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Szczuka Z, Siwa M, Abraham C, Baban A, Brooks S, Cipolletta S, Danso E, Dombrowski SU, Gan Y, Gaspar T, Gaspar de Matos M, Griva K, Jongenelis M, Keller J, Knoll N, Ma J, Abdul Awal Miah M, Morgan K, Peraud W, Quintard B, Shah V, Schenkel K, Scholz U, Schwarzer R, Taut D, Tomaino SC, Vilchinsky N, Wolf H, Luszczynska A. Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory. Soc Sci Med 2023; 317:115569. [PMID: 36436259 PMCID: PMC9677570 DOI: 10.1016/j.socscimed.2022.115569] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022]
Abstract
RATIONALE The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information. OBJECTIVE Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs). METHOD The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection). RESULTS Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators. CONCLUSIONS We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.
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Affiliation(s)
- Zofia Szczuka
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities; Aleksandra Ostrowskiego 30b, 50505 Wroclaw, Poland.
| | - Maria Siwa
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities; Aleksandra Ostrowskiego 30b, 50505 Wroclaw, Poland.
| | - Charles Abraham
- School of Psychology, Deakin University; 221 Burwood Hwy, Burwood VIC 3125, Australia.
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University; Strada Mihail Kogălniceanu 1, Cluj-Napoca 400000, Romania.
| | - Sydney Brooks
- Faculty of Kinesiology, University of New Brunswick; 90 MacKay Dr, Fredericton, NB E3B 5A3, Canada.
| | - Sabrina Cipolletta
- Department of General Psychology, University of Padova; Via Venezia, 8 - 35131 Padova, Italy.
| | - Ebrima Danso
- Medical Research Council Unit - the Gambia at, London School of Hygiene and Tropical Medicine; F8F5+XP5, Atlantic Boulevard, Serrekunda, Gambia.
| | - Stephan U. Dombrowski
- Faculty of Kinesiology, University of New Brunswick; 90 MacKay Dr, Fredericton, NB E3B 5A3, Canada
| | - Yiqun Gan
- School of Psychological and Cognitive Sciences, Peking University; No. 52, Haidian Road, Haidian District, Beijing 100805, China.
| | - Tania Gaspar
- Institute of Environmental Health, Medical School, University of Lisbon; Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal.
| | - Margarida Gaspar de Matos
- Institute of Environmental Health, Medical School, University of Lisbon; Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal.
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University; 11 Mandalay Road, Singapore 308232.
| | - Michelle Jongenelis
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne; Redmond Barry Building, Parkville Campus, Melbourne VIC 3010, Australia.
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin; Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Nina Knoll
- Department of Education and Psychology, Freie Universität Berlin; Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Jinjin Ma
- School of Psychological and Cognitive Sciences, Peking University; No. 52, Haidian Road, Haidian District, Beijing 100805, China.
| | - Mohammad Abdul Awal Miah
- Perdana University-Royal College of Surgeons in Ireland School of Medicine; Wisma Chase Perdana Jalan Semantan Damansara Heights 50490 Kuala Lumpur, 50490, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland School of Medicine; Wisma Chase Perdana Jalan Semantan Damansara Heights 50490 Kuala Lumpur, 50490, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - William Peraud
- Department of Psychology, University of Bordeaux; Amphithéâtre 3 à 12, 33000 Bordeaux, France.
| | - Bruno Quintard
- Department of Psychology, University of Bordeaux; Amphithéâtre 3 à 12, 33000 Bordeaux, France.
| | - Vishna Shah
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel Street, WC1E 7HT United Kingdom.
| | - Konstantin Schenkel
- Applied Social and Health Psychology, Department of Psychology, University of Zurich; Binzmuehlestrasse 14, 8050 Zurich, Switzerland.
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University of Zurich; Binzmuehlestrasse 14, 8050 Zurich, Switzerland.
| | - Ralf Schwarzer
- Department of Education and Psychology, Freie Universität Berlin; Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Diana Taut
- Department of Psychology, Babes-Bolyai University; Strada Mihail Kogălniceanu 1, Cluj-Napoca 400000, Romania.
| | - Silvia C.M. Tomaino
- Department of General Psychology, University of Padova; Via Venezia, 8 - 35131 Padova, Italy
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University; Anna and Max Webb and Family Psychology Building, Ramat Gan, Israel.
| | - Hodaya Wolf
- Department of Psychology, Bar-Ilan University; Anna and Max Webb and Family Psychology Building, Ramat Gan, Israel.
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities; Aleksandra Ostrowskiego 30b, 50505 Wroclaw, Poland; Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne; Redmond Barry Building, Parkville Campus, Melbourne VIC 3010, Australia.
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Todorova I, Albers L, Aronson N, Baban A, Benyamini Y, Cipolletta S, del Rio Carral M, Dimitrova E, Dudley C, Guzzardo M, Hammoud R, Fadil Azim DH, Hilverda F, Huang Q, John L, Kaneva M, Khan S, Kostova Z, Kotzeva T, Fathima M, Anto MM, Michoud C, Awal Miah MA, Mohr J, Morgan K, Nastase ES, Neter E, Panayotova Y, Patel H, Pillai D, Polidoro Lima M, Qin DB, Salewski C, Sankar KA, Shao S, Suresh J, Todorova R, Tomaino SCM, Vollmann M, Winter D, Xie M, Xuan Ning S, Zlatarska A. "What I thought was so important isn't really that important": international perspectives on making meaning during the first wave of the COVID-19 pandemic. Health Psychol Behav Med 2021; 9:830-857. [PMID: 34650834 PMCID: PMC8510597 DOI: 10.1080/21642850.2021.1981909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The global COVID-19 pandemic has had a significant impact on the physical and mental health of people everywhere. The aim of the study is to understand how people living in 15 countries around the globe experience an unexpected crisis which threatens their health and that of loved ones, and how they make meaning of this disruption in their narratives. METHODS Data were collected through an anonymous online survey during May-September 2020, which was during or just after the first wave of the COVID-19 pandemic, depending on the country. The questionnaire included demographic and three open-ended questions as prompts for stories about experiences during the initial months of the pandemic. The text was analyzed through inductive thematic content analysis and quantified for full sample description, demographic and subsequently international comparisons. RESULTS The final qualitative dataset included stories from n = 1685 respondents. The sample was 73.6% women and 26.4% men. The mean age of participants was 39.55 years (SD = 14.71). The identified four groups of overarching themes were: The presence and absence of others; Rediscovering oneself; The meaning of daily life; Rethinking societal and environmental values. We discuss the prevalence of each theme for the sample as a whole and differences by demographic groups. The most prevalent theme referred to disruptions in interpersonal contacts, made meaningful by the increased appreciation of the value of relationships, present in (45.6%) of stories. It was more prevalent in the stories of women compared to men (χ² = 24.88, p = .001). CONCLUSIONS The paper provides a detailed overview of the methodology, the main themes identified inductively in the stories and differences according to select demographic variables. We identify several major ways of making meaning of the pandemic. The pandemic has impacted many aspects of people's lives which give it meaning, no matter where they live.
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Affiliation(s)
- Irina Todorova
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | | | - Nicole Aronson
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Sabrina Cipolletta
- Department of General Psychology, Università degli Studi di Padova, Padova, Italy
| | - Maria del Rio Carral
- Research Center for Psychology of Health, Aging and Sport Examination (PHASE), Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Elitsa Dimitrova
- Institute for Population and Human Studies, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Claire Dudley
- Department of Psychology, St. Lawrence University Canton, New York, NY, USA
| | - Mariana Guzzardo
- Department of Human Development and Women's Studies, California State University, East Bay, CA, USA
| | - Razan Hammoud
- Department of General Psychology, Università degli Studi di Padova, Padova, Italy
| | - Darlina Hani Fadil Azim
- Perdana University Royal College of Surgeons School of Medicine (PURCSI), Kuala Lumpur, Malaysia
| | - Femke Hilverda
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Qi Huang
- Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Liji John
- Department of Psychology, Prajyoti Niketan College, Thrissur, India
| | - Michaela Kaneva
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sanjida Khan
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Zlatina Kostova
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Tatyana Kotzeva
- Institute for Population and Human Studies, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - M.A. Fathima
- Department of Psychology, Prajyoti Niketan College, Thrissur, India
| | - Milu Maria Anto
- Department of Psychology, Prajyoti Niketan College, Thrissur, India
| | - Chloé Michoud
- Research Center for Psychology of Health, Aging and Sport Examination (PHASE), Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | | | - Julia Mohr
- Fakultät für Psychologie, Fernuniversität, Hagen, Germany
| | - Karen Morgan
- School of Health Psychology, RCSI, Dublin, Ireland
| | | | | | | | - Hemali Patel
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Dhanya Pillai
- Perdana University Royal College of Surgeons School of Medicine (PURCSI), Kuala Lumpur, Malaysia
| | - Manuela Polidoro Lima
- Hospital da Liga Norte Riograndense Against Cancer in Natal, and INSA Institute Prepares - CESAC, Natal, Brazil
| | - Desiree Baolian Qin
- Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | | | - K. Anu Sankar
- Department of Psychology, Prajyoti Niketan College, Thrissur, India
| | - Sabrina Shao
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Jeevanisha Suresh
- Perdana University Royal College of Surgeons School of Medicine (PURCSI), Kuala Lumpur, Malaysia
| | - Ralitsa Todorova
- Department of Psychology, City University of New York, New York, NY, USA
| | | | - Manja Vollmann
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - David Winter
- Centre for Research in Psychology and Sport Sciences, University of Hertfordshire, Hatfield, UK
| | - Mingjun Xie
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Sam Xuan Ning
- Perdana University Royal College of Surgeons School of Medicine (PURCSI), Kuala Lumpur, Malaysia
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Szczuka Z, Abraham C, Baban A, Brooks S, Cipolletta S, Danso E, Dombrowski SU, Gan Y, Gaspar T, de Matos MG, Griva K, Jongenelis M, Keller J, Knoll N, Ma J, Miah MAA, Morgan K, Peraud W, Quintard B, Shah V, Schenkel K, Scholz U, Schwarzer R, Siwa M, Szymanski K, Taut D, Tomaino SCM, Vilchinsky N, Wolf H, Luszczynska A. The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries. BMC Public Health 2021; 21:1791. [PMID: 34610808 PMCID: PMC8492037 DOI: 10.1186/s12889-021-11822-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). METHODS The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. RESULTS Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. CONCLUSIONS To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic. TRIAL REGISTRATION Clinical Trials.Gov, # NCT04367337.
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Affiliation(s)
- Zofia Szczuka
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland
| | - Charles Abraham
- School of Psychology, Deakin University, Melbourne, Australia
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Sydney Brooks
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | | | - Ebrima Danso
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, Gambia
| | | | - Yiqun Gan
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Tania Gaspar
- Institute of Environmental Health, Medical School, University of Lisbon, Lisbon, Portugal
| | | | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Michelle Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nina Knoll
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Jinjin Ma
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Mohammad Abdul Awal Miah
- Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia
| | - William Peraud
- Department of Psychology, INSERM 1219, University of Bordeaux, Bordeaux, France
| | - Bruno Quintard
- Department of Psychology, INSERM 1219, University of Bordeaux, Bordeaux, France
| | - Vishna Shah
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Konstantin Schenkel
- Applied Social and Health Psychology, University Research Priority Program "Dynamics of Healthy Ageing", Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, University Research Priority Program "Dynamics of Healthy Ageing", Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Ralf Schwarzer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Maria Siwa
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland
| | - Kamil Szymanski
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland
| | - Diana Taut
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Hodaya Wolf
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland.
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
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Tay AK, Miah MAA, Khan S, Mohsin M, Alam AM, Ozen S, Mahmuda M, Ahmed HU, Silove D, Ventevogel P. A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh. EClinicalMedicine 2021; 38:100999. [PMID: 34505027 PMCID: PMC8413262 DOI: 10.1016/j.eclinm.2021.100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Studies of scalable psychological interventions in humanitarian setting are usually carried out when the acute emergency has stabilized. We report the first evaluation of an evidence-based group psychological intervention, Group Integrative Adapt Therapy (IAT-G), during the emergency phase of a mass humanitarian crisis amongst Rohingya refugees in Cox's Bazar, Bangladesh. Methods: We did a pragmatic naturalistic evaluation (2018-2020) of a seven-session group intervention with adult Rohingya refugees with elevated symptoms of depression (≥10 on the Patient Health Questionnaire) and/or posttraumatic stress disorder, PTSD, (≥3 on the Posttraumatic Stress Disorder-8), and functional impairment (≥17 on WHO Disability Assessment Schedule or WHODAS-brief). Screening was done across the most densely populated campsites. Blind assessments were completed at baseline, posttreatment, and at 3-month follow-up using culturally adapted measures of depression, anxiety, posttraumatic stress symptoms, complicated bereavement, adaptive stress associated with disrupted psychosocial support systems, functional impairment, and resilience. Findings: 383 persons were screened and of the 144 persons who met inclusion criteria all participated in the group intervention. Compared to baseline scores, IAT-G participants recorded significantly lower mean scores on key outcome indices (mental health symptoms, adaptive stress, and functional impairment) at posttreatment and 3-month follow-up (all pairwise tests significant Ps<.05). From baseline to 3-month follow-up, score changes were greatest for functional impairment (d = 2.24), anxiety (d = 2.15) and depression (d = 1.9), followed by PTSD symptoms (d = 1.17). Interpretation: A group-based intervention designed specifically to reflect the refugee experience and adapted to the language and culture, showed positive outcomes in the context of a pragmatic, naturalistic trial implemented in a mass humanitarian emergency. Funding: United Nations High Commissioner for Refugees; National Health and Medical Research Council Australia.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
- Correspondence: Alvin Kuowei Tay, : School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.
| | | | - Sanjida Khan
- Independent Researcher, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - A.N.M. Mahmudul Alam
- Mental Health and Psychosocial Support Subunit, Public Health & Nutrition Unit, United Nations High Commissioner for Refugees, Cox's Bazar, Bangladesh
| | - Sanem Ozen
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | | | - Helal U. Ahmed
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Peter Ventevogel
- National Institute of Mental Health, Dhaka, Bangladesh
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Tay AK, Mung HK, Miah MAA, Balasundaram S, Ventevogel P, Badrudduza M, Khan S, Morgan K, Rees S, Mohsin M, Silove D. An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial. PLoS Med 2020; 17:e1003073. [PMID: 32231364 PMCID: PMC7108685 DOI: 10.1371/journal.pmed.1003073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience. METHODS AND FINDINGS We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up. CONCLUSIONS Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings. TRIAL REGISTRATION The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Selangor, Malaysia
| | - Hau Khat Mung
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | | | - Susheela Balasundaram
- Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia
| | - Peter Ventevogel
- Public Health Section/ Division of Programme Support & Management, United Nations High Commissioner for Refugees (UNHCR), Geneva, Switzerland
| | - Mohammad Badrudduza
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Sanjida Khan
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Susan Rees
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
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Urmi AZ, Leung DT, Wilkinson V, Miah MAA, Rahman M, Azim T. Profile of an HIV Testing and Counseling Unit in Bangladesh: Majority of New Diagnoses among Returning Migrant Workers and Spouses. PLoS One 2015; 10:e0141483. [PMID: 26513357 PMCID: PMC4625959 DOI: 10.1371/journal.pone.0141483] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/08/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Analysis of data from HIV testing and counseling (HTC) services provides an opportunity to identify important populations for targeting of HIV prevention efforts. Our primary aim was to describe the demographics of clients presenting to HTC in Bangladesh, a low HIV prevalence country. Our secondary aim was to determine the risk factors for HIV positivity among returning migrant workers who were tested. Methods We performed a cross-sectional study of data collected between 2002 and 2010 from the first HTC service established in Bangladesh, located in three large cities. Results 8973 individuals attended HTC services, with 558 (6.2%) of clients testing positive for HIV, including 33 children. The majority of those who tested positive were aged 25–44 (71%), male (70%), and married (68%). Key populations considered at increased risk of HIV, such as female sex workers, people who inject drugs, and males who have sex with males accounted for only 11% of adults who tested positive. Notably, 75% of adults testing positive had a history of migrant work or was the spouse of a migrant worker. In multivariable logistic regression of those with a migrant work history presenting for HTC, we found rural residence, working in the Middle East, and longer duration of migrant work to be independently associated with testing positive, and female gender and higher level of education to be negatively associated. Conclusions These data suggest that in Bangladesh, in addition to targeting traditional key populations, HIV prevention efforts should also focus on migrant workers and their spouses.
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Affiliation(s)
- Arunthia Zaidi Urmi
- Centre for HIV/AIDS, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Hospitals, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Daniel T. Leung
- Centre for HIV/AIDS, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Centre for Vaccine Sciences, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- * E-mail:
| | - Vanessa Wilkinson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Mohammad Abdul Awal Miah
- Centre for HIV/AIDS, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Hospitals, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahfuza Rahman
- Centre for HIV/AIDS, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Hospitals, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tasnim Azim
- Centre for HIV/AIDS, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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