1,721,327 research outputs found
Psychosocial interventions for disruptive behavioural problems in children living in low- and middle-income countries: study protocol of a systematic review
No full textDisruptive behaviour disorders (DBDs) are among the most common forms of child psychopathology and have serious long-term academic, social, and mental health consequences worldwide. Psychosocial treatments are the first line of evidence-based treatments for DBDs, yet their effectiveness often varies according to patient sociodemographic characteristics, practice setting, and implementation procedures. While a large majority of the world's children live in low- and middle-income countries (LMIC), most studies have evaluated psychosocial treatments for DBDs in high-income Anglo countries
Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations
No full textThe co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings
The Impact of Gender on the Relationship between Coping, Self-Validation, and Suicidality Among Earthquake-Affected Adolescents in Nepal
No full textPurpose. Suicide is the second leading cause of death globally among young adults 15-29 years old. Addressing adolescent suicidal thoughts and behavior (STB) is especially important in low and middle income countries (LMIC) where 46% of suicides occur before 25 years of age. This burden is highest in Asia, with adolescent rates two times greater than the global average. This study examines the role of gender in influencing the relationship between coping dysfunction, self-validation, and suicidality among adolescents in the context of a school-based mental health promotion program in post-earthquake Nepal. Methods. In this mixed-methods study, adolescents (N = 102, 50% female) attending secondary school (12 – 18 years old, average age 14.3 years) in a highly earthquake-affected region near Kathmandu, Nepal, completed the Ways of Coping Checklist, Self-Validation/Self-Invalidation Questionnaire, and the Suicide Screener Questionnaire. Participants of semi-structured interviews included 23 students, 2 teachers, and 3 caregivers. Gender-stratified focus group discussions (n = 2) were also conducted among students. Results. The stressor that students identified most frequently (71.4% of interviewees) in qualitative interviews was academic-related sources. Scores on the Ways of Coping Checklist skills and dysfunction scales did not differ significantly by gender. However, girls scoring high in coping dysfunction (t = -2.511, p = 0.015) and low in self-validation (t = 2.916, p = 0.005) were significantly more likely to endorse suicidal ideations in the past two weeks compared to boys with similar dysfunction (t = -0.237, p = 0.813; and self-validation scores t = 1.087, p = 0.282).Conclusions. Although gender differences in coping skills and coping dysfunction were not quantitatively observed, qualitative analyses revealed that dysfunctional coping was more frequently reported by girls. Future studies should examine the temporal relationship between coping strategies and suicidality. Suicide risk reduction programs should evaluate enhancing adaptive coping skills usage as a mechanism of action to reduce suicidality among girls. Additional research is needed to identify salient risk factors for boys.</p
Participatory Methods for Climate Change and Mental Health Research: Photovoice in Nepal
No full textBackground: The relationship between mental health and climate change are poorly understood. Participatory methods represent ethical, feasible, and culturally-appropriate approaches to engage community members for mental health promotion in the context of climate change. Aim: Photovoice, a community-based participatory research methodology uses images as a tool to deconstruct problems by posing meaningful questions in a community to find actionable solutions. This community-enhancing technique was used to elicit experiences of climate change among women in rural Nepal and the association of climate change with mental health. Subjects and methods: Mixed-methods, including in-depth interviews and self-report questionnaires, were used to evaluate the experience of 10 women participating in photovoice. Quantitative tools included Nepali versions of Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) and a resilience scale. Results: In qualitative interviews after photovoice, women reported climate change adaptation and behavior change strategies including environmental knowledge-sharing, group mobilization, and increased hygiene practices. Women also reported beneficial effects for mental health. The mean BDI score prior to photovoice was 23.20 (SD=9.00) and two weeks after completion of photovoice, the mean BDI score was 7.40 (SD=7.93), paired t-test = 8.02, p<.001, n=10. Conclusion: Photovoice, as a participatory method, has potential to inform resources, adaptive strategies and potential interventions to for climate change and mental health.</p
Documenting the Contextualization and Implementation of mhGAP-HIG in Post-earthquake Nepal
No full textBackground: The burden of mental health is increased in humanitarian settings, and needs to be addressed in emergency situations. The World Health Organization has recently released the mental health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG) in order to scale up mental health service delivery in humanitarian settings through task-shifting. This study aims to evaluate, contextualize and identify possible barriers and challenges to mhGAP-HIG manual content, training and implementation in post-earthquake Nepal.Methods: This qualitative study was conducted in Kathmandu, Nepal. Key informant interviews were conducted with fourteen psychiatrists involved in a mhGAP-HIG Training of Trainers and Supervisors (ToTS) in order to assess the mhGAP-HIG, ToTS training, and the potential challenges and barriers to mhGAP-HIG implementation. Themes identified by informants were supplemented by process notes taken by the researcher during observed training sessions and meetings.Results: Key themes emerging from key informant interviews include the need to take three factors into account in manual contextualization: culture, health systems and the humanitarian setting. This includes translation of the manual into the local language, adding or expanding upon conditions prevalent in Nepal, and more consideration to improving feasibility of manual use by non-specialists.Conclusion: The mhGAP-HIG must be tailored to specific humanitarian settings for effective implementation. This study shows the importance of conducting a manual contextualization workshop prior to training in order to maximize the feasibility and success in training health care workers in mhGAP.</p
Suicide Prevention in Rural Nepal: A Cultural Adaptation of Dialectical Behavior Therapy
No full textPublished research on suicide and suicidal behavior has expanded rapidly in recent years and indicates the presence of a growing global public health concern. In Nepal, suicide is the number one of cause of mortality in women of childbearing age, accounting for 16 percent of deaths within this age group. Although treatments and therapies for suicide vary considerably, adapting existing interventions to allow them to remain culturally congruent with the worldviews of ethnic and racial minority groups is becoming an essential practice. In this study, we conducted a cultural adaptation, training, and piloting of manualized dialectical behavior therapy (DBT) in rural Nepal. DBT is a pliable, evidence-based treatment that is proven effective for risk reduction of suicidal behavior and non-suicidal self-injury (NSSI). However, its feasibility and acceptability has yet to be studied in a low-resource, international setting. In this study, the formative process used to guide modification of the standard DBT regimen is outlined. Qualitative research including focus group discussions and key informant interviews aided in incorporation of crucial elements of Nepali ethnopsychology, and a training based on the manualized adaptation with psychosocial counselors was conducted. Culturally adapted DBT (CA-DBT) was then piloted with ten women in a rural district in Northwest Nepal. Preliminary data suggests that, with additional modification and piloting, CA-DBT holds promising potential as a psychological intervention in Nepal. A number of qualitative successes and challenges in implementation are highlighted, as are suggestions for program bolstering and further testing.</p
Attending to the Burden of Disease for Isolated Indigenous Populations of the Amazon: An Experience with Expedicionarios da Saude
No full textBackground: Indigenous People around the world experience inequalities in health care. In Brazil, Indigenous inequalities in health are exacerbated by the poor system of health care delivery. The aim of this study is to understand barriers to care as defined from the Indigenous perspective.Methods: This study was conducted on three Indigenous reserves of the Xavante people in Mato Grosso, Brazil. We utilized a mixed methods approach. In the quantitative portion of the study, we surveyed 50 individuals using an adapted version of the World Health Organization 2002 World Health Survey. Participants for the quantitative survey were recruited from a randomized list of prospective patients for a medical outreach mission. In the qualitative portion of the study, we interviewed 37 individuals, including patients, health care providers, and village chiefs, about their experiences with health care. Participants for the qualitative interviews were recruited randomly from a medical outreach patient listing (Expedicionários da Saúde). Results: Overall, participants reported dissatisfaction with health-seeking experiences. We identified five barriers to obtaining satisfactory care: lack of transportation, lack of health care services and medication, attitudes of health care workers, lack of culturally appropriate services, and social determinants.Conclusions: Given an overall sense of dissatisfaction with health care use among indigenous people, future research should focus on identifying interventions to help overcome key barriers to accessing care. Private-public partnerships and other innovative health systems models should be explored to meet the needs of underserved indigenous communities.</p
Cultural Concepts of Negative Emotion: A Mixed-Methods Study Among Nepali Adolescents
No full textBackground: Emotions are shaped through the internalization of culturally relevant values. Contextualized systems of meaning influence an individual’s experience of emotion, the consequences of a given response, and their connection to long-term functional outcomes. The present study aims to explore the socioemotional world of Nepali adolescents, in order to understand emotional needs and identify opportunities for psychosocial intervention. Methods: A tablet-based battery of quantitative assessments was administered to 102 students in grades 7-9 (age 12-18) in an earthquake affected region of the Kathmandu Valley. Assessments included measures of anxiety, PTSD, functional impairment, and a local idiom of distress (problems in the heart-mind). Semi-structured interviews were conducted with 21 students and explored the emotional experience of a recent stressor. Results: Three domains of emotion experience emerged: cognitive, physical, and social. While key differences in emotional distress across gender and cultural groups emerged, similarities in the overarching model suggest a shared understanding of negative emotion among Nepali adolescents. Of particular note is the social domain, involving both interpersonal and communal elements, which included the local idiom of distress, which has previously been linked to depression risk. Conclusion: This tripartite conceptualization of emotion is a critical step toward understanding cultural meanings of emotional wellbeing, and the connection between socially experienced emotion and psychopathology underlines the importance of psychosocial integration in future interventions.</p
Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis
No full textBACKGROUND: Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. METHODS: We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). RESULTS: Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95% confidence interval (CI): -0.41 to -0.09; I2 : 78%) and of treatment studies was -0.56 (95% CI: -0.51 to -0.24; I2 : 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95% CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95% CI: -0.66 to -0.20), and that interventions were effective across age ranges. CONCLUSIONS: Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings
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