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Augustinavicius J, Purgato M, Tedeschi F, Musci R, Leku MR, Carswell K, Lakin D, van Ommeren M, Cuijpers P, Sijbrandij M, Karyotaki E, Tol WA, Barbui C. Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda. BMJ Open 2023; 13:e048043. [PMID: 37699637 PMCID: PMC10503328 DOI: 10.1136/bmjopen-2020-048043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/26/2022] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda. METHODS This study used secondary data from treatment-oriented pilot (n=50) and fully-powered cluster randomised controlled trials (cRCT)s (n=694) of SH+ versus EUC. Data from baseline and post-intervention assessments were combined. A composite latent indicator for mental health problems was generated using mental health and well-being measures included in both cRCTs. In order to assess incidence, a binary variable approximating probable mental disorder was created to exclude those with probable mental disorder from the analysis sample and as the primary prevention outcome. The promotive effects of SH+ relative to EUC were examined in the same sample by assessing subjective well-being and psychological flexibility scale scores. RESULTS A single factor for mental health problems was identified with all factor loadings >0.30 and acceptable internal consistency (α=0.70). We excluded 161 women who met criteria for probable mental disorder at baseline. Among those with at least moderate psychological distress but without probable mental disorder at baseline and with follow-up data (n=538), the incidence of probable mental disorder at post-intervention was lower among those who participated in SH+ relative to EUC (Risk ratio =0.16, 95% CI: 0.05 to 0.53). Participation in SH+ versus EUC was also associated with increased subjective well-being (β=2.62, 95% CI: 1.63 to 3.60) and psychological flexibility (β=4.55, 95% CI: 2.92 to 6.18) at post-intervention assessment. CONCLUSIONS These results support the use and further testing of SH+ as a selective and indicated prevention and promotion focused psychosocial intervention in humanitarian settings. TRIAL REGISTRATION NUMBER ISRCTN50148022.
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Affiliation(s)
- Jura Augustinavicius
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
| | - Rashelle Musci
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Daniel Lakin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, Vrije Univ Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Center for Research and Dissemination of Psychological Interventions and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Wietse A Tol
- Global Health Section, University of Copenhagen, Kobenhavn, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- HealthRight International, New York city, New York, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Veneto, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Veneto, Italy
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Calia C, Chakrabarti A, Sarabwe E, Chiumento A. Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings: ethical considerations. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18269.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.
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Calia C, Chakrabarti A, Sarabwe E, Chiumento A. Maximising impactful and locally relevant mental health research: ethical considerations. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18269.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection. Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.
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Ethical Challenges and Coping Strategies about Issues Related to The Healthcare System and Social Issues During the COVID-19 Pandemic: A Narrative Review. JORJANI BIOMEDICINE JOURNAL 2022. [DOI: 10.52547/jorjanibiomedj.10.1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Satisfaction with mental health and psycho-social support services provided to Syrians under temporary protection in Turkey, evidence from refugee health training centers. J Migr Health 2021; 1-2:100022. [PMID: 34405173 PMCID: PMC8352094 DOI: 10.1016/j.jmh.2020.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Aim The objectives of the study were to determine the level of satisfaction with Mental Health and Psycho-social Support Services (MHPSS) provided to Syrians under temporary protection (SuTP) in Turkey and identify predictors that significantly determine the satisfaction with the MHPSS. This study is part of an effort by Ministry of Health (MoH) and World Health Organization (WHO) to evaluate the improvement in the MHPSS following capacity strengthening of social and health providers. Methods 357 Syrians under temporary protection were interviewed as they exited the Refugee Health Training Centers in 7 provinces in Turkey (Adana, Gaziantep, Hatay, Istanbul, Izmir and Sanliurfa), using patient exit interviews during mid-Oct – mid-Nov 2019. Uni and bivariate analysis for association was done using Chi square test for categorical variables, looking for significance at p < 0.05. Multivariate analysis (logistic regression) was used to determine the profile of service users and the predictors of satisfaction with MHPSS. Results Overall satisfaction with services was 93%. The profile of the MHPSS user suggests that the odds of using the service are twice as much for people aged 40+ years (OR 2.016, CI95% [1.129–3.601]), and five times less for married women (OR 0.180, CI95% [0.083–0.391]). The service characteristics that can predict service satisfaction are “having the needs met” (OR 138.73, CI95% [27.99–687.54]) and “satisfaction with the length of the appointments” (OR 54.50, CI95% [6.07–489.57]). There was no multicollinearity detected between the predictors. Conclusions MHPSS services provided by professionals trained by MoH and WHO, have a high satisfaction rate and are serving the SuTP population in need. The high satisfaction rate is predicted by having MHPSS needs met, which is a key indication of the usefulness of these services.
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Calia C, Reid C, Guerra C, Oshodi AG, Marley C, Amos A, Barrera P, Grant L. Ethical challenges in the COVID-19 research context: a toolkit for supporting analysis and resolution. ETHICS & BEHAVIOR 2020. [DOI: 10.1080/10508422.2020.1800469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Clara Calia
- School of Health in Social Sciences, The University of Edinburgh, UK
| | | | - Cristóbal Guerra
- School of Health in Social Sciences, The University of Edinburgh, UK
- Universidad Santo Tomás, Chile
| | | | - Charles Marley
- School of Health in Social Sciences, The University of Edinburgh, UK
| | | | | | - Liz Grant
- Global Health Academy, The University of Edinburgh, UK
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Perera C, Salamanca-Sanabria A, Caballero-Bernal J, Feldman L, Hansen M, Bird M, Hansen P, Dinesen C, Wiedemann N, Vallières F. No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings. Confl Health 2020; 14:46. [PMID: 32684948 PMCID: PMC7362525 DOI: 10.1186/s13031-020-00290-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/30/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. METHODS The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. RESULTS The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols. CONCLUSION The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.
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Affiliation(s)
- Camila Perera
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | | | | | - Lya Feldman
- Department of Behavioural Science and Technology, Simon Bolivar University, Caracas, Venezuela
| | - Maj Hansen
- ThRIVE, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Martha Bird
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Pernille Hansen
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Cecilie Dinesen
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Nana Wiedemann
- The IFRC Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
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Inchausti F, García-Poveda NV, Prado-Abril J, Sánchez-Reales S. La Psicología Clínica ante la Pandemia COVID-19 en España. CLINICA Y SALUD 2020. [DOI: 10.5093/clysa2020a11] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Special issues raised by evolving areas of clinical research. ETHICAL CONSIDERATIONS WHEN PREPARING A CLINICAL RESEARCH PROTOCOL 2020. [PMCID: PMC7329119 DOI: 10.1016/b978-0-12-386935-7.00014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Each study presents its own set of ethical considerations. Certain kinds of ethical issues are inherent in particular areas of clinical research, regardless of specific ethical questions associated with a specific study. In this chapter, some of the most common special areas of clinical research are presented, highlighting the ethical issues most frequently associated with each.
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Kohrt BA, Mistry AS, Anand N, Beecroft B, Nuwayhid I. Health research in humanitarian crises: an urgent global imperative. BMJ Glob Health 2019; 4:e001870. [PMID: 31798999 PMCID: PMC6861060 DOI: 10.1136/bmjgh-2019-001870] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/30/2023] Open
Abstract
Globally, humanitarian crises—such as armed conflict, forced displacement, natural disasters and major disease outbreaks—affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in humanitarian settings. While working in these settings is uniquely challenging, there are effective strategies that can be employed, such as using flexible and adaptive research methodologies, partnering with non-governmental organisations and other humanitarian actors, and devoting greater attention to issues of research ethics, community engagement, local LMIC-based partners, building humanitarian research capacity and collaborating across disciplines.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences and Department of Global Health, George Washington University, Washington, DC, USA
| | - Amit S Mistry
- Fogarty International Center, NIH, Bethesda, Maryland, USA
| | - Nalini Anand
- Fogarty International Center, NIH, Bethesda, Maryland, USA
| | | | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Morse AR, Forbes O, Jones BA, Gulliver A, Banfield M. Australian Mental Health Consumer and Carer Perspectives on Ethics in Adult Mental Health Research. J Empir Res Hum Res Ethics 2019; 14:234-242. [PMID: 31018753 DOI: 10.1177/1556264619844396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Barriers to research arise when national ethical guidelines governing the inclusion of consumers in mental health research are implemented at the local level. Equivalent guidelines for research involving carers are not available. A social science investigation of Australian mental health consumer and carer perspectives on research ethics procedures was conducted in two interlinked stages: (a) a discussion forum with consumers, carers, and lived-experience researchers and (b) in-depth interviews with consumers and carers. Data collection and analysis drew strongly on methodological features of grounded theory. Privacy, confidentiality, and stigmatizing ethics procedures were key issues for consumer and carer participants. Recommendations for research practice include the following: considering the impact of information sharing on participants' relationships and adopting individual-focused approaches to managing research risks.
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Affiliation(s)
- Alyssa R Morse
- 1 The Australian National University, Acton, Australian Capital Territory, Australia
| | - Owen Forbes
- 1 The Australian National University, Acton, Australian Capital Territory, Australia
| | - Bethany A Jones
- 1 The Australian National University, Acton, Australian Capital Territory, Australia
| | - Amelia Gulliver
- 1 The Australian National University, Acton, Australian Capital Territory, Australia
| | - Michelle Banfield
- 1 The Australian National University, Acton, Australian Capital Territory, Australia
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Abstract
PURPOSE OF THE REVIEW As mental health professionals assist individuals and communities affected by disaster, they are likely to encounter ethical issues. We conducted a review of academic and grey literature to identify ethical issues associated with the provision of mental health care during disasters, with particular attention to children and families. RECENT FINDINGS We identified nine categories of ethical challenge: ensuring competent care; protecting confidentiality and privacy; obtaining informed consent and respecting autonomy; providing culturally sensitive care; avoiding harm; allocating limited resources; maintaining neutrality and avoiding bias; addressing issues of liability and employer responsibilities; and conducting research ethically. The organization and provision of mental health services during disasters presents ethical challenges for care providers-as well as for communities, coordinators, and policymakers. Mental health professionals need to navigate this ethical terrain in order to provide needed care to individuals and communities affected by crisis.
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Ferrarello F, Viligiardi M, Di Bari M. Ethics reporting practices in randomized controlled trials of physical therapy interventions after stroke. Arch Physiother 2018; 8:8. [PMID: 29992047 PMCID: PMC5989458 DOI: 10.1186/s40945-018-0049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adequate reporting of ethics-related research methods promotes convergence on best ethics practices. In physical therapy, studies on ethics reporting are limited to few aspects, and none focuses on stroke research. Our objectives were to investigate the reporting of multiple ethics-related features and its variation over time, and the characteristics of the studies associated with ethics reporting in Randomized Controlled Trials (RCTs) of physical therapy interventions after stroke. METHODS A random sample of RCTs published in the years 2004, 2009 and 2014, was extracted from the PubMed database, regardless of the publishing journal. For each trial we investigated year of publication, trial registration, sample size, stroke subtype, phase of the disease, setting, interventions and dosing, outcome measures, outcome of the study, PEDro score and 5-year impact factor of the publishing journal. Reporting of ethics-related issues was analyzed. Differences between groups were examined. Multiple regression was used to evaluate the relationship between ethics-related issues reporting and some studies' characteristics. RESULTS Eighty studies were reviewed. Groups differed in the proportion of registered trials (p = .009), 5-year impact factor (p = .011), assessment of cognitive capacity (p = .049), declaration about conflict of interest (p < .001), and number of ethics-related issues reported (p = .009). The proportion of issues reported ranged from 92.5% (consent obtaining) to 0% (eventual follow up care). Post-hoc comparisons showed significantly greater reporting of ethics issues in trials published in the year 2014 compared to 2004 (p = .014, 95%CI = 0.40/4.26). Year of publication and PEDro score were significant predictors of adequate reporting. CONCLUSIONS Authors, editors, and reviewers should be more rigorous and demanding about the reporting of ethic-related methods in randomized controlled trials of physical therapy interventions after stroke.
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Affiliation(s)
- Francesco Ferrarello
- Functional Rehabilitation, Azienda USL Toscana Centro, Via Cavour 118/120, 59100 Prato, Italy
| | - Matteo Viligiardi
- Outpatient Rehabilitation, CRT Clinica di Riabilitazione Toscana Terranuova Bracciolini Spa, Via Gaetano Donizetti 2, 52028 Terranuova Bracciolini, AR Italy
| | - Mauro Di Bari
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Aging, University of Florence, and Azienda Ospedaliero–Universitaria Careggi, Viale Pieraccini 18, 50139 Florence, Italy
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Ostuzzi G, Barbui C, Hanlon C, Chatterjee S, Eaton J, Jones L, Silove D, Ventevogel P. Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance. BMC Med 2017; 15:197. [PMID: 29224570 PMCID: PMC5724240 DOI: 10.1186/s12916-017-0960-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Populations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings. METHODS Following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations. RESULTS When first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions. CONCLUSIONS Adapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.
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Affiliation(s)
- Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Charlotte Hanlon
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Sudipto Chatterjee
- Sangath Centre, Porvorim, Goa, India.,School of Population Health, Melbourne, Australia
| | - Julian Eaton
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,CBM International, Bensheim, Germany
| | - Lynne Jones
- FXB Center for Health & Human Rights, Harvard University, Boston, USA
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Greene MC, Jordans MJD, Kohrt BA, Ventevogel P, Kirmayer LJ, Hassan G, Chiumento A, van Ommeren M, Tol WA. Addressing culture and context in humanitarian response: preparing desk reviews to inform mental health and psychosocial support. Confl Health 2017; 11:21. [PMID: 29163666 PMCID: PMC5686886 DOI: 10.1186/s13031-017-0123-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/04/2017] [Indexed: 11/16/2022] Open
Abstract
Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies.
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Affiliation(s)
- M. Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Rm. 888, Baltimore, MD 21205 USA
| | - Mark J. D. Jordans
- Research & Development Department, War Child Holland, Amsterdam, the Netherlands
- Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Laurence J. Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC Canada
- Culture and Mental Health Research Unit, Jewish General Hospital, Montréal, QC Canada
| | - Ghayda Hassan
- Department of Psychology, Université du Québec à Montréal, Montréal, QC Canada
| | - Anna Chiumento
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Wietse A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Rm. 888, Baltimore, MD 21205 USA
- Peter C. Alderman Foundation, Kampala, Uganda
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Chiumento A, Rahman A, Frith L, Snider L, Tol WA. Erratum to: Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates. Global Health 2017; 13:41. [PMID: 28662666 PMCID: PMC5490201 DOI: 10.1186/s12992-017-0264-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anna Chiumento
- University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, L69 3GL, Liverpool, UK.
| | - Atif Rahman
- University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, L69 3GL, Liverpool, UK
| | - Lucy Frith
- University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, L69 3GL, Liverpool, UK
| | - Leslie Snider
- Independent Consultant, Peace in Practice, Amsterdam, The Netherlands
| | - Wietse A Tol
- Johns Hopkins University, School of Public Health and The Peter C. Alderman Foundation, Baltimore, USA
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