Sea-level rise and mental health among coastal communities: A quantitative survey and conditional process analysis

This is the first large-scale empirical study examining the impact of sea-level rise induced by climate change on mental health outcomes among coastal communities. The study focuses on Bangladesh, a country severely affected by salinity ingress, flood risks, and agricultural damage due to sea-level changes. Participants (n = 1,200) randomly selected from three coastal regions each having high, moderate, or low vulnerability to sea-level rise were surveyed during the pre-monsoon season in 2021. The cross-sectional survey included validated measures of psychological distress, depression, anxiety, stress, environmental stressors, resource loss, and demographics. The results indicated significantly higher levels of psychological distress, depression, anxiety, and stress in residents of high-vulnerability areas compared to moderate or low-vulnerability regions. Resource loss served as a mediating variable between environmental stressors and mental health outcomes. Furthermore, demographic analyses showed that older adults and women reported higher levels of psychological distress. These findings align with the Sendai Framework for Disaster Risk Reduction, highlighting urgent need for targeted mental health interventions and sustainable models of care in coastal areas increasingly threatened by sea-level rise.

Barriers and Facilitators to Implementing a Community-Based Psychosocial Support Intervention Conducted In-Person and Remotely: A Qualitative Study in Quibdó, Colombia

Community-based psychosocial support group (CB-PSS) interventions using task-shifting approaches are well suited to provide culturally appropriate services in low- and middle-income countries. However, contextual barriers and facilitators must be considered to tailor interventions effectively, particularly considering the challenges introduced by the COVID-19 pandemic. We explore the barriers, facilitators, and psychosocial changes associated with implementing a CB-PSS group intervention delivered by local lay providers to conflict-affected adults in Quibdó, Colombia, using both in-person and remote modalities. Data were analyzed from 25 individual interviews with participants and a focus group discussion involving staff members, including 7 community psychosocial agent facilitators and 2 mental health professional supervisors. The analysis used a thematic approach grounded in a descriptive phenomenology to explore the lived experiences of participants and staff members during implementation. Participant attendance in the in-person modality was compromised by factors such as competing work and family responsibilities and disruption caused by the COVID-19 pandemic. Participants in the remote modality faced challenges concerning unstable Internet connectivity, recurrent power outages caused by heavy rain, distractions, interruptions, and threats to confidentiality by family and coworkers. Despite these challenges, data revealed key contextual facilitators, including the community-based knowledge of facilitators and integration of traditional practices, such as the comadreo (informal talks and gatherings). Respondents shared that the CB-PSS groups promoted stronger community relationships and created opportunities for participants to exchange peer support, practice leadership skills, develop problem-solving skills based on peers' experiences, and enhance emotional regulation skills. Differences and similarities across in-person and remote modalities are discussed, as are key considerations for practitioners and policymakers.

Strategies to Alleviate the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Low- and Middle-Income Countries: Scoping Review

BACKGROUND

There is considerable evidence of the burden of care encountered by informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Previous studies have highlighted the need to support these informal caregivers as key players in the care of these patients. To date, limited evidence exists on the extent and types of strategies for supporting these informal caregivers in low- and middle-income countries.

OBJECTIVE

This scoping review aims to identify and describe the extent and type of evidence on the existing strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries.

METHODS

A systematic literature search was completed following the Joanna Briggs Institute methodology for scoping reviews. The participants, concept, and context framework was used to guide the search for literature sources across 5 databases: PubMed, MEDLINE, CINAHL, and PsycINFO for published literature and ProQuest for unpublished literature. This review included studies that reported on strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions, with a focus on studies that evaluated or recommended caregiver interventions and support strategies in low- and middle-income countries. The search was limited to studies conducted between 2001 and 2021, and only papers written in English were considered for inclusion. Using the Covidence software (Veritas Health Innovation), 2 reviewers independently screened the papers, applied the inclusion and exclusion criteria, and met biweekly to discuss and resolve conflicts. The relevant studies and reported outcomes were summarized, organized, and analyzed descriptively using numeric summary analysis and deductive content analysis.

RESULTS

Of the 18,342 studies identified, 44 (0.24%) met the inclusion criteria. The included studies were from 16 low- and middle-income countries in Asia, Africa, Europe, and South and North America. Most studies (21/44, 48%) were randomized controlled trials conducted in Asian countries. The identified strategies were grouped into 2 categories: implemented and recommended intervention strategies. Identified strategies included community-based interventions, psychoeducation interventions, support groups, cognitive behavioral therapy, spirituality-based interventions, and smartphone-based interventions. In addition, mindfulness and empowerment, collaborative interventions, standard care, financial and social support, counseling, occupation-based interventions, policy and legislature, and access to mental health care were identified. Psychoeducation and support group interventions were identified as common strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions.

CONCLUSIONS

This review provides evidence on the types of implemented and recommended strategies for alleviating the burden of care among informal caregivers in low- and middle-income countries. Although psychoeducational interventions were the most preferred strategy for alleviating burden, their benefits were short-lived when compared with peer-led support groups.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/44268.

Navigating Turbulent Waves of Emotions: Multi-Level Stress and Coping Among Chinese Men Who Have Sex with Men Living with HIV

Men who have sex with men (MSM) bear a disproportionate burden of HIV in China and are particularly vulnerable to mental health challenges. This study is phase one of a multi-phase project that aimed to identify unmet needs of MSM living with HIV to inform the development of a multi-level intervention. We interviewed 24 stakeholders through videoconferencing, including 15 MSM living with HIV, five staff from a community-based organization serving gender and sexual minority individuals, and four staff from the Centers for Disease Control and Prevention in Shanghai, China. We conducted content analysis using inductive and deductive coding and identified the following themes: 1) Navigating Turbulent Waters: multi-level stress currents; 2) Mapping Anchors: multifaceted support network; 3) Staying Afloat: Daily strategies and functioning; and 4) Charting New Courses: paths for intervention. Examining the stress and coping process among MSM living with HIV from a socio-ecological lens is especially important in the collective cultural context. The interactive nature of the stress from multiple socio-ecological levels, lack of individual coping skills, and scarcity of psychosocial services highlighted the importance of community-based, multi-level interventions to meet the needs of MSM living with HIV in China.

People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India

Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n  =  647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n  =  649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b  =  -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.

Exploring inter- and intra-organisational dynamics supporting task-shifting opportunities in AIDS service organisations: A qualitative study

Task-shifting of combination sexual health services from clinicians to community workers has been well-studied in low-resource settings, but lacks empirical examination as a response to service inequities in North American community-based AIDS service organisations (ASOs). This study adopts a qualitative exploratory approach to understanding how ASOs may support task-shifting for gay, bisexual and other men who have sex with men (GBMSM), drawing from interviews (n = 33) with clinicians and community workers in southern Ontario. Results include intra-organisational (including resource supports, development of community worker roles, providing task-shifting training, provider representation and inclusive service environment) and inter-organisational (including structure of engagement, streamlining referrals, development of effective partnerships, development of a formal organisational network and increasing awareness) dynamics which, when applied at an organisation level within ASOs, encourage successful and effective task-shifting. Related activities may be used to increase service quality and access for GBMSM. Considerations for application and management practice is provided.

The availability of psychological support following road travel injuries in Namibia: A qualitative study

Road traffic injuries (RTIs) are a major problem worldwide with a high burden of mental health problems and the importance of psychological support following road injury is well documented. However, globally there has been very little research on the accessibility of psychological services following road injury. Namibia is one of the countries most affected by RTIs but no previous studies have been done on this. In this qualitative study we investigated the availability of psychological services to RTI injured in Namibia. Our study findings are in line with those of other global studies in showing inadequate access to psychological support for injury survivors and we discuss the reasons. It is hoped these findings will help policymakers develop ways of enhancing access to psychological support for the many people injured in RTIs in Namibia. The models they develop may also be of use to other LMICs countries with high RTI rates.

Scaling up evidence-based treatments in youth behavioral healthcare: Social work licensing influences on task-shifting opportunities

Youth behavioral healthcare workforce shortages have inhibited the scale-up of evidence-based treatments to address longstanding unmet needs andinequitable service coverage. Task-shifting is a strategy that could bolster workforce shortages. Legal and regulatory barriers, such as scope of practice licensing regulations, have hampered the use of task-shifting. Social workers make up the majority of the behavioral healthcare workforce in the U.S. and most social workers provide services to children and families. As such, social workers would play a pivotal role in any scale-up effort. In this guest editorial, we discuss the importance of social work licensing and use a case example to illustrate the unintended consequences that certain licensing regulations have on scaling-up evidence-based treatments via task-shifting. We conclude with recommendations on how social workers could be involved in taskshifting efforts to scale-up evidence-based treatments.

Determining the vocational competencies required to deliver community-based rehabilitation and inclusive development services in India

PURPOSE

To identify the competencies required by Community-Based Rehabilitation (CBR) practitioners in India and determine typical pathways of competency development, including minimum practice standards.

METHODS

Following a literature review of existing frameworks and guidelines for CBR delivery, Delphi methods were used with Indian CBR experts to identify the main competency requirements of CBR personnel. Rubric writing workshops with CBR experts then expressed the performance of these competencies developmentally as learning progressions. The rubrics were converted into an observation form and field tested with 100 CBR personnel of varying expertise levels, through third party assessments by workplace supervisors. Finally, a second Delphi panel determined major competency stages and minimum standards for practice.

RESULTS

Three broad job functions pertaining to five focus areas and 37 developmentally described competencies were found important for delivery of quality CBR. Through a standard setting process, for each job function experts reached agreement on major competency stages, including a minimum practice standard.

CONCLUSIONS

The study suggests India's CBR expertise proceeds in four stages within three broad job functions - Assessment and Intervention, Inclusive Community Development, and Professional and Ethical Behaviour and Practice. The findings have direct implications for designing curricula to facilitate the competency development of CBR personnel.Implications for rehabilitationMeeting the rehabilitation and inclusion needs of people with disability in low and middle-income countries requires adequately trained local personnel.Currently, lack of knowledge and understanding of the competencies required of CBR personnel is affecting training and workforce quality.Consensus amongst Indian experts about a CBR learning pathway indicates possibilities for effective competency-based course design.

Choosing Life in the Black Community, Achieving the Dream: A Traumatic Stress Curriculum Pilot Study

This study measured changes in post-traumatic stress symptoms and collective-efficacy in African Americans participating in cohorts of "Choosing Life in the Black Community: Achieving the Dream", an Afrocentricity-based Cognitive Behavioral Therapy curriculum for trauma. Participants were recruited by key leaders in the black community of the Twin Cities, Minnesota Metropolitan Area and completed a 6-week group counselling curriculum led by lay health workers and supervised by professional psychologists. Twenty-six participants provided pre- and post-curriculum responses to validated measures of post-traumatic stress symptoms, collective-efficacy and adverse childhood experiences. Thirteen participants provided semi-structured interviews. Pre- to post-curriculum change score were calculated for post-traumatic stress symptoms and collective-efficacy. Interviews were analyzed using thematic analysis. Post-traumatic stress symptoms decreased and collective-efficacy increased, though neither change achieved statistical significance. Participants with more adverse childhood experiences showed significantly greater decreases in post-traumatic stress symptoms. There is evidence that this program may be particularly effective in participants that have greater past experiences of trauma.

Towards closing the treatment gap: a team-led model of brief psycho-educational intervention

Purpose

Many pupils who experience distress and emotional difficulties are left untreated because of the shortage of mental health professionals at schools. This study aims to explore a brief psycho-educational intervention based on school psychologist–teacher cooperation aimed at closing this treatment gap.

Design/methodology/approach

With a randomized controlled methodology, 79 preschools to 12th grade teachers were asked to lead a brief psycho-educational intervention with one of their pupils. A second pupil was assigned to a waiting list (control group). Each teacher and one of her/his colleagues filled a Pupil Adjustment questionnaire, being developed for this study, before and after the intervention.

Findings

The findings show that the intervention significantly improved the adjustment of the participating pupils, compared to the control group. That improvement related to all the dimensions of adjustment (i.e. social, protection and learning).

Originality/value

Teacher–school psychologist cooperation, as described here, is hardly practiced. It emerges as an effective model to assist many pupils who are currently left with no treatment. The discussion traces the next stages for outreaching that would apply to pupils in many countries and cultures.

Commentary: Challenges and opportunities in autism assessment - a commentary on Kanne and Bishop (2020)

Kanne and Bishop's (2020) Editorial Perspective 'The Autism waitlist crisis and remembering what families need' offers a strong argument to provide greater access to high-quality assessments for Autism Spectrum Disorder (ASD). They note, correctly, that due to increasing numbers of referrals practitioners are under increasing pressure to provide quicker or abbreviated evaluations, that some cases are extremely complex and require considerable expertise to assess, and that a good assessment is a good investment in effective intervention. I agree with these points but also want to highlight some difficulties and dilemmas associated with the assessment of ASD; and to argue that improving access to assessments and interventions through the use of nonspecialists and new technologies may be a promising direction.

Distant mood monitoring for depressive and bipolar disorders: a systematic review

BACKGROUND

Broadening our knowledge of the longitudinal course of mood symptoms is cardinal to providing effective long-term treatments. Research indicates that patients with mental illness are willing to engage in the use of telemonitoring and mobile technology to assess and monitor their mood states. However, without the provision of distant support, adverse outcomes and events may be difficult to prevent and manage through self-monitoring. Understanding patient perspectives is important to achieving the best balance of self-monitoring, patient empowerment, and distant supporter involvement.

METHODS

This systematic review synthesises quantitative and qualitative evidence of the effectiveness and feasibility of daily/weekly/monthly remote mood monitoring that includes distant support in participants with mood disorders. Inclusion criteria comprised mood monitoring of mood disorder patients as main intervention, study design, method of monitoring, and presence of psychotherapy and psychoeducation. Effectiveness was defined by the change in depression and/or mania scores. Feasibility was determined on participant feedback and completion/attrition rates. Studies were assessed for quality using the Mixed Methods Appraisal Tool version 2018.

RESULTS

Nine studies of acceptable quality met the inclusion criteria. Distant mood monitoring was effective in improving depression scores but not mania scores. Feasibility, as measured through compliance and completion rates and participant feedback, varied.

CONCLUSION

Distant mood monitoring with support may be a useful, acceptable, and feasible intervention for diverse groups of patients in terms of age and ethnicity. Further, it may be effective in improving symptoms of depression, increasing treatment adherence, and facilitating the prevention and management of adverse outcomes. As a task-shifting intervention, distant mood monitoring may help to alleviate the burden on mental health providers in developing countries.