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Maudrie TL, Grubin F, Conrad M, Velasquez Baez J, Saniguq Ullrich J, Allison-Burbank J, Martin L, Austin C, Joyner J, Ronyak M, Masten K, Ingalls A, Haroz EE, O’Keefe VM. Honoring our teachings: children's storybooks as indigenous public health practice. Front Public Health 2024; 12:1354761. [PMID: 38463160 PMCID: PMC10924303 DOI: 10.3389/fpubh.2024.1354761] [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: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction American Indian and Alaska Native (AIAN) communities continue to flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an important tradition for AIAN communities that can function as an intervention modality. To support the needs of AIAN children and caregivers, we (a collaborative workgroup of Indigenous health researchers) developed a culturally grounded storybook that provides pandemic-related public health guidance and mental health coping strategies woven with Inter-Tribal values and teachings. Methods A collaborative workgroup, representing diverse tribal affiliations, met via four virtual meetings in early 2021 to discuss evolving COVID-19 pandemic public health guidance, community experiences and responses to emerging challenges, and how to ground the story in shared AIAN cultural strengths. We developed and distributed a brief survey for caregivers to evaluate the resulting book. Results The workgroup iteratively reviewed versions of the storyline until reaching a consensus on the final text. An AI artist from the workgroup created illustrations to accompany the text. The resulting book, titled Our Smallest Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 contains 46 pages of text and full-color illustrations. An online toolkit including coloring pages, traditional language activities, and caregiver resources accompanies the book. We printed and distributed 50,024 physical copies of the book and a free online version remains available. An online survey completed by N = 34 caregivers who read the book with their child(ren) showed strong satisfaction with the book and interest in future books. Discussion The development of this storybook provides insights for creative dissemination of future public health initiatives, especially those geared toward AIAN communities. The positive reception and widespread interest in the storybook illustrate how braiding AIAN cultural teachings with public health guidance can be an effective way to disseminate health information. This storybook highlights the importance of storytelling as an immersive learning experience through which caregivers and children connect to family, community, culture, and public health guidance. Culturally grounded public health interventions can be effective and powerful in uplifting AIAN cultural values and promoting health and well-being for present and future generations.
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Affiliation(s)
- Tara L. Maudrie
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Fiona Grubin
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Maisie Conrad
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Jocelyn Velasquez Baez
- Department of Molecular Biology and Biochemistry, Wesleyan University, Middletown, CT, United States
| | - Jessica Saniguq Ullrich
- Institute for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, United States
| | | | - Lisa Martin
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Crystal Austin
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Joelle Joyner
- Department of Public Health, Wayne State University, Detroit, MI, United States
| | | | - Kristin Masten
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Allison Ingalls
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
| | - Emily E. Haroz
- Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States
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Martin P, Haroz EE, Lee C, Bolton P, Martin K, Meza R, McCarthy E, Dorsey S. A qualitative study of mental health problems among children living in New Delhi slums. Transcult Psychiatry 2024:13634615231202098. [PMID: 38389504 DOI: 10.1177/13634615231202098] [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: 02/24/2024]
Abstract
Children living in urban slums in India are exposed to chronic stressors that increase their risk of developing mental disorders, but they remain a neglected group. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived and prioritized locally to tailor interventions for this population. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of children living in Indian slums, including local descriptions, perceived causes, impact, and coping behavior. Local Hindi-speaking interviewers conducted 77 free-list interviews and 33 key informant interviews with children and adults (N = 107) from two slums in New Delhi. Results identified a range of internalizing and externalizing symptoms consistent with depression, anxiety, and conduct problems in children. Findings included both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., "madness or anger," "pain in the heart and mind") not typically included on western standardized measures of psychopathology. Mental health problems appeared to be highly interconnected, with experiences such as harassment and fighting often described as both causes and impacts of mental health symptoms in children. Community perspectives indicated that even in the face of several unmet basic needs, mental health problems were important to the community and counseling interventions were likely to be acceptable. We discuss implications for adapting mental health interventions and assessing their effectiveness to reduce the burden of mental illness among children living in urban slums in India.
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Affiliation(s)
- Prerna Martin
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Emily E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Lee
- UNICEF New York Child Protection in Humanitarian Action, New York, NY, USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- USAID, Washington, DC, USA
| | - Kiran Martin
- Asha Community Health and Development Society, New Delhi, India
| | - Rosemary Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Adams LB, Watts T, DeVinney A, Haroz EE, Thrul J, Stephens JB, Campbell MN, Antoine D, Lê Cook B, Joe S, Thorpe RJ. Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study. JMIR Form Res 2024; 8:e48992. [PMID: 38252475 PMCID: PMC10845025 DOI: 10.2196/48992] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. OBJECTIVE This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. METHODS We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study's conclusion. RESULTS In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. CONCLUSIONS Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/31241.
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Affiliation(s)
- Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Thomasina Watts
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Aubrey DeVinney
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | | | - Mia N Campbell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Benjamin Lê Cook
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
| | - Sean Joe
- George Warren Brown School of Social Work, Washington University at St. Louis, St. Louis, MO, United States
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Wexler L, White LA, O'Keefe VM, Rasmus S, Haroz EE, Cwik MF, Barlow A, Goklish N, Elliott E, Pearson CR, Allen J. Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities. Arch Suicide Res 2024:1-16. [PMID: 38240632 DOI: 10.1080/13811118.2023.2300321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.
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Archuleta S, Ingalls A, Allison-Burbank JD, Begay R, Harvey B, Grass R, Haroz EE. Summarizing Implementation Support for School-Based COVID-19 Testing Programs in Southwest American Indian Communities. J Public Health Manag Pract 2023; 29:E223-E230. [PMID: 37738603 PMCID: PMC10550253 DOI: 10.1097/phh.0000000000001793] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
CONTEXT American Indian communities have been disproportionately affected by the COVID-19 pandemic, with school closures exacerbating health and education disparities. PROGRAM Project SafeSchools' COVID-19 school-based testing program utilized federal and state funding to provide weekly pooled testing with follow-up rapid antigen testing to students and staff from the White Mountain Apache Tribe and Navajo Nation. IMPLEMENTATION The project provided partner schools with training and continual logistical and technical support to aid in school-based testing and adherence to state and local reporting requirements. EVALUATION Using the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework, we identified facilitators and barriers to successful program function. While community support and buy-in were essential for successfully implementing school-based testing in these communities, communication, school staff turnover, and funding are among the most significant challenges. DISCUSSION Community partnerships in American Indian communities involving schools and local health authorities can successfully implement testing protocols by remaining flexible and working together to maintain strong lines of communication.
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Affiliation(s)
- Shannon Archuleta
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kemp CG, Danforth K, Aldridge L, Murray LK, Haroz EE. Implementation measurement in global mental health: Results from a modified Delphi panel and investigator survey. Glob Ment Health (Camb) 2023; 10:e74. [PMID: 38024804 PMCID: PMC10663693 DOI: 10.1017/gmh.2023.63] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Limited guidance exists to support investigators in the choice, adaptation, validation and use of implementation measures for global mental health implementation research. Our objectives were to develop consensus on best practices for implementation measurement and identify strengths and opportunities in current practice. We convened seven expert panelists. Participants rated approaches to measure adaptation and validation according to appropriateness and feasibility. Follow-up interviews were conducted and a group discussion was held. We then surveyed investigators who have used quantitative implementation measures in global mental health implementation research. Participants described their use of implementation measures, including approaches to adaptation and validation, alongside challenges and opportunities. Panelists agreed that investigators could rely on evidence of a measure's validity, reliability and dimensionality from similar contexts. Panelists did not reach consensus on whether to establish the pragmatic qualities of measures in novel settings. Survey respondents (n = 28) most commonly reported using the Consolidated Framework for Implementation Research Inner Setting Measures (n = 9) and the Program Assessment Sustainability Tool (n = 5). All reported adapting measures to their settings; only two reported validating their measures. These results will support guidance for implementation measurement in support of mental health services in diverse global settings.
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Affiliation(s)
- Christopher G. Kemp
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Luke Aldridge
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
| | - Emily E. Haroz
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
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Bajaj MA, Wilcox HC, Adams LB, Berman AL, Cwik M, Kitchen C, Miller L, Nestadt PS, Slade EP, Haroz EE. Demographic predictors of emergency service utilization patterns in youth at risk of suicide. Suicide Life Threat Behav 2023; 53:702-712. [PMID: 37431982 PMCID: PMC10916713 DOI: 10.1111/sltb.12975] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To explore demographic predictors of Emergency Department (ED) utilization among youth with a history of suicidality (i.e., ideation or behaviors). METHODS Electronic health records were extracted from 2017 to 2021 for 3094 8-22 year-old patients with a history of suicidality at an urban academic medical center ED in the Mid-Atlantic. Logistic regression analyses were used to assess for demographic predictors of ED utilization frequency, timing of subsequent visits, and reasons for subsequent visits over a 24-month follow-up period. RESULTS Black race (OR = 1.45, 95% CI = 1.11-1.92), Female sex (OR = 1.59, 95% CI = 1.26-2.03), and having Medicaid insurance (OR = 1.71, 95% CI = 1.37-2.14) were associated with increased utilization, while being under 18 was associated with lower utilization (<12: OR = 0.38, 95% CI = 0.26-0.56; 12-18: OR = 0.47, 95% CI = 0.35-0.63). These demographics were also associated with ED readmission within 90 days, while being under 18 was associated with a lower odds of readmission. CONCLUSIONS Among patients with a history of suicidality, those who identify as Black, young adults, patients with Medicaid, and female patients were more likely to be frequent utilizers of the ED within the 2 years following their initial visit. This pattern may suggest inadequate health care access for these groups, and a need to develop better care coordination with an intersectional focus to facilitate utilization of other health services.
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Affiliation(s)
- Mira A. Bajaj
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Holly C. Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leslie B. Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alan L. Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mary Cwik
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eric P. Slade
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily E. Haroz
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Uthappa DM, Mann TK, Goldman JL, Schuster JE, Newland JG, Anderson WB, Dozier A, Inkelas M, Foxe JJ, Gwynn L, Gurnett CA, McDaniels-Davidson C, Walsh T, Watterson T, Holden-Wiltse J, Potts JM, D’Agostino EM, Zandi K, Corbett A, Spallina S, DeMuri GP, Wu YP, Pulgaron ER, Kiene SM, Oren E, Allison-Burbank JD, Okihiro M, Lee RE, Johnson SB, Stump TK, Coller RJ, Mast DK, Haroz EE, Kemp S, Benjamin DK, Zimmerman KO. Common Data Element Collection in Underserved School Communities: Challenges and Recommendations. Pediatrics 2023; 152:e2022060352N. [PMID: 37394503 PMCID: PMC10312277 DOI: 10.1542/peds.2022-060352n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of mistrust between researchers and underserved communities. METHODS We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies. RESULTS There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives. CONCLUSIONS Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.
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Affiliation(s)
- Diya M. Uthappa
- Duke University School of Medicine, Doctor of Medicine Program
| | - Tara K. Mann
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | - Moira Inkelas
- Department of Health Policy and Management, UCLA Fielding School of Public Health UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - John J. Foxe
- The Del Monte Institute for Neuroscience and The Department of Neuroscience, University of Rochester School of Medicine, Rochester, New York
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Christina A. Gurnett
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tyler Walsh
- Department of Pediatrics, Division of Infectious Diseases
| | | | | | | | | | | | | | | | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yelena P. Wu
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, California
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, California
| | | | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii Manoa, Honolulu, Hawaii
| | - Rebecca E. Lee
- Edson College of Nursing & Health Innovation, Center for Health Promotion and Disease Prevention, Senior Global Futures Scientist, Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Phoenix, Arizona
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tammy K. Stump
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Emily E. Haroz
- Department of International Health & Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven Kemp
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
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Haroz EE, Goklish N, Walsh CG, Cwik M, O’Keefe VM, Larzelere F, Garcia M, Minjarez T, Barlow A. Evaluation of the Risk Identification for Suicide and Enhanced Care Model in a Native American Community. JAMA Psychiatry 2023; 80:675-681. [PMID: 37195713 PMCID: PMC10193257 DOI: 10.1001/jamapsychiatry.2022.5068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/18/2022] [Indexed: 05/18/2023]
Abstract
Importance There are many prognostic models of suicide risk, but few have been prospectively evaluated, and none has been developed specifically for Native American populations. Objective To prospectively validate a statistical risk model implemented in a community setting and evaluate whether use of this model was associated with improved reach of evidence-based care and reduced subsequent suicide-related behavior among high-risk individuals. Design, Setting, and Participants This prognostic study, done in partnership with the White Mountain Apache Tribe, used data collected by the Apache Celebrating Life program for adults aged 25 years or older identified as at risk for suicide and/or self-harm from January 1, 2017, through August 31, 2022. Data were divided into 2 cohorts: (1) individuals and suicide-related events from the period prior to suicide risk alerts being active (February 29, 2020) and (2) individuals and events from the time after alerts were activated. Main Outcomes and Measures Aim 1 focused on a prospective validation of the risk model in cohort 1. Aim 2 compared the odds of repeated suicide-related events and the reach of brief contact interventions among high-risk cases between cohort 2 and cohort 1. Results Across both cohorts, a total of 400 individuals identified as at risk for suicide and/or self-harm (mean [SD] age, 36.5 [10.3] years; 210 females [52.5%]) had 781 suicide-related events. Cohort 1 included 256 individuals with index events prior to active notifications. Most index events (134 [52.5%]) were for binge substance use, followed by 101 (39.6%) for suicidal ideation, 28 (11.0%) for a suicide attempt, and 10 (3.9%) for self-injury. Among these individuals, 102 (39.5%) had subsequent suicidal behaviors. In cohort 1, the majority (220 [86.3%]) were classified as low risk, and 35 individuals (13.3%) were classified as high risk for suicidal attempt or death in the 12 months after their index event. Cohort 2 included 144 individuals with index events after notifications were activated. For aim 1, those classified as high risk had a greater odds of subsequent suicide-related events compared with those classified as low risk (odds ratio [OR], 3.47; 95% CI, 1.53-7.86; P = .003; area under the receiver operating characteristic curve, 0.65). For aim 2, which included 57 individuals classified as high risk across both cohorts, during the time when alerts were inactive, high-risk individuals were more likely to have subsequent suicidal behaviors compared with when alerts were active (OR, 9.14; 95% CI, 1.85-45.29; P = .007). Before the active alerts, only 1 of 35 (2.9%) individuals classified as high risk received a wellness check; after the alerts were activated, 11 of 22 (50.0%) individuals classified as high risk received 1 or more wellness checks. Conclusions and Relevance This study showed that a statistical model and associated care system developed in partnership with the White Mountain Apache Tribe enhanced identification of individuals at high risk for suicide and was associated with a reduced risk for subsequent suicidal behaviors and increased reach of care.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Novalene Goklish
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Colin G. Walsh
- Department of Biomedical Informatics, Department of Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Cwik
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Victoria M. O’Keefe
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Francene Larzelere
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mitchell Garcia
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Tina Minjarez
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Allison Barlow
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Haroz EE, Sarapik LM, Adams LB, Nestadt PS, Athey A, Alvarez K, Slade EP, Cwik M, Berman AL, Wilcox HC. A Cascade of Care Model for Suicide Prevention. Am J Prev Med 2023; 64:599-603. [PMID: 36402646 PMCID: PMC10166000 DOI: 10.1016/j.amepre.2022.09.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Emily E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Liina M Sarapik
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul S Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison Athey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kiara Alvarez
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric P Slade
- Johns Hopkins School of Nursing, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan L Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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Brockie T, Decker E, Barlow A, Cwik M, Ricker A, Aguilar T, Wetsit L, Wilson D, Haroz EE. Planning for implementation and sustainability of a community-based suicide surveillance system in a Native American community. Implement Sci Commun 2023; 4:1. [PMID: 36600290 DOI: 10.1186/s43058-022-00376-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/11/2021] [Accepted: 11/09/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Native American youth, primarily living on reservations, suffer the highest burden of suicide of any racial group in the USA. Implementation and sustainability of culturally grounded, evidence-based interventions are needed to address suicide in Native American populations. For nearly 40 years, Montana has ranked at or near the top nationwide for suicide. Fort Peck Tribal leadership declared a state of emergency in 2010 after six suicides and 20 attempts that occurred over a 5-month period. METHODS We used a community-based participatory research approach for adapting the Celebrating Life (CL) program with a specific focus on long-term sustainability, which has demonstrated efficacy in addressing suicide with the White Mountain Apache. The aims were to (1) adapt the CL program intake forms through roundtable discussions, (2) conduct asset and resource mapping to identify community and cultural resources to leverage for the CL program within the Fort Peck context, and (3) develop a sustainability plan for CL in Fort Peck through qualitative approaches informed by the Program Sustainability Assessment Tool. RESULTS Roundtable discussions resulted in adapted intake forms that capture variables relevant to the Fort Peck context. Asset mapping identified 13 community assets and 10 cultural resources to incorporate within the CL implementation process. Focus group discussions yielded four key themes that were incorporated into a plan for sustainability: (1) strategic partnerships, (2) long-term funding, (3) communication planning, and (4) workforce planning and engagement. CONCLUSIONS This paper outlines an avenue for using culturally adapted tools to design an implementation system driven by community and cultural assets within tribal communities and for integrating program planning for sustainability early in the implementation process.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA. .,Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA.
| | - Ellie Decker
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Mary Cwik
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Adriann Ricker
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Theresa Aguilar
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Lawrence Wetsit
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Deborah Wilson
- Johns Hopkins School of Nursing, 525 North Wolfe St, Baltimore, MD, 21205, USA
| | - Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.,Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, 415 North Washington St., 4th Floor, Baltimore, MD, 21231, USA
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12
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Haroz EE, Ingalls A, Decker Sorby K, Dozier M, Kaye MP, Sarche M, Supplee LH, Whitaker DJ, Grubin F, Daro D. Expert-generated standard practice elements for evidence-based home visiting programs using a Delphi process. PLoS One 2022; 17:e0275981. [PMID: 36251646 PMCID: PMC9576067 DOI: 10.1371/journal.pone.0275981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND States, territories, non-profits, and tribes are eligible to obtain federal funding to implement federally endorsed evidence-based home visiting programs. This represents a massive success in translational science, with $400 million a year allocated to these implementation efforts. This legislation also requires that 3% of this annual funding be allocated to tribal entities implementing home visiting in their communities. However, implementing stakeholders face challenges with selecting which program is best for their desired outcomes and context. Moreover, recent reviews have indicated that when implemented in practice and delivered at scale, many evidence-based home visiting programs fail to replicate the retention rates and effects achieved during clinical trials. To inform program implementers and better identify the active ingredients in home visiting programs that drive significant impacts, we aimed to develop an expert derived consensus taxonomy on the elements used in home visiting practice that are essential to priority outcome domains. METHODS We convened a panel of 16 experts representing researchers, model representatives, and program implementers using a Delphi approach. We first elicited standard practice elements (SPEs) using open-ended inquiry, then compared these elements to behavior change techniques (BCTs) given their general importance in the field of home visiting; and finally rated their importance to 10 outcome domains. RESULTS Our process identified 48 SPEs derived from the panel, with 83 additional BCTs added based on the literature. Six SPEs, mostly related to home visitor characteristics and skills, were rated essential across all outcome domains. Fifty-three of the 83 BCTs were rated unnecessary across all outcome domains. CONCLUSIONS This work represents the first step in a consensus-grounded taxonomy of techniques and strategies necessary for home visiting programs and provides a framework for future hypothesis testing and replication studies.
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Affiliation(s)
- Emily E. Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America,* E-mail:
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Karla Decker Sorby
- Minnesota Department of Health, Family Home Visiting, Bemidji, MN, United States of America
| | - Mary Dozier
- Department of Psychology, University of Delaware, Newark, DE, United States of America
| | - Miranda P. Kaye
- Pennsylvania State University, State College, PA, United States of America
| | - Michelle Sarche
- Colorado School of Public Health, Centers for American Indian & Alaska Native Health, Aurora, CO, United States of America
| | | | - Daniel J. Whitaker
- School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Deborah Daro
- Chapin Hall, University of Chicago, Chicago, IL, United States of America
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Grubin F, Maudrie TL, Neuner S, Conrad M, Waugh E, Barlow A, Coser A, Hill K, Pioche S, Haroz EE, O'Keefe VM. Development and Cultural Adaptation of Psychological First Aid for COVID-19 Frontline Workers in American Indian/Alaska Native Communities. J Prev (2022) 2022; 43:697-717. [PMID: 35841432 PMCID: PMC9288204 DOI: 10.1007/s10935-022-00695-y] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/07/2022]
Abstract
The coronavirus disease 19 (COVID-19) pandemic is broadly affecting the mental health and well-being of people around the world, and disproportionately affecting some groups with already pre-existing health inequities. Two groups at greater risk of physical and/or mental health detriments from COVID-19 and more profoundly impacted by the pandemic include frontline workers and American Indian/Alaska Native (AI/AN) communities. To provide support and prevent long-term mental health problems, we culturally adapted a psychological first aid guide specifically for COVID-19 frontline workers serving AI/AN communities. We engaged a diverse, collaborative work group to steer the adaptation content and process. We also held two focus group discussions with frontline workers in AI/AN communities to incorporate their perspectives into the adapted guide. Results from the group discussions and the collaborative work group were compiled, analyzed to extract themes and suggestions, and integrated into the adapted content of the guide. Main adaptations included updating language (i.e., to be more culturally appropriate, less prescriptive, and less text heavy), framing the guide from a harm-reduction lens, incorporating cultural activities, values, and teachings common across diverse AI/AN communities (e.g., importance of being a good relative), and validating feelings and experiences of frontline workers. The resulting adapted guide includes four modules and is available as a free online training. Our adaptation process may serve as a guiding framework for future adaptations of similar resources for specific groups. The adapted guide may stand as an enduring resource to support mental well-being, the prevention of mental health problems, and reduction of health inequities during the pandemic and beyond.
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Affiliation(s)
- Fiona Grubin
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA.
| | - Tara L Maudrie
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | - Sophie Neuner
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | - Maisie Conrad
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | - Emma Waugh
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | - Allison Barlow
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | | | - Kyle Hill
- Department of Indigenous Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, USA
| | - Shardai Pioche
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | - Emily E Haroz
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
| | - Victoria M O'Keefe
- Department of International Health, Social and Behavioral Interventions, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA
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Ingalls A, Rebman P, Martin L, Kushman E, Leonard A, Cisler A, Gschwind I, Brayak A, Amsler AM, Haroz EE. Towards precision home visiting: results at six months postpartum from a randomized pilot implementation trial to assess the feasibility of a precision approach to Family Spirit. BMC Pregnancy Childbirth 2022; 22:725. [PMID: 36151535 PMCID: PMC9502904 DOI: 10.1186/s12884-022-05057-4] [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] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Shared implementation challenges at scale in early childhood home visiting have led researchers to explore precision home visiting as a promising service delivery mechanism to better address families’ unique needs and build greater program efficiencies. This randomized controlled pilot study aimed to assess the acceptability of a precision approach to one home visiting model, Family Spirit® and explore potential differences between Precision Family Spirit (PFS) and Standard Family Spirit (Standard FS) on participant-home visitor relationship and maternal outcomes. Methods Participants (N = 60) were at least 14 years old, pregnant or within 2 months postpartum, and enrolled in Family Spirit. Four sites in Michigan were randomized 1:1 to deliver PFS (up to 17 core lessons plus up to 13 additional lessons as needed) or Standard FS (home visiting services as usual). Primary (program acceptability, participant satisfaction, home visitor-participant relationship quality, retention, adherence) and secondary (knowledge, quality of life, difficulty with parenting problems, substance use, depression, stress) outcomes at 6 months postpartum are presented. PFS participants also self-reported on quality of life, difficulty with parenting problems, stress, substance use, and concerns with sexual and reproductive health and self and child’s nutrition status at each home visit. This informed which lessons they should receive. Results Mothers in both groups reported positive program acceptability, satisfaction, and home visitor-participant relationships at 6 months postpartum. However, open-ended feedback from Standard FS participants indicates that some lesson content may not be applicable to all participants. At 6 months, retention was 82.3% for PFS and 66.7% for Standard FS, and adherence was 30.1% for PFS and 20.6% for Standard FS. Conclusions Preliminary findings indicate that precision home visiting may be acceptable and feasible. A definitive trial is needed to build on this pilot data, assess outcomes for mothers and children participating in a precision approach to home visiting as compared to standard home visiting, and ready this approach for scale. Trial registration ClinicalTrials.govNCT03975530 (first posted on 05/06/2019).
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Affiliation(s)
- Allison Ingalls
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA.
| | - Paul Rebman
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA
| | - Lisa Martin
- Inter-Tribal Council of Michigan, Inc, Sault Ste. Marie, MI, USA
| | | | - Amanda Leonard
- Inter-Tribal Council of Michigan, Inc, Sault Ste. Marie, MI, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, MI, USA
| | | | | | | | - Emily E Haroz
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA
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15
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Russette HC, Grubin F, Ingalls A, Martin L, Leonard A, Kushman E, Cisler A, Leffler E, Herman A, Haroz EE. Home visitor perspectives on implementing a precision approach to home visiting in communities serving Native American families. Infant Ment Health J 2022; 43:744-755. [PMID: 35921432 DOI: 10.1002/imhj.22012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
Family Spirit (FS) is a federally endorsed evidence-based home visiting programs serving as a key prevention strategy for expectant families and families with young children. Like other home-visiting programs, it shares client challenges in retention and engagement during implementation. We assessed (1) the feasibility and acceptability of implementing a precision approach to FS; and (2) differences in approaches to FS delivery. Home visitors, serving primarily Native American families, that delivered a standard (N = 6) or a precision approach (N = 6) to FS across four study sites each participated in up to four virtual focus group discussions (FGDs) (N = 16). Facilitators and barriers to implementation were identified across the curriculum approach, relational and contextual levels. Facilitators: Relevant and culturally sensitive lessons, lesson structure, client-home visitor relationship, client buy-in, home visitor autonomy, leadership support, flexible funding, and training. Barriers: Irrelevant lessons, substance use content, missing topics, families experiencing crises, client and home visitor availability, client feedback, nonsupportive leadership, inadequate funding, and organizational policies and practices. The precision approach offers (1) tailoring of lessons that supports relevance of content to clients; and (2) a target timeframe that supports flexibility in lesson delivery. This model structure may improve client participation and retention.
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Affiliation(s)
- Helen C Russette
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Martin
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Amanda Leonard
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Elizabeth Kushman
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, Michigan, USA
| | | | | | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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O’Keefe VM, Fish J, Maudrie TL, Hunter AM, Tai Rakena HG, Ullrich JS, Clifford C, Crawford A, Brockie T, Walls M, Haroz EE, Cwik M, Whitesell NR, Barlow A. Centering Indigenous Knowledges and Worldviews: Applying the Indigenist Ecological Systems Model to Youth Mental Health and Wellness Research and Programs. Int J Environ Res Public Health 2022; 19:6271. [PMID: 35627809 PMCID: PMC9140847 DOI: 10.3390/ijerph19106271] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Globally, Indigenous communities, leaders, mental health providers, and scholars have called for strengths-based approaches to mental health that align with Indigenous and holistic concepts of health and wellness. We applied the Indigenist Ecological Systems Model to strengths-based case examples of Indigenous youth mental health and wellness work occurring in CANZUS (Canada, Australia, New Zealand, and United States). The case examples include research, community-led programs, and national advocacy. Indigenous youth development and well-being occur through strengths-based relationships across interconnected environmental levels. This approach promotes Indigenous youth and communities considering complete ecologies of Indigenous youth to foster their whole health, including mental health. Future research and programming will benefit from understanding and identifying common, strengths-based solutions beyond narrow intervention targets. This approach not only promotes Indigenous youth health and mental health, but ripples out across the entire ecosystem to promote community well-being.
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Affiliation(s)
- Victoria M. O’Keefe
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
| | - Jillian Fish
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA;
| | - Tara L. Maudrie
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
| | - Amanda M. Hunter
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | - Hariata G. Tai Rakena
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
| | | | - Carrie Clifford
- Department of Psychology, University of Otago, Dunedin 9016, New Zealand;
| | - Allison Crawford
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 1X5, Canada;
| | - Teresa Brockie
- School of Nursing, Johns Hopkins University, Baltimore, MD 21231, USA;
| | - Melissa Walls
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
| | - Emily E. Haroz
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
| | - Mary Cwik
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
| | - Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA; (T.L.M.); (H.G.T.R.); (M.W.); (E.E.H.); (M.C.); (A.B.)
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17
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Aldridge LR, Kemp CG, Bass JK, Danforth K, Kane JC, Hamdani SU, Marsch LA, Uribe-Restrepo JM, Nguyen AJ, Bolton PA, Murray LK, Haroz EE. Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries. Implement Sci Commun 2022; 3:54. [PMID: 35590428 PMCID: PMC9118868 DOI: 10.1186/s43058-022-00301-6] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants and outcomes across four key stakeholder groups-consumers, providers, organization leaders, and policy makers-with dedicated versions of scales for each group. These were field tested and refined in several contexts, and criterion validity was established in Ukraine. The Consumer and Provider mhIST have since grown in popularity in mental health research, outpacing psychometric evaluation. Our objective was to establish the cross-context psychometric properties of these versions and inform future revisions. METHODS We compiled secondary data from seven studies across six LMIC-Colombia, Myanmar, Pakistan, Thailand, Ukraine, and Zambia-to evaluate the psychometric performance of the Consumer and Provider mhIST. We used exploratory factor analysis to identify dimensionality, factor structure, and item loadings for each scale within each stakeholder version. We also used alignment analysis (i.e., multi-group confirmatory factor analysis) to estimate measurement invariance and differential item functioning of the Consumer scales across the six countries. RESULTS All but one scale within the Provider and Consumer versions had Cronbach's alpha greater than 0.8. Exploratory factor analysis indicated most scales were multidimensional, with factors generally aligning with a priori subscales for the Provider version; the Consumer version has no predefined subscales. Alignment analysis of the Consumer mhIST indicated a range of measurement invariance for scales across settings (R2 0.46 to 0.77). Several items were identified for potential revision due to participant nonresponse or low or cross- factor loadings. We found only one item, which asked consumers whether their intervention provider was available when needed, to have differential item functioning in both intercept and loading. CONCLUSION We provide evidence that the Consumer and Provider versions of the mhIST are internally valid and reliable across diverse contexts and stakeholder groups for mental health research in LMIC. We recommend the instrument be revised based on these analyses and future research examine instrument utility by linking measurement to other outcomes of interest.
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Affiliation(s)
- Luke R Aldridge
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
| | - Christopher G Kemp
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Judith K Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Kristen Danforth
- University of Washington Department of Global Health, Seattle, USA
| | - Jeremy C Kane
- Columbia University Mailman School of Public Health, New York, USA
| | - Syed U Hamdani
- University of Liverpool Institute of Population Health, Liverpool, UK
| | - Lisa A Marsch
- Dartmouth Center for Technology & Behavioral Health, Lebanon, USA
| | - José M Uribe-Restrepo
- Pontificia Universidad Javeriana Department of Psychiatry and Mental Health, Bogota, Colombia
| | - Amanda J Nguyen
- University of Virginia School of Education and Human Development, Charlottesville, USA
| | - Paul A Bolton
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Laura K Murray
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Emily E Haroz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
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18
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Alfonso YN, Bishai D, Ivanich JD, O'Keefe VM, Usher J, Aldridge LR, Haroz EE, Goklish N, Barlow A, Cwik M. Suicide Ideation and Depression Quality of Life Ratings in a Reservation-Based Community of Native American Youths and Young Adults. Community Ment Health J 2022; 58:779-787. [PMID: 34455531 PMCID: PMC8933312 DOI: 10.1007/s10597-021-00883-w] [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: 01/11/2021] [Accepted: 08/19/2021] [Indexed: 01/12/2023]
Abstract
Suicide among adolescents is a significant public health concern in the U.S., especially within American Indian and Alaska Native (AIAN) communities. Lack of quality of life (QoL) estimates for both suicide ideation and depression specific to the AIAN population hinders the ability to compare interventions in cost-effectiveness analysis. We surveyed 200 AI youth and young adults from the Fort Apache Indian Reservation to estimate utility weights for experiencing suicide ideation and depression. Our results indicate that, on a scale of 0-100, with higher scores indicating better health, the general community rates both suicide ideation and depression at 15.8 and 25.1, respectively. These weights are statistically significantly different and lower than for other cultures. Culturally specific QoL values will allow the comparison and identification of the most effective and feasible interventions to reduce the suicide burden among tribal communities.
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Affiliation(s)
- Y N Alfonso
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - D Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - J D Ivanich
- Department of Community and Behavioral Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - V M O'Keefe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - J Usher
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - L R Aldridge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - E E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - N Goklish
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - A Barlow
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - M Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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19
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Haroz EE, Ivanich JD, Barlow A, O’Keefe VM, Walls M, Kaytoggy C, Suttle R, Goklish N, Cwik M. Balancing cultural specificity and generalizability: Brief qualitative methods for selecting, adapting, and developing measures for research with American Indian communities. Psychol Assess 2022; 34:311-319. [PMID: 34941353 PMCID: PMC9124435 DOI: 10.1037/pas0001092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Culturally appropriate, valid and reliable measures are critical to assessing how interventions impact health. There is a tension between measures for specific cultural settings versus more general measures that permit comparisons across samples. We illustrate a feasible approach to measurement selection, adaptation and testing for a study of brief interventions to prevent suicide among American Indian youth ages 10-24. We used a modified Nominal Group Technique (NGT) with N = 7 Apache Community Mental Health Specialists (CMHS') to elicit priority impacts of interventions under study. We then tested the reliability and validity in N = 93 youth at baseline. The NGT results included selection of alternative measures, item removal and addition, and creation of a local well-being index. Measurement testing indicated excellent to good internal consistency (α: 0.82-0.96) and strong construct validity. Study results demonstrate a feasible approach to balancing cultural specificity and generalizability while producing valid and reliable measures to use in an intervention trial. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Emily E. Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Jerreed D. Ivanich
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Victoria M. O’Keefe
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Melissa Walls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Cindy Kaytoggy
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Rose Suttle
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Mary Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health
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20
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Haroz EE, Kemp CG, O'Keefe VM, Pocock K, Wilson DR, Christensen L, Walls M, Barlow A, Hammitt L. Nurturing Innovation at the Roots: The Success of COVID-19 Vaccination in American Indian and Alaska Native Communities. Am J Public Health 2022; 112:383-387. [PMID: 35196058 PMCID: PMC8887173 DOI: 10.2105/ajph.2021.306635] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Emily E Haroz
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Christopher G Kemp
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Victoria M O'Keefe
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Katherine Pocock
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - David R Wilson
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Loretta Christensen
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Melissa Walls
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Allison Barlow
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
| | - Laura Hammitt
- Emily E. Haroz, Christopher G. Kemp, Victoria M. O'Keefe, Melissa Walls, Allison Barlow, and Laura Hammitt are with the Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD. Katherine Pocock is with the Whiteriver Indian Hospital, Whiteriver, AZ. David R. Wilson is with the Tribal Health Research Office, National Institutes of Health, Bethesda, MD. Loretta Christensen is with the Indian Health Service, Rockville, MD
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21
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Haroz EE, Kalb LG, Newland JG, Goldman JL, Mast DK, Ko LK, Grass R, Shah P, Walsh T, Schuster JE. Implementation of School-Based COVID-19 Testing Programs in Underserved Populations. Pediatrics 2022; 149:e2021054268G. [PMID: 34737173 PMCID: PMC9647741 DOI: 10.1542/peds.2021-054268g] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Evidence suggests that coronavirus disease 2019 (COVID-19) testing in schools can add a layer of protection to reduce the spread of Severe Acute Respiratory Syndrome Coronavirus 2 and facilitate a safer return to in-person learning. Despite this evidence, implementation of testing in school settings has been challenging initially because of a lack of funding and limited availability of testing, but, as the pandemic has progressed and more funding and resources have been devoted to testing, other implementation challenges have arisen. We describe key implementation barriers and strategies that have been operationalized across 5 projects working to help schools with predominantly underserved populations who have faced significant COVID-19-related health disparities. We leveraged a key framework from the implementation science field to identify the challenges and used a matching tool to align implementation strategies to these challenges. Our findings suggest that the biggest obstacles to COVID-19 testing were the perceived relative advantages versus burden of COVID-19 testing, limited engagement with the target beneficiaries (eg, families, students, staff), and innovation complexity. Common strategies to overcome these challenges included identifying and preparing testing champions, altering incentive and allowance structures, assessing for readiness, and identifying barriers and facilitators. We aim to augment existing implementation guidance for schools by describing common barriers and recommended solutions from the implementation science field. Our results indicate a clear need to provide implementation support to schools to facilitate COVID-19 testing as an added layered mitigation strategy.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Center for American Indian Health, Baltimore, Maryland
| | - Luther G. Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Linda K. Ko
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan Grass
- Johns Hopkins Center for American Indian Health, Baltimore, Maryland
| | - Parth Shah
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tyler Walsh
- Washington University in St Louis, St Louis, Missouri
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22
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D’Agostino EM, Haroz EE, Linde S, Layer M, Green M, Ko LK. School-Academic Partnerships in Support of Safe Return to Schools During the COVID-19 Pandemic. Pediatrics 2022; 149:e2021054268C. [PMID: 34737180 PMCID: PMC9647737 DOI: 10.1542/peds.2021-054268c] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Safely returning underserved youth to school during the coronavirus disease 2019 (COVID-19) pandemic through diagnostic testing and health education is imperative to mitigate the ongoing negative impact of COVID-19 and reduce health inequalities in underserved communities. The Rapid Acceleration of Diagnostics-Underserved Populations program is a consortium of research projects across the United States funded by the National Institutes of Health to understand the factors associated with the disproportionate burden of the pandemic among underserved populations and to leverage mitigation strategies, including diagnostic testing, with a focus on reducing health disparities. In this article, we provide an overview and introduce the articles from 8 Rapid Acceleration of Diagnostics-Underserved Populations projects featured in the supplement "Navigating a Pandemic in the K-12 Setting: Keeping Our School Communities Safe" published in Pediatrics. These projects funded in the program's first phase focus on COVID-19 diagnostic testing approaches for youth and employees at schools in underserved communities to support safe in-person learning. In the articles comprising the supplement, researchers present barriers and facilitators of the community engagement process necessary to establish school-academic partnerships. These efforts showcase school-based implementation testing strategies during the COVID-19 pandemic but are translatable to tackling other challenges related to reducing health disparities.
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Affiliation(s)
- Emily M. D’Agostino
- Departments of Orthopaedic Surgery
- Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - Emily E. Haroz
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sandra Linde
- Astria Sunnyside Hospital, Sunnyside, Washington
| | - Marcus Layer
- Duke Clinical Research Institute, Durham, North Carolina
| | - Melissa Green
- Center for Health Equity Research, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Linda K. Ko
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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23
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Haroz EE, Kitchen C, Nestadt PS, Wilcox HC, DeVylder JE, Kharrazi H. Comparing the predictive value of screening to the use of electronic health record data for detecting future suicidal thoughts and behavior in an urban pediatric emergency department: A preliminary analysis. Suicide Life Threat Behav 2021; 51:1189-1202. [PMID: 34515351 PMCID: PMC8961462 DOI: 10.1111/sltb.12800] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 01/22/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
AIM Brief screening and predictive modeling have garnered attention for utility at identifying individuals at risk of suicide. Although previous research has investigated these methods, little is known about how these methods compare against each other or work in combination in the pediatric population. METHODS Patients were aged 8-18 years old who presented from January 1, 2017, to June 30, 2019, to a Pediatric Emergency Department (PED). All patients were screened with the Ask Suicide Questionnaire (ASQ) as part of a universal screening approach. For all models, we used 5-fold cross-validation. We compared four models: Model 1 only included the ASQ; Model 2 included the ASQ and EHR data gathered at the time of ED visit (EHR data); Model 3 only included EHR data; and Model 4 included EHR data and a single item from the ASQ that asked about a lifetime history of suicide attempt. The main outcome was subsequent PED visit with suicide-related presenting problem within a 3-month follow-up period. RESULTS Of the N = 13,420 individuals, n = 141 had a subsequent suicide-related PED visit. Approximately 63% identified as Black. Results showed that a model based only on EHR data (Model 3) had an area under the curve (AUC) of 0.775 compared to the ASQ alone (Model 1), which had an AUC of 0.754. Combining screening and EHR data (Model 4) resulted in a 17.4% (absolute difference = 3.6%) improvement in sensitivity and 13.4% increase in AUC (absolute difference = 6.6%) compared to screening alone (Model 1). CONCLUSION Our findings show that predictive modeling based on EHR data is helpful either in the absence or as an addition to brief suicide screening. This is the first study to compare brief suicide screening to EHR-based predictive modeling and adds to our understanding of how best to identify youth at risk of suicidal thoughts and behaviors in clinical care settings.
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Affiliation(s)
- Emily E. Haroz
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher Kitchen
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Holly C. Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jordan E. DeVylder
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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24
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Ivanich JD, Weckstein J, Nestadt PS, Cwik MF, Walls M, Haroz EE, O’Keefe VM, Goklish N, Barlow A. Suicide and the opioid overdose crisis among American Indian and Alaska Natives: a storm on two fronts demanding swift action. Am J Drug Alcohol Abuse 2021; 47:527-534. [PMID: 34374620 PMCID: PMC9091944 DOI: 10.1080/00952990.2021.1955895] [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] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
The opioid crisis in the United States has received national attention and critical resources in the past decade. However, what has been overlooked is the effect the opioid crisis may be having on a three-decade suicide crisis among American Indian and Alaska Native (AIAN) communities that already have too few resources to address behavioral and mental health issues. This paper describes recent epidemiological trends associated with both opioid overdose and suicide at a national level for AIANs and the rest of the United States. We used data reported by the Centers for Disease Control and Prevention to report historical trends of opioid overdose and suicide for AIAN and non-AIAN populations. We found alarming and potentially correlated trends of opioid use and suicidality among AIAN populations. We highlight both current and future research that will be essential to understanding and addressing the unique intersection between opioid and suicide risk and protective factors to inform dual prevention and intervention efforts among AIAN populations with potential relevance to public health response among other at-risk populations.
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Affiliation(s)
- Jerreed D. Ivanich
- Centers for American Indian and Alaska Native Health, University of Colorado – Anschutz Medical Campus, Aurora, CO, USA
| | - Julia Weckstein
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary F. Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Walls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E. Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria M. O’Keefe
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Haroz EE, Grubin F, Goklish N, Pioche S, Cwik M, Barlow A, Waugh E, Usher J, Lenert MC, Walsh CG. Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers. JMIR Public Health Surveill 2021; 7:e24377. [PMID: 34473065 PMCID: PMC8446841 DOI: 10.2196/24377] [Citation(s) in RCA: 7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.
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Affiliation(s)
- Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shardai Pioche
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma Waugh
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Usher
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew C Lenert
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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26
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Haroz EE, Fine SL, Lee C, Wang Q, Hudhud M, Igusa T. Planning for suicide prevention in Thai refugee camps: Using community-based system dynamics modeling. Asian Am J Psychol 2021; 12:193-203. [PMID: 35251488 PMCID: PMC8890690 DOI: 10.1037/aap0000190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Suicide and associated behaviors represent a significant health disparity among refugees and displaced persons. Despite this burden, evidence for prevention programing in these populations is limited. This study aimed to inform the selection and implementation of suicide prevention strategies in refugee camps in Northwestern, Thailand - camps that had experienced recent spikes in suicides and suicide attempts at the time of the study. We leveraged Community Based System Dynamics modeling through a series of four workshops with key local stakeholders and suicide prevention experts, to build a qualitative systems model that accounts for complexities and is aimed at assisting local partners with selecting the most promising strategies for implementation and evaluation. The process expanded local understanding of the causes and consequences of suicide and resulted in selection of priority interventions aimed at reducing suicide in this context. Our research illustrates the application of a novel methodology that aims to account for the complexities of suicide prevention in the context of displacement and helps to optimize local suicide prevention efforts.
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Affiliation(s)
- Emily E. Haroz
- Center for American Indian Health; Center for Humanitarian Health; Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Shoshanna L. Fine
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Catherine Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Qi Wang
- Department of Civil and Systems Engineering, Johns Hopkins University
| | - Muhammed Hudhud
- Department of Health Behavior, University of North Carolina Gillings School of Public Health
| | - Takuru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins University
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27
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Ravi SJ, Warmbrod KL, Barlow A, Cepeda J, Falade-Nwulia OO, Haroz EE, Purnell TS. Why Social Distance Demands Social Justice: Systemic Racism, COVID-19, and Health Security in the United States. Health Secur 2021; 19:S1-S4. [PMID: 34138671 DOI: 10.1089/hs.2021.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sanjana J Ravi
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelsey Lane Warmbrod
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison Barlow
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Javier Cepeda
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oluwaseun O Falade-Nwulia
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily E Haroz
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tanjala S Purnell
- Sanjana J. Ravi, MPH, and Kelsey Lane Warmbrod, MS, MPH, are Senior Analysts, Johns Hopkins Center for Health Security; Allison Barlow, PhD, MPH, is Director and Emily E. Haroz, MA, PhD, is an Assistant Scientist, Johns Hopkins Center for American Indian Health; Javier Cepeda, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Public Health and Human Rights; Tanjala S. Purnell, PhD, MPH, is an Assistant Professor, Department of Epidemiology and Johns Hopkins Center for Health Equity; and Oluwaseun O. Falade-Nwulia, MBBS, MPH, is an Associate Professor, Johns Hopkins Center for Health Equity; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Oluwaseun O. Falade-Nwulia is also an Associate Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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O'Keefe VM, Maudrie TL, Ingalls A, Kee C, Masten KL, Barlow A, Haroz EE. Development and Dissemination of a Strengths-Based Indigenous Children's Storybook: "Our Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19". Front Sociol 2021; 6:611356. [PMID: 33869558 PMCID: PMC8022673 DOI: 10.3389/fsoc.2021.611356] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
The traditions, strengths, and resilience of communities have carried Indigenous peoples for generations. However, collective traumatic memories of past infectious diseases and the current impact of the coronavirus disease 2019 (COVID-19) pandemic in many Indigenous communities point to the need for Indigenous strengths-based public health resources. Further, recent data suggest that COVID-19 is escalating mental health and psychosocial health inequities for Indigenous communities. To align with the intergenerational strengths of Indigenous communities in the face of the pandemic, we developed a strengths- and culturally-based public health education and mental health coping resource for Indigenous children and families. Using a community-engaged process, the Johns Hopkins Center for American Indian Health collaborated with 14 Indigenous and allied child development, mental health, health communications experts and public health professionals, as well as a Native American youth artist. Indigenous collaborators and Indigenous Johns Hopkins project team members collectively represented 12 tribes, and reservation-based, off-reservation, and urban geographies. This group shared responsibility for culturally adapting the children's book "My Hero is You: How Kids Can Fight COVID-19!" developed by the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings and developing ancillary materials. Through an iterative process, we produced the storybook titled "Our Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19" with content and illustrations representing Indigenous values, experiences with COVID-19, and strengths to persevere. In addition, parent resource materials, children's activities, and corresponding coloring pages were created. The book has been disseminated online for free, and 42,364 printed copies were distributed to early childhood home visiting and tribal head start programs, Indian Health Service units, tribal health departments, intertribal, and urban Indigenous health organizations, Johns Hopkins Center for American Indian Health project sites in partnering communities, schools, and libraries. The demand for and response to "Our Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19" demonstrates the desire for Indigenous storytelling and the elevation of cultural strengths to maintain physical, mental, emotional, and spiritual health during the COVID-19 pandemic.
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Abstract
There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders. Underresourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Ingalls A, Barlow A, Kushman E, Leonard A, Martin L, Team PFSS, West AL, Neault N, Haroz EE. Precision Family Spirit: a pilot randomized implementation trial of a precision home visiting approach with families in Michigan-trial rationale and study protocol. Pilot Feasibility Stud 2021; 7:8. [PMID: 33407939 PMCID: PMC7786970 DOI: 10.1186/s40814-020-00753-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background Home visiting is a well-supported strategy for addressing maternal and child health disparities. However, evidence-based models generally share implementation challenges at scale, including engagement and retention of families. Precision home visiting may address this issue. This paper describes the first known pilot randomized implementation trial of a precision home visiting approach vs. standard implementation. Primary aims are to: 1) explore the acceptability and feasibility of a precision approach to home visiting and 2) examine the difference between Standard Family Spirit and Precision Family Spirit on participants’ program satisfaction, client-home visitor relationship, goal alliance, and the impact of these factors on participant engagement and retention. Secondary aims are to explore potential differences on maternal behavioral and mental health outcomes and child development outcomes to inform sample size estimations for a fully powered study. Methods This is a pilot Hybrid Type 3 implementation trial. Four Michigan communities primarily serving the Native American families and already using Family Spirit were randomized by site to receive Standard Family Spirit or Precision Family Spirit. Participants include N = 60 mothers at least 14 years of age (pregnant or with a newborn < 2 months of age) currently enrolled in Family Spirit. Precision Family Spirit participants receive core lessons plus additional lessons based on needs identified at baseline and that emerge during the trial. Control mothers receive the standard sequence of Family Spirit lessons. Data is collected at baseline (< 2 months postpartum), and 2, 6, and 12 months postpartum. All Precision Family Spirit participants are invited to complete qualitative interviews at study midpoint and endpoint. All home visitors are invited to participate in focus groups between study midpoint and endpoint. Exploratory data analysis will assess feasibility, acceptability, client-home visitor relationship, retention, adherence, and potential differences in intervention outcomes. Discussion This trial will provide new information about the acceptability and feasibility of precision home visiting and pilot data on program satisfaction, client-home visitor relationship, goal alliance, retention, and targeted maternal-child intervention outcomes. Findings will inform the design of a fully powered randomized implementation trial of precision vs. standard home visiting. Trial registration ClinicalTrials.gov #NCT03975530; Registered on June 5, 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-020-00753-4.
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Affiliation(s)
- Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Kushman
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, MI, USA
| | - Amanda Leonard
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, MI, USA
| | - Lisa Martin
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, MI, USA
| | | | - Allison L West
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicole Neault
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
The number of children and adolescents dying by suicide is increasing over time. Patterns for who is at risk are also changing, leading to a need to review clinical suicide prevention progress and identify limitations with existing practices and research that can help us further address this growing problem. This paper aims to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts. Our review shows that universal screening is strongly recommended, feasible and acceptable, and that there are screening tools that have been validated with youth. However, screening may not accurately identify those at risk of dying due to the relative rarity of suicide death and the associated research and clinical challenges in studying such a rare event and predicting future behaviour. Similarly, while risk assessments have been developed and tested in some populations, there is limited research on their validity and challenges with their implementation. Several promising suicide-specific treatments have been developed for youth, but overall there is an insufficient number of randomised trials. Despite great need, the research evidence to support screening, risk assessment and treatment is still limited. As suicide rates increase for children and adolescents, continued research in all three domains is needed to reverse this trend.
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Affiliation(s)
- Mary F. Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Victoria M. O’Keefe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E. Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Haroz EE, Ingalls A, Wadlin J, Kee C, Begay M, Neault N, Barlow A. Utilizing broad-based partnerships to design a precision approach to implementing evidence-based home visiting. J Community Psychol 2020; 48:1100-1113. [PMID: 31970805 PMCID: PMC8082059 DOI: 10.1002/jcop.22281] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/02/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
The aim of this paper is to describe a participatory process for adapting an implementation strategy, using a precision approach, for an evidence-based home visiting program, Family Spirit. Family Spirit serves Native American and low-income communities nationwide. To redesign Family Spirit's implementation strategy, we used workshops (n = 5) with key stakeholders and conducted an online survey with implementers (n = 81) to identify hypothesized active ingredients and "pivot points" to guide when to tailor the program and for whom. Active ingredients identified included the relationship between the home visitor and clients, lessons ensuring child safety and healthy development, parent-child communication, and goal setting. Pivot points included whether the client is a first-time mother who has substance abuse history, has a baby at risk for childhood obesity, and/or has sexual or reproductive health concerns. These results are informing the adaptation of Family Spirit' implementation strategy making it more responsive to diverse families while balancing fidelity to the previously proven standard model.
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Affiliation(s)
- Emily E. Haroz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Ingalls
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Joshua Wadlin
- Department of Internal Medicine, Chinle Comprehensive Care Unit, Indian Health Service, Chinle, Arizona
| | - Crystal Kee
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Marissa Begay
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole Neault
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Barlow
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Levis B, Benedetti A, Ioannidis JPA, Sun Y, Negeri Z, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Rice DB, Riehm KE, Saadat N, Azar M, Boruff J, Cuijpers P, Gilbody S, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Alamri SH, Amtmann D, Ayalon L, Baradaran HR, Beraldi A, Bernstein CN, Bhana A, Bombardier CH, Carter G, Chagas MH, Chibanda D, Clover K, Conwell Y, Diez-Quevedo C, Fann JR, Fischer FH, Gholizadeh L, Gibson LJ, Green EP, Greeno CG, Hall BJ, Haroz EE, Ismail K, Jetté N, Khamseh ME, Kwan Y, Lara MA, Liu SI, Loureiro SR, Löwe B, Marrie RA, Marsh L, McGuire A, Muramatsu K, Navarrete L, Osório FL, Petersen I, Picardi A, Pugh SL, Quinn TJ, Rooney AG, Shinn EH, Sidebottom A, Spangenberg L, Tan PLL, Taylor-Rowan M, Turner A, van Weert HC, Vöhringer PA, Wagner LI, White J, Winkley K, Thombs BD. Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis. J Clin Epidemiol 2020; 122:115-128.e1. [PMID: 32105798 DOI: 10.1016/j.jclinepi.2020.02.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [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: 08/22/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. STUDY DESIGN AND SETTING Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. RESULTS A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). CONCLUSION PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.
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Affiliation(s)
- Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash Mani Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, NY, UK
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Dean McMillan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sultan H Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Hamid R Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran; Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Anna Beraldi
- Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik für Psychiatrie, Psychotherapie & Psychosomatik, Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Marcos H Chagas
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dixon Chibanda
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Crisanto Diez-Quevedo
- Servei de Psiquiatria, Hospital Germans Trias i Pujol, Badalona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Felix H Fischer
- Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Lorna J Gibson
- Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eric P Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Brian J Hall
- Department of Psychology, Faculty of Social Sciences, Global and Community Mental Health Research Group, University of Macau, Macau Special Administrative Region, China; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, UK
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Yunxin Kwan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | - Maria Asunción Lara
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. San Lorenzo Huipulco, Tlalpan, México D. F. Mexico
| | - Shen-Ing Liu
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Sonia R Loureiro
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Marsh
- Baylor College of Medicine, Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Anthony McGuire
- Department of Nursing, St. Joseph's College, Standish, ME, USA
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
| | - Laura Navarrete
- Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Flávia L Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA; American College of Radiology, Philadelphia, PA, USA
| | - Terence J Quinn
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK
| | - Eileen H Shinn
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | | | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, Scotland, UK
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Henk C van Weert
- Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Paul A Vöhringer
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Ministry of Economy, Macul, Santiago, Chile; Psychiatry Department, Tufts Medical Center, Tufts University, Boston, MA, USA
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer White
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada.
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Haroz EE, Decker E, Lee C, Bolton P, Spiegel P, Ventevogel P. Evidence for suicide prevention strategies with populations in displacement: a systematic review. Intervention (Amstelveen) 2020; 18:37-44. [PMID: 32665770 PMCID: PMC7359961] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Little is known about effective strategies to reduce rates of suicide among refugees and other displaced populations. This review aims to synthesise and assess the evidence base for suicide prevention and response programmes in refugee settings. We conducted a systematic review from peer-reviewed literature databases (five databases) and grey literature sources of literature published prior to November 27, 2017. We identified eight records (six peer-reviewed articles and two grey literature reports) that met our inclusion criteria. None of the eight records provided conclusive evidence of effectiveness. Five records had an unclear level of evidence and three records were potentially promising or promising. Most of the studies reviewed utilised multiple synergistic strategies. The most rigorous study showed the effectiveness of Brief Intervention and Contact and Safety planning. There is limited evidence of the effectiveness of other suicide prevention strategies for these groups. Future studies should attempt to better understand the impact of suicide prevention strategies, and explicitly unpack the individual and synergistic effects of multiple-strategies on suicide-related outcomes. Evidence from this review supports the use of Brief Intervention and Contact type interventions, but more research is needed to replicate findings particularly among populations in displacement.
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Affiliation(s)
- Emily E. Haroz
- PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Catherine Lee
- PhD, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | - Paul Bolton
- MBBS, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | - Paul Spiegel
- MD, Department of International Health, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health
| | - Peter Ventevogel
- MD, Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees
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O'Keefe VM, Haroz EE, Goklish N, Ivanich J, Cwik MF, Barlow A. Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide. BMC Public Health 2019; 19:1675. [PMID: 31830933 PMCID: PMC6909588 DOI: 10.1186/s12889-019-7996-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by local community mental health specialists (CMHSs) who strive to connect at-risk youth to treatment and brief, adjunctive interventions piloted in past research. METHODS Our primary aim is to evaluate which brief interventions, alone or in combination, have the greater effect on suicide ideation (primary outcome) and resilience (secondary outcome) among AI youth ages 10-24 ascertained for suicide-related behaviors by the tribal surveillance system. We are using a Sequential Multiple Assignment Randomized Trial with stratified assignment based on age and suicidal-behavior type, and randomizing N = 304 youth. Brief interventions are delivered by AI CMHSs, or by Elders with CMHS support, and include: 1) New Hope, an evidence-based intervention to reduce immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections; and 2) Elders' Resilience, a culturally-grounded intervention to promote resilience through connectedness, self-esteem and cultural identity/values. The control condition is Optimized Case Management, which all study participants receive. We hypothesize that youth who receive: a) New Hope vs. Optimized Case Management will have significant reductions in suicide ideation; b) Elders' Resilience vs. Optimized Case Management will have significant gains in resilience; c) New Hope followed by Elders' Resilience will have the largest improvements on suicide ideation and resilience; and d) Optimized Case Management will have the weakest effects of all groups. Our secondary aim will examine mediators and moderators of treatment effectiveness and sequencing. DISCUSSION Due to heterogeneity of suicide risk/protective factors among AI youth, not all youth require the same types of interventions. Generating evidence for what works, when it works, and for whom is paramount to AI youth suicide prevention efforts, where rates are currently high and resources are limited. Employing Native paraprofessionals is a means of task-shifting psychoeducation, culturally competent patient support and continuity of care. TRIAL REGISTRATION Clinical Trials NCT03543865, June 1, 2018.
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Affiliation(s)
- Victoria M O'Keefe
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA.
| | - Emily E Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Jerreed Ivanich
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | | | - Mary F Cwik
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
| | - Allison Barlow
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 415 N. Washington Street, 4th Floor, Baltimore, MD, 21231, USA
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Kemp CG, Wagenaar BH, Haroz EE. Expanding Hybrid Studies for Implementation Research: Intervention, Implementation Strategy, and Context. Front Public Health 2019; 7:325. [PMID: 31781528 PMCID: PMC6857476 DOI: 10.3389/fpubh.2019.00325] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Successful implementation reflects the interplay between intervention, implementation strategy, and context. Hybrid effectiveness-implementation studies allow investigators to assess the effects of both intervention and implementation strategy, though the role of context as a third independent variable (IV) is incompletely specified. Our objective is to expand the hybrid typology to include mixtures of all three types of IVs: intervention, implementation strategy, and context. We propose to use I to represent the IV of intervention, IS to represent implementation strategy, and C to represent context. Primary IVs are written first and in upper case. Secondary IVs are written after a forward slash and in lower case; co-primary IVs are written after a dash and in upper case. The expanded framework specifies nine two-variable hybrid types: I/is, I-IS, IS/i, IS/c, IS-C, C/is, C/i, I-C, and I/c. We describe four in detail: I/is, IS/c, IS-C, and C/is. We also specify seven three-variable hybrid types. We argue that many studies already meet our definitions of two- or three-variable hybrids. Our proposal builds from the typology proposed by Curran et al. (1), but offers a more complete specification of hybrid study types. We need studies that measure the implementation-related effects of variations in contextual determinants, both to advance the science and to optimize intervention delivery in the real world. Prototypical implementation studies that evaluate the effectiveness of an implementation strategy, in isolation from its context, risk perpetuating the gap between evidence and practice, as they will not generate context-specific knowledge around implementation, scale-up, and de-implementation.
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Affiliation(s)
- Christopher G Kemp
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Emily E Haroz
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States.,Center for American Indian Health, Johns Hopkins University, Baltimore, MD, United States
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Haroz EE, Ingalls A, Kee C, Goklish N, Neault N, Begay M, Barlow A. Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit. Prev Sci 2019; 20:1244-1254. [PMID: 31432381 PMCID: PMC7082862 DOI: 10.1007/s11121-019-01039-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
The Maternal, Infant, and Early Childhood Home Visiting Program was reauthorized February 8, 2018, and invests $2 billion over 5 years to improve mothers' and children's outcomes across the life course. Along with this investment, the home-visiting field is striving for implementation innovations to deliver the greatest impact to the most families at the most efficient cost through a focus on precision home visiting. Consistent with the precision home-visiting approach to identify meaningful subgroups to guide content tailoring, the purpose of this paper is to answer (1) how and to what degree an evidence-based home-visiting model benefits mothers and children with substance use or depression and (2) what baseline characteristics indicate who can benefit most. We completed a secondary data analysis of the most recently completed randomized controlled trial (RCT) of Family Spirit (N = 322), a federally endorsed home-visiting intervention designed for young Native American mothers and their children. We examined how baseline differences in mothers' substance use, depression, and demographic characteristics (household mobility, education, parity, and premature birth) moderated mothers' and children's intervention-related outcomes. Children born to mothers with past substance use histories benefited more from the intervention than children born to abstinent mothers (p < 0.01). Unstable housing, parity, and low educational attainment emerged as moderators of intervention effectiveness. Results from this investigation will serve as a basis for designing and evaluating a precision approach to Family Spirit and may provide lessons for other models to explore tailoring variables for optimal impact and efficiency. Trial Registry: NCT00373750.
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Affiliation(s)
- E E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - A Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Kee
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Neault
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Begay
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Misra S, Stevenson A, Haroz EE, de Menil V, Koenen KC. 'Global mental health': systematic review of the term and its implicit priorities. BJPsych Open 2019; 5:e47. [PMID: 31530316 PMCID: PMC6582218 DOI: 10.1192/bjo.2019.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/24/2018] [Accepted: 04/28/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The term 'global mental health' came to the fore in 2007, when the Lancet published a series by that name. AIMS To review all peer-reviewed articles using the term 'global mental health' and determine the implicit priorities of scientific literature that self-identifies with this term. METHOD We conducted a systematic review to quantify all peer-reviewed articles using the English term 'global mental health' in their text published between 1 January 2007 and 31 December 2016, including by geographic regions and by mental health conditions. RESULTS A total of 467 articles met criteria. Use of the term 'global mental health' increased from 12 articles in 2007 to 114 articles in 2016. For the 111 empirical studies (23.8% of articles), the majority (78.4%) took place in low- and middle-income countries (LMICs), with the most in Sub-Saharan Africa (28.4%) and South Asia (25.5%) and none from Central Asia. The most commonly studied mental health conditions were depression (29.7%), psychoses (12.6%) and conditions specifically related to stress (12.6%), with fewer studies on epilepsy (2.7%), self-harm and suicide (1.8%) and dementia (0.9%). The majority of studies lacked contextual information, including specific region(s) within countries where studies took place (20.7% missing), specific language(s) in which studies were conducted (36.9% missing), and details on ethnic identities such as ethnicity, caste and/or tribe (79.6% missing) and on socioeconomic status (85.4% missing). CONCLUSIONS Research identifying itself as 'global mental health' has focused predominantly on depression in LMICs and lacked contextual and sociodemographic data that limit interpretation and application of findings. DECLARATION OF INTEREST None.
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Affiliation(s)
- Supriya Misra
- Doctoral Candidate, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Anne Stevenson
- Program Director, Neuropsychiatric Genetics of African Populations-Psychosis Study, Harvard T.H. Chan School of Public Health, USA
| | - Emily E. Haroz
- Assistant Scientist, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Victoria de Menil
- Research Associate, Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA
| | - Karestan C. Koenen
- Professor, Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA
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Haroz EE, Bolton P, Nguyen AJ, Lee C, Bogdanov S, Bass J, Singh NS, Doty SB, Murray L. Measuring implementation in global mental health: validation of a pragmatic implementation science measure in eastern Ukraine using an experimental vignette design. BMC Health Serv Res 2019; 19:262. [PMID: 31036002 PMCID: PMC6489318 DOI: 10.1186/s12913-019-4097-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is mounting evidence supporting the effectiveness of task-shifted mental health interventions in low- and middle-income countries (LMIC). However, there has been limited systematic scale-up or sustainability of these programs, indicating a need to study implementation. One barrier to progress is a lack of locally relevant and valid implementation measures. We adapted an existing brief dissemination and implementation (D&I) measure which includes scales for acceptability, appropriateness, feasibility and accessibility for local use and studied its validity and reliability among a sample of consumers in Ukraine. METHODS Local qualitative data informed adaptation of the measure and development of vignettes to test the reliability and validity. Participants were veterans and internally displaced persons (IDPs) recruited as part of a separate validity study of adapted mental health instruments. We examined internal consistency reliability, test-retest reliability, and construct and criterion validity for each scale on the measure. We randomly assigned half the participants to respond to a vignette depicting existing local psychiatric services which we knew were not well regarded, while the other half was randomized to a vignette describing a potentially more well-implemented mental health service. Criterion validity was assessed by comparing scores on each scale by vignette and by overall summary ratings of the programs described in the vignettes. RESULTS N = 169 participated in the qualitative study and N = 153 participated in the validity study. Qualitative findings suggested the addition of several items to the measure and indicated the importance of addressing professionalism/competency of providers in both the scales and the vignettes. Internal consistency reliabilities ranged from α = 0.85 for feasibility to α = 0.91 for appropriateness. Test-rest reliabilities were acceptable to good for all scales (rho: 0.61-0.79). All scales demonstrated substantial and significant differences in average scores by vignette assignment (ORs: 2.21-5.6) and overall ratings (ORs: 5.1-14.47), supporting criterion validity. CONCLUSIONS This study represents an innovative mixed-methods approach to testing an implementation science measure in contexts outside the United States. Results support the reliability and validity of most scales for consumers in Ukraine. Challenges included large amounts of missing data due to participants' difficulties responding to questions about a hypothetical program.
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Affiliation(s)
- E E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway 8th fl, Baltimore, MD, 21205, USA.
| | - P Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway 8th fl, Baltimore, MD, 21205, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - A J Nguyen
- University of Virginia Curry School of Education, Virginia, USA
| | - C Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - S Bogdanov
- Center for Mental Health and Psychosocial Support National University of Kyiv-Mohyla, Kyiv-Mohyla, Ukraine
| | - J Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway 8th fl, Baltimore, MD, 21205, USA
| | - N S Singh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - S B Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway 8th fl, Baltimore, MD, 21205, USA
| | - L Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway 8th fl, Baltimore, MD, 21205, USA
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Burkey MD, Adhikari RP, Ghimire L, Kohrt BA, Wissow LS, Luitel NP, Haroz EE, Jordans MJD. Validation of a cross-cultural instrument for child behavior problems: the Disruptive Behavior International Scale - Nepal version. BMC Psychol 2018; 6:51. [PMID: 30390713 PMCID: PMC6215604 DOI: 10.1186/s40359-018-0262-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obtaining accurate and valid measurements of disruptive behavior disorders remains a challenge in non-Western settings due to variability in societal norms for child behavior and a lack of tools developed outside of Western contexts. This paper assesses the reliability and construct validity of the Disruptive Behavior International Scale - Nepal version (DBIS-N)-a scale developed using ethnographic research in Nepal-and compares it with a widely used Western-derived scale in assessing locally defined child behavior problems. METHODS We assessed a population-based sample of 268 children ages 5-15 years old in Nepal for behavior problems with a pool of candidate items developed from ethnographic research. We selected final items for the DBIS-N using exploratory factor analysis in a randomly selected half of the sample and then evaluated the model fit using confirmatory factor analysis in the remaining half. We compared the classification accuracy and incremental validity of the DBIS-N and Eyberg Child Behavior Inventory (ECBI) using local defined behavior problems as criteria. Local criteria were assessed via parent report using: 1) local behavior problem terms, and 2) a locally developed vignette-based assessment. RESULTS Ten items were selected for the final scale. The DBIS-N had good internal consistency (Cronbach's α: 0.84) and excellent test-retest reliability (intraclass correlation 0.93, r = .93). Classification accuracy and area under the curve (AUC) were similar and high for both the ECBI (AUC: 0.83 and 0.85) and DBIS-N (AUC: 0.83 and 0.85) on both local criteria. The DBIS-N added predictive value above the ECBI in logistic regression models, supporting its incremental validity. CONCLUSIONS While both the DBIS-N and the ECBI had high classification accuracy for local idioms for behavior problems, the DBIS-N had a more coherent factor structure and added predictive value above the ECBI. Items from the DBIS-N were more consistent with cultural themes identified in qualitative research, whereas multiple items in the ECBI that did not fit with these themes performed poorly in factor analysis. In conjunction with practical considerations such as price and scale length, our results lend support for the utility of the DBIS-N for the assessment of locally prioritized behavior problems in Nepal.
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Affiliation(s)
- Matthew D. Burkey
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Lajina Ghimire
- Research Department, Transcultural Psychosocial Organization—Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC USA
| | - Lawrence S. Wissow
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization—Nepal, Kathmandu, Nepal
| | - Emily E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Mark J. D. Jordans
- Research Department, War Child, and Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Kane JC, Vinikoor MJ, Haroz EE, Al-Yasiri M, Bogdanov S, Mayeya J, Simenda F, Murray LK. Mental health comorbidity in low-income and middle-income countries: a call for improved measurement and treatment. Lancet Psychiatry 2018; 5:864-866. [PMID: 30174288 PMCID: PMC6644038 DOI: 10.1016/s2215-0366(18)30301-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 06/27/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Jeremy C Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Michael J Vinikoor
- University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294, USA
| | - Emily E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Sergiy Bogdanov
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | | | | | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Doty SB, Haroz EE, Singh NS, Bogdanov S, Bass JK, Murray LK, Callaway KL, Bolton PA. Adaptation and testing of an assessment for mental health and alcohol use problems among conflict-affected adults in Ukraine. Confl Health 2018; 12:34. [PMID: 30127843 PMCID: PMC6092824 DOI: 10.1186/s13031-018-0169-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/13/2017] [Accepted: 05/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia. Our purpose was to develop reliable and valid instruments to screen for common mental health and alcohol use problems in these populations. Methods We used a three-step process of instrument adaptation and testing. The instrument-the Mental Health Assessment Inventory (MHAI)-combines adapted standard screeners with items derived locally in Ukraine. A validity study was conducted using a sample of 153 adults (54% male) ages 18 years and older. All participants in the sample were IDPs or veterans living in or near the major urban areas of Kyiv and Zaporizhia. Reliability testing (internal consistency, test-retest) and validity testing (construct, criterion) of the MHAI were conducted using classical test theory. After initial testing, we used Item Response Theory (IRT) to shorten and further refine the instrument. Results The MHAI showed good internal consistency and test-retest reliability for the main outcomes: depression (α = 0.94; r = .84), post-traumatic stress (PTS; α = 0.97; r = 0.87), anxiety (α = 0.90; r = 0.80), and alcohol use (α = 0.86; r = 0.91). There was good evidence of convergent construct validity among the scales for depression, PTS, and anxiety, but not for alcohol use. Item Response Theory (IRT) analysis supported use of shortened versions of the scales for depression, PTS, and anxiety, as they retained comparable psychometric properties to the full scales of the MHAI. Conclusion The findings support the reliability and validity of the assessment-the MHAI-for screening of common mental health problems among Ukrainian IDPs and veterans. Use of IRT shortened the instrument to improve practicality and potential sustainability.
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Affiliation(s)
- S Benjamin Doty
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Emily E Haroz
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Namrita S Singh
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sergiy Bogdanov
- 3Center for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Judith K Bass
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Laura K Murray
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Karis L Callaway
- 4Department of Psychology, Western Michigan University, Kalamazoo, MI USA
| | - Paul A Bolton
- 1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.,2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Murray LK, Haroz EE, Doty SB, Singh NS, Bogdanov S, Bass J, Dorsey S, Bolton P. Testing the effectiveness and implementation of a brief version of the Common Elements Treatment Approach (CETA) in Ukraine: a study protocol for a randomized controlled trial. Trials 2018; 19:418. [PMID: 30075806 PMCID: PMC6090833 DOI: 10.1186/s13063-018-2752-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental illness is a major public health concern. Despite progress understanding which treatments work, a significant treatment gap remains. An ongoing concern is treatment length. Modular, flexible, transdiagnostic approaches have been offered as one solution to scalability challenges. The Common Elements Treatment Approach (CETA) is one such approach and offers the ability to treat a wide range of common mental health problems. CETA is supported by two randomized trials from low- and middle-income countries showing strong effectiveness and implementation outcomes. METHODS/DESIGN This trial evaluates the effectiveness and implementation of two versions of CETA using a non-inferiority design to test two primary hypotheses: (1) a brief five-session version of CETA (Brief CETA) will provide similar effectiveness for reducing the severity of common mental health problems such as depression, post-traumatic stress, impaired functioning, anxiety, and substance use problems compared with the standard 8-12-session version of CETA (Standard CETA); and (2) both Brief and Standard CETA will have superior impact on the outcomes compared to a wait-list control condition. For both hypotheses, the main effect will be assessed using longitudinal data and mixed-effects regression models over a 6-month period post baseline. A secondary aim includes exploration of implementation factors. Additional planned analyses will include exploration of: moderators of treatment impact by disorder severity and comorbidity; the impact of individual therapeutic components; and trends in symptom change between end of treatment and 6-month assessment for all participants. DISCUSSION This trial is the first rigorous study comparing a standard-length (8-12 sessions) modular, flexible, transdiagnostic, cognitive-behavioral approach to a shortened version of the approach (five sessions). Brief CETA entails "front-loading" with elements that research suggests are strong mechanisms of change. The study design will allow us to draw conclusions about the effects of both Brief and Standard CETA as well as which elements are integral to their mechanisms of action, informing future implementation and fidelity efforts. The results from this trial will inform future dissemination, implementation and scale-up of CETA in Ukraine and contribute to our understanding of the effects of modular, flexible, transdiagnostic approaches in similar contexts. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03058302 (U.S. National Library of Medicine). Registered on 20 February 2017.
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Affiliation(s)
- Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Emily E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - S. Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Namrita S. Singh
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sergey Bogdanov
- Centre for Mental Health and Psychosocial Support, National University Kyiv-Mohyla Academy, Glasunova str 2/4, Kyiv, 01042 Ukraine
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA 98105 USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205 USA
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Bolton P, Haroz EE. Experience versus diagnosis as the appropriate basis for assessment of depression: A reply to the commentary from Kirmayer et al. (2017). Soc Sci Med 2018; 232:432-433. [PMID: 29329943 DOI: 10.1016/j.socscimed.2018.01.002] [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] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 11/15/2022]
Affiliation(s)
- P Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - E E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
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Haroz EE, Jordans M, de Jong J, Gross A, Bass J, Tol W. Measuring Hope Among Children Affected by Armed Conflict: Cross-Cultural Construct Validity of the Children's Hope Scale. Assessment 2017; 24:528-539. [PMID: 26508802 PMCID: PMC5835958 DOI: 10.1177/1073191115612924] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Indexed: 11/16/2022]
Abstract
We investigated the cross-cultural construct validity of hope, a factor associated with mental health protection and promotion, using the Children's Hope Scale (CHS). The sample ( n = 1,057; 48% girls) included baseline data from three cluster-randomized controlled trials with children affected by armed conflict ( n = 329 Burundi; n = 403 Indonesia; n = 325 Nepal). The confirmatory factor analysis in each country indicated good fit for the hypothesized two-factor model. Analysis by gender indicated that configural invariance was supported and that scalar invariance was demonstrated in Indonesia. However, metric and scalar invariance were not supported in Burundi and Nepal. In country comparisons, configural and metric invariance were met, but scalar invariance was not supported. Evidence from this study supports the use of the CHS within various sociocultural settings and across genders, but direct comparisons of CHS scores across groups should be done with caution. Rigorous evaluations of the measurement properties of mental health protective and promotive factors are necessary to inform both research and practice.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Jordans
- HealthNet TPO, Amsterdam, Netherlands
- Kings College London, London, UK
| | | | - Alden Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith Bass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse Tol
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Haroz EE, Ritchey M, Bass JK, Kohrt BA, Augustinavicius J, Michalopoulos L, Burkey MD, Bolton P. How is depression experienced around the world? A systematic review of qualitative literature. Soc Sci Med 2017; 183:151-162. [PMID: 28069271 PMCID: PMC5488686 DOI: 10.1016/j.socscimed.2016.12.030] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022]
Abstract
To date global research on depression has used assessment tools based on research and clinical experience drawn from Western populations (i.e., in North American, European and Australian). There may be features of depression in non-Western populations which are not captured in current diagnostic criteria or measurement tools, as well as criteria for depression that are not relevant in other regions. We investigated this possibility through a systematic review of qualitative studies of depression worldwide. Nine online databases were searched for records that used qualitative methods to study depression. Initial searches were conducted between August 2012 and December 2012; an updated search was repeated in June of 2015 to include relevant literature published between December 30, 2012 and May 30, 2015. No date limits were set for inclusion of articles. A total of 16,130 records were identified and 138 met full inclusion criteria. Included studies were published between 1976 and 2015. These 138 studies represented data on 170 different study populations (some reported on multiple samples) and 77 different nationalities/ethnicities. Variation in results by geographical region, gender, and study context were examined to determine the consistency of descriptions across populations. Fisher's exact tests were used to compare frequencies of features across region, gender and context. Seven of the 15 features with the highest relative frequency form part of the DSM-5 diagnosis of Major Depressive Disorder (MDD). However, many of the other features with relatively high frequencies across the studies are associated features in the DSM, but are not prioritized as diagnostic criteria and therefore not included in standard instruments. The DSM-5 diagnostic criteria of problems with concentration and psychomotor agitation or slowing were infrequently mentioned. This research suggests that the DSM model and standard instruments currently based on the DSM may not adequately reflect the experience of depression at the worldwide or regional levels.
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Affiliation(s)
- E E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - M Ritchey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - B A Kohrt
- Duke University, Duke Global Health Institute & Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, United States
| | - J Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - L Michalopoulos
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - M D Burkey
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - P Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
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Teel KS, Verdeli H, Wickramaratne P, Warner V, Vousoura E, Haroz EE, Talati A. Impact of a Father Figure's Presence in the Household on Children's Psychiatric Diagnoses and Functioning in Families at High Risk for Depression. J Child Fam Stud 2016; 25:588-597. [PMID: 29056837 PMCID: PMC5648344 DOI: 10.1007/s10826-015-0239-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
The consequences of living in single-parent households on children's wellbeing are well documented, but less is known about the impact of living in single-mother households among children with high familial risk for depression. Utilizing data from an ongoing three-generation study of high-risk families, this preliminary study examined a sample of 161 grandchildren of probands diagnosed with major depressive disorder, comparing those in single-parent households to those in dual-parent households with household status defined as the full-time presence of a resident male in the home. High-risk children were compared across households in terms of psychiatric diagnoses (measured by Schedule for Affective Disorders and Schizophrenia for School-Age Children; K-SADS-PL) and global functioning (assessed by Global Assessment Scale, child version; C-GAS). Results indicated that high-risk children in single-parent households had 4.7 times greater odds for developing a mood disorder and had significantly lower mean C-GAS scores (p = 0.01) compared to those in dual-parent households. Differences remained significant when controlling for household income, child's age, and either parent's depression status. There were no significant differences between high-risk children across households when household status was instead defined as legal marital status. This study has several limitations: sample size was small, pro-bands were recruited from a clinical population, and participants had not passed completely through the period of risk for adult psychiatric disorders. These findings point towards the importance of identifying and closely monitoring children at risk for depression, particularly if they reside in households without a resident father figure.
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Affiliation(s)
- Karen Shoum Teel
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
| | - Helen Verdeli
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Priya Wickramaratne
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Epidemiology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Virginia Warner
- Division of Epidemiology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Eleni Vousoura
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W. 120th Street, New York, NY 10027, USA
| | - Emily E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ardesheer Talati
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Epidemiology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Kaiser BN, Haroz EE, Kohrt BA, Bolton PA, Bass JK, Hinton DE. "Thinking too much": A systematic review of a common idiom of distress. Soc Sci Med 2015; 147:170-83. [PMID: 26584235 PMCID: PMC4689615 DOI: 10.1016/j.socscimed.2015.10.044] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 12/16/2022]
Abstract
Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.
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Affiliation(s)
- Bonnie N Kaiser
- Department of Anthropology and Department of Epidemiology, Emory University, 1557 Dickey Drive, Atlanta, GA 30322, USA; Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27701, USA.
| | - Emily E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Brandon A Kohrt
- Department of Psychiatry & Behavioral Sciences, Duke Global Health Institute, and Department of Cultural Anthropology, Duke University, 310 Trent Drive, Durham, NC 27710, USA
| | - Paul A Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Broadway, Baltimore, MD 21205, USA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Devon E Hinton
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, WACC 812, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Michalopoulos LM, Unick GJ, Haroz EE, Bass J, Murray LK, Bolton PA. Exploring the fit of Western PTSD models across three non-Western low- and middle-income countries. ACTA ACUST UNITED AC 2015. [DOI: 10.1037/trm0000020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, Ugueto AM, Bass J. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med 2014; 11:e1001757. [PMID: 25386945 PMCID: PMC4227644 DOI: 10.1371/journal.pmed.1001757] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Existing studies of mental health interventions in low-resource settings have employed highly structured interventions delivered by non-professionals that typically do not vary by client. Given high comorbidity among mental health problems and implementation challenges with scaling up multiple structured evidence-based treatments (EBTs), a transdiagnostic treatment could provide an additional option for approaching community-based treatment of mental health problems. Our objective was to test such an approach specifically designed for flexible treatments of varying and comorbid disorders among trauma survivors in a low-resource setting. METHODS AND FINDINGS We conducted a single-blinded, wait-list randomized controlled trial of a newly developed transdiagnostic psychotherapy, Common Elements Treatment Approach (CETA), for low-resource settings, compared with wait-list control (WLC). CETA was delivered by lay workers to Burmese survivors of imprisonment, torture, and related traumas, with flexibility based on client presentation. Eligible participants reported trauma exposure and met severity criteria for depression and/or posttraumatic stress (PTS). Participants were randomly assigned to CETA (n = 182) or WLC (n = 165). Outcomes were assessed by interviewers blinded to participant allocation using locally adapted standard measures of depression and PTS (primary outcomes) and functional impairment, anxiety symptoms, aggression, and alcohol use (secondary outcomes). Primary analysis was intent-to-treat (n = 347), including 73 participants lost to follow-up. CETA participants experienced significantly greater reductions of baseline symptoms across all outcomes with the exception of alcohol use (alcohol use analysis was confined to problem drinkers). The difference in mean change from pre-intervention to post-intervention between intervention and control groups was -0.49 (95% CI: -0.59, -0.40) for depression, -0.43 (95% CI: -0.51, -0.35) for PTS, -0.42 (95% CI: -0.58, -0.27) for functional impairment, -0.48 (95% CI: -0.61, -0.34) for anxiety, -0.24 (95% CI: -0.34, -0.15) for aggression, and -0.03 (95% CI: -0.44, 0.50) for alcohol use. This corresponds to a 77% reduction in mean baseline depression score among CETA participants compared to a 40% reduction among controls, with respective values for the other outcomes of 76% and 41% for anxiety, 75% and 37% for PTS, 67% and 22% for functional impairment, and 71% and 32% for aggression. Effect sizes (Cohen's d) were large for depression (d = 1.16) and PTS (d = 1.19); moderate for impaired function (d = 0.63), anxiety (d = 0.79), and aggression (d = 0.58); and none for alcohol use. There were no adverse events. Limitations of the study include the lack of long-term follow-up, non-blinding of service providers and participants, and no placebo or active comparison intervention. CONCLUSIONS CETA provided by lay counselors was highly effective across disorders among trauma survivors compared to WLCs. These results support the further development and testing of transdiagnostic approaches as possible treatment options alongside existing EBTs. TRIAL REGISTRATION ClinicalTrials.gov NCT01459068 Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Catherine Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emily E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, Washington, United States of America
| | - Courtland Robinson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ana M. Ugueto
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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