
Abstract
Child abuse is a global problem, and parents with histories of childhood abuse are at increased risk of abusing their offspring. The objective of this systematic review is to provide a clear overview of the existing literature of randomized controlled trials evaluating the effectiveness of interventions to prevent child abuse. PubMed, PsychINFO, Web of Science, Sociological Abstracts, and CINAHL were systematically searched and expanded by hand search. This review includes all randomized controlled trials (RCTs) of interventions designed to prevent abuse among mothers identified as high-risk. Of the eight studies identified, only three found statistically significant reductions in abuse by any measure, and only two found reductions in incidents reported to child protective services. While much has been written about child abuse in high-risk families, few RCTs have been performed. Only home visitation has a significant evidence base for reducing child abuse, and the findings vary considerably. Also, data from low- and middle-income countries are limited.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 5 Longfellow Pl., Suite 215, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Institute for Juvenile Research, University of Illinois College of Medicine, 1747 W Roosevelt Rd., Chicago, IL 60608, USA.
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
| | - Paul Bain
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Marta B Rondon
- Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, San Martin de Porras, Lima, Peru
| | - Christina P C Borba
- Boston Medical Center, Department of Psychiatry, 840 Harrison Ave., Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA
| | - David C Henderson
- Boston Medical Center, Department of Psychiatry, 840 Harrison Ave., Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA
| | - Michelle A Williams
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
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47
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Levey EJ, Oppenheim CE, Lange BCL, Plasky NS, Harris BL, Lekpeh GG, Kekulah I, Henderson DC, Borba CPC. A qualitative analysis of parental loss and family separation among youth in post-conflict Liberia. Vulnerable Child Youth Stud 2017; 12:1-16. [PMID: 28163770 PMCID: PMC5214285 DOI: 10.1080/17450128.2016.1262978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/09/2016] [Indexed: 06/06/2023]
Abstract
Between 1989 and 2003, the Republic of Liberia experienced a brutal civil war. In 2008, the population was approximately 3.5 million people, and there were an estimated 340,000 orphans. Nearly 6000 more children were orphaned by the Ebola epidemic from 2014-2015. The goal of this research was to explore the impact of parental loss, identify moderating factors, and consider interventions that could help vulnerable youth in post-conflict societies following the loss of a parent. Seventy-five young people (age 13-18 years) in Monrovia, the capital city of Liberia, were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. The loss of a parent or other primary caregiver had a significant impact on psychosocial and emotional health. The timing of the loss, strength of connection with the deceased parent, and relationship with surviving parent or substitute caregiver were all relevant factors. Children separated from living parents were functioning better than those whose parents were deceased. The case of Liberian children underscores the importance of early caregiver relationships and the difficulties children face when such relationships are disrupted. Children who did not experience stable early relationships suffered disconnection from their families and communities.
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Affiliation(s)
- Elizabeth J. Levey
- Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | | | | | - Naomi S. Plasky
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - G. Gondah Lekpeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Isaac Kekulah
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Christina P. C. Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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48
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Denckla CA, Consedine NS, Spies G, Cherner M, Henderson DC, Koenen KC, Seedat S. Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma. Eur J Psychotraumatol 2017; 8:1394146. [PMID: 29163865 PMCID: PMC5687801 DOI: 10.1080/20008198.2017.1394146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Prior research on adaptation after early trauma among black South African women typically assessed resilience in ways that lacked contextual specificity. In addition, the neurocognitive correlates of social and occupational resilience have not been investigated. Objective: The primary aim of this exploratory study was to identify domains of neurocognitive functioning associated with social and occupational resilience, defined as functioning at a level beyond what would be expected given exposure to childhood trauma. Methods: A sample of black South African women, N = 314, completed a neuropsychological battery, a questionnaire assessing exposure to childhood trauma, and self-report measures of functional status. We generated indices of social and occupational resilience by regressing childhood trauma exposure on social and occupational functioning, saving the residuals as indices of social and occupational functioning beyond what would be expected given exposure to childhood trauma. Results: Women with lower non-verbal memory evidenced greater social and occupational resilience above and beyond the effects attributable to age, education, HIV status, and depressive and posttraumatic stress symptoms. In addition, women with greater occupational resilience exhibited lower semantic language fluency and processing speed. Conclusion: Results are somewhat consistent with prior studies implicating memory effects in impairment following trauma, though our findings suggest that reduced abilities in these domains may be associated with greater resilience. Studies that use prospective designs and objective assessment of functional status are needed to determine whether non-verbal memory, semantic fluency, and processing speed are implicated in the neural circuitry of post-traumatic exposure resilience.
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Affiliation(s)
- C A Denckla
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - N S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - G Spies
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - M Cherner
- HIV Neurobehavioral Research Center, University of California, San Diego, CA, USA
| | - D C Henderson
- Boston Medical Center, Boston University, Boston, MA, USA
| | - K C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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49
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Levey EJ, Oppenheim CE, Lange BCL, Plasky NS, Harris BL, Lekpeh GG, Kekulah I, Henderson DC, Borba CPC. A qualitative analysis of factors impacting resilience among youth in post-conflict Liberia. Child Adolesc Psychiatry Ment Health 2016; 10:26. [PMID: 27525038 PMCID: PMC4983000 DOI: 10.1186/s13034-016-0114-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2008, 5 years after the Liberian civil war ended, there were an estimated 340,000 orphans in Liberia, 18 % of the total child population of the country. Given that children make up half the population and that these children experienced significant trauma and loss both through direct exposure to the war and then to the Ebola epidemic, and indirectly as a result of the trauma experienced by their parents, the recovery of these children is essential to the recovery of the nation as a whole. The goal of this research was to identify factors contributing to resilience among youth in post-conflict Liberia. Resilience was defined as evidence of adaptive functioning and psychological health. METHODS Seventy-five young people (age 13-18) in the capital city of Monrovia, Liberia were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. RESULTS Forty-six of the participants were attending school, and 29 were not enrolled in school. Youth enrolled in school demonstrated greater adaptive functioning. This was particularly true for boys in any school setting and girls attending private school. Youth not attending school were more likely to have lost family members or become estranged from them, and many were also engaging in substance use. Emotion regulation, cognitive flexibility, agency, social intelligence and, in some cases, meaning-making were found in participants who showed resilient outcomes. CONCLUSIONS Caregiver relationships mediate the development of psychological capacities that impact resilience. These findings suggest that youth who have lost a caregiver, many of whom are not attending school, are experiencing a significant ongoing burden in terms of their daily functioning and psychological health in the post-war period and should be the focus of further study and intervention targeting substance use and community reintegration. Trial registration Partners Healthcare IRB Protocol# 2012P000367.
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Affiliation(s)
- Elizabeth J. Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 5 Longfellow Place, Boston, MA 02114 USA ,Harvard Medical School, 25 Shattuck St., Boston, MA 02115 USA ,University of Illinois College of Medicine, 1853 West Polk St, Chicago, IL 60612 USA
| | - Claire E. Oppenheim
- Department of Psychiatry, Boston Medical Center, 840 Harrison Ave, Boston, MA 02118 USA
| | - Brittany C. L. Lange
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, UK
| | - Naomi S. Plasky
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205 USA
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - G. Gondah Lekpeh
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Isaac Kekulah
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, 840 Harrison Ave, Boston, MA 02118 USA ,Boston University School of Medicine, 72 East Concord St, Boston, MA 02118 USA
| | - Christina P. C. Borba
- Department of Psychiatry, Boston Medical Center, 840 Harrison Ave, Boston, MA 02118 USA ,Boston University School of Medicine, 72 East Concord St, Boston, MA 02118 USA
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Ng LC, Magidson JF, Hock RS, Joska JA, Fekadu A, Hanlon C, Galler JR, Safren SA, Borba CPC, Fricchione GL, Henderson DC. Proposed Training Areas for Global Mental Health Researchers. Acad Psychiatry 2016; 40:679-85. [PMID: 26976395 PMCID: PMC4938780 DOI: 10.1007/s40596-016-0518-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/16/2016] [Indexed: 05/17/2023]
Affiliation(s)
- Lauren C Ng
- Massachusetts General Hospital, Boston, MA, USA.
| | | | | | - John A Joska
- University of Cape Town, Cape Town, South Africa
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