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Agarwal D, Bailie CR, Rana S, Balan L, Grills NJ, Mathias K. Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study. Glob Ment Health (Camb) 2023; 10:e85. [PMID: 38161744 PMCID: PMC10755371 DOI: 10.1017/gmh.2023.79] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
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Affiliation(s)
- Disha Agarwal
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Samson Rana
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Laxman Balan
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaaren Mathias
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
- Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
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Kumar M, Tele A, Kathono J, Nyongesa V, Yator O, Mwaniga S, Huang KY, McKay M, Lai J, Levy M, Cuijpers P, Quaife M, Unutzer J. Understanding depression treatment and perinatal service preferences of Kenyan pregnant adolescents: A discrete choice experiment. PLoS One 2023; 18:e0273274. [PMID: 36888596 PMCID: PMC9994687 DOI: 10.1371/journal.pone.0273274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/26/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Understanding mental health treatment preferences of adolescents and youth is particularly important for interventions to be acceptable and successful. Person-centered care mandates empowering individuals to take charge of their own health rather than being passive recipients of services. METHODS We conducted a discrete choice experiment to quantitatively measure adolescent treatment preferences for different care characteristics and explore tradeoffs between these. A total of 153 pregnant adolescents were recruited from two primary healthcare facilities in the informal urban settlement of Nairobi. We selected eight attributes of depression treatment option models drawn from literature review and previous qualitative work. Bayesian d-efficient design was used to identify main effects. A total of ten choice tasks were solicited per respondent. We evaluated mean preferences using mixed logit models to adjust for within subject correlation and account for unobserved heterogeneity. RESULTS Respondents showed a positive preference that caregivers be provided with information sheets, as opposed to co-participation with caregivers. With regards to treatment options, the respondents showed a positive preference for 8 sessions as compared to 4 sessions. With regards to intervention delivery agents, the respondents had a positive preference for facility nurses as compared to community health volunteers. In terms of support, the respondents showed positive preference for parenting skills as compared to peer support. Our respondents expressed negative preferences of ANC service combined with older mothers as compared to adolescent friendly services and of being offered refreshments alone. A positive preference was revealed for combined refreshments and travel allowance over travel allowance or refreshments alone. A number of these suggestions were about enhancing their experience of maternity clinical care experience. CONCLUSION This study highlights unique needs of this population. Pregnant adolescents' value responsive maternity and depression care services offered by nurses. Participants shared preference for longer psychotherapy sessions and their preference was to have adolescent centered maternal mental health and child health services within primary care.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Albert Tele
- Vrije University, Amsterdam, Netherlands
- Ikuze Africa, Nairobi, Kenya
| | - Joseph Kathono
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Nairobi Metropolitan Services, Nairobi, Kenya
| | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Shillah Mwaniga
- Vrije University, Amsterdam, Netherlands
- Nairobi Metropolitan Services, Nairobi, Kenya
| | - Keng Yen Huang
- New York University Medical School, New York, New York, United States of America
| | - Mary McKay
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, New York, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, New York, United States of America
| | | | - Matthew Quaife
- London School of Tropical Medicine and Hygiene, Bloomsbury, United Kingdom
| | - Jurgen Unutzer
- University of Washington, Seattle, Washington, United States of America
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Spoelstra SL, Schueller M, Basso V, Sikorskii A. Results of a multi-site pragmatic hybrid type 3 cluster randomized trial comparing level of facilitation while implementing an intervention in community-dwelling disabled and older adults in a Medicaid waiver. Implement Sci 2022; 17:57. [PMID: 36028873 PMCID: PMC9419328 DOI: 10.1186/s13012-022-01232-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/14/2022] [Indexed: 01/28/2023] Open
Abstract
Background Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver. Methods In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF and EF. Adoption and sustainability were assessed via Stages of Implementation Completion (SIC) for each site. Clinician attitudes toward evidence-based practice and self-efficacy were evaluated among 539 registered nurses, social workers, and occupational therapists. Medicaid beneficiary outcomes of activities of daily living, depression, pain, falls, emergency department visits, and hospitalizations were evaluated in a sample of N = 7030 as reflected by electronic health records data of the Medicaid waiver program. Linear mixed-effects models were used to compare outcomes between trial arms while accounting for cluster-randomized design. Results The mean SIC scores were 72.22 (standard deviation [SD] = 16.98) in the IF arm (9 sites) and 61.33 (SD = 19.29) in the IF + EF arm (9 sites). The difference was not statistically significant but corresponded to the medium clinically important effect size Cohen’s d = 0.60. Clinician implementation outcomes of attitudes and self-efficacy did not differ by trial arm. Beneficiary depression was reduced significantly in the IF + EF arm compared to the IF arm (p = .04, 95% confidence interval for the difference [0.01, 0.24]). No differences between trial arms were found for other beneficiary outcomes. Conclusions Level of facilitation did not enhance capacity for adoption and sustainability of an evidence-based intervention in a Medicaid setting that cares for disabled and older adults. Improved beneficiary depression favored use of IF and EF compared to IF alone, and no differences were found for other outcomes. These findings also suggest level of facilitation may not have impacted beneficiary outcomes. Trial registration ClinicalTrials.gov, NCT03634033; date registered August 16, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01232-5.
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Affiliation(s)
- Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA.
| | - Monica Schueller
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA
| | - Viktoria Basso
- Statistics Department, Grand Valley State University, Grand Rapids, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, USA
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Hook K, Ametaj A, Cheng Y, Serba EG, Henderson DC, Hanlon C, Ng LC. Psychotherapy in a resource-constrained setting: Understanding context for adapting and integrating a brief psychological intervention into primary care. Psychotherapy (Chic) 2021; 58:557-575. [PMID: 34410763 PMCID: PMC8664957 DOI: 10.1037/pst0000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Low- and middle-income countries have few mental health professionals, and efforts to increase access to treatment are a global priority. A key gap is the lack of integration of psychotherapy interventions as a part of accessible evidence-based care. Current recommendations suggest that the integration of mental health treatments, including psychotherapy, into existing primary care pathways may serve as a means to address this disparity. Understanding the cultural and contextual factors that affect this process is a critical step in identifying necessary adaptations. The aim of this qualitative study was to identify contextual factors associated with integrating psychotherapy in primary care in a predominantly rural district in south-central Ethiopia. Purposive sampling was used to recruit 48 mental health service users, caregivers, health care providers, and community leaders. Semistructured interviews were conducted, recorded, and transcribed in Amharic and translated into English. Although challenges (e.g., stigma, job strain, lack of belief in formal treatments) are present, other existing strengths (e.g., openness to seeking treatment, increasing knowledge about mental health treatment, familiarity with practices similar to therapy) support subsequent psychotherapy adaptation and implementation. These findings suggest possible mechanisms to improve delivery and adaptation in the effort to lower the existing global treatment gap. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kimberly Hook
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Amantia Ametaj
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | | | - Eyerusalem G. Serba
- Addis Ababa University, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
| | - David C. Henderson
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Charlotte Hanlon
- Addis Ababa University, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- King’s College London, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren C. Ng
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
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Lange KW. Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. Global Health Journal 2021; 5:120-7. [DOI: 10.1016/j.glohj.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Janse van Rensburg A, Kathree T, Breuer E, Selohilwe O, Mntambo N, Petrus R, Bhana A, Lund C, Fairall L, Petersen I. Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa. Glob Health Action 2021; 14:1940761. [PMID: 34402770 PMCID: PMC8381905 DOI: 10.1080/16549716.2021.1940761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Integrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention. OBJECTIVE This study aimed to explore factors that could have influenced key outcomes of an integrated mental healthcare intervention in South Africa. METHODS Drawing from an embedded multiple case study design, the analysis used qualitative comparative analysis. Focusing on nine PHC clinics in the Dr Kenneth Kaunda District as cases, with depression reduction scores set as outcome measures, trial data variables were modelled in a hypothetical causal process. A fuzzy-set qualitative comparative analysis was performed by 1) developing the research questions, 2) developing the fuzzy set, 3) testing necessity and 4) testing sufficiency. These steps were undertaken collaboratively among the research team. RESULTS The data were calibrated during several meetings among team members to gain a degree of consensus. Necessity analyses suggested that none of the causal conditions exceeded the threshold of necessity and triviality, and confirmed the inclusion of relevant variables in line with the proposed models. Sufficiency analyses produced two configurations, which were subjected to standard and specific analyses. Ultimately, the results suggested that none of the causal conditions were necessary for a reduction in depression scores to occur, while programme fidelity was identified as a sufficient condition for a reduction in scores to occur. CONCLUSIONS The study highlights the importance of understanding implementation pathways to enable better integration of mental health services within primary healthcare in low-to-middle-income settings. It underlines the importance of programme fidelity in achieving the goals of implementation.
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Affiliation(s)
- André Janse van Rensburg
- Centre for Rural Health, University of KwaZulu-Natal, School of Nursing and Public Health, Durban, South Africa
| | - Tasneem Kathree
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - One Selohilwe
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ntokozo Mntambo
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ruwayda Petrus
- Department of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Arvin Bhana
- Centre for Rural Health, University of KwaZulu-Natal & South African Medical Research Council, Durban, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, University of Cape Town & Centre for Global Mental Health, King's College London, Cape Town, South Africa
| | - Lara Fairall
- Centre for Knowledge Translation, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
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7
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Kanzler KE, McGeary DD, McGeary C, Blankenship AE, Young-McCaughan S, Peterson AL, Buhrer JC, Cobos BA, Dobmeyer AC, Hunter CL, Bhagwat A, Star JAB, Goodie JL. Conducting a Pragmatic Trial in Integrated Primary Care: Key Decision Points and Considerations. J Clin Psychol Med Settings 2021; 29:185-194. [PMID: 34100153 PMCID: PMC8184053 DOI: 10.1007/s10880-021-09790-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Pragmatic trials testing the effectiveness of interventions under “real world” conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.
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Affiliation(s)
- Kathryn E Kanzler
- Research to Advance Community Health (ReACH) Center, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7768, San Antonio, TX, 78229, USA. .,Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. .,Family & Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Donald D McGeary
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Cindy McGeary
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abby E Blankenship
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Briana A Cobos
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anne C Dobmeyer
- Psychological Health Center of Excellence J-9/Defense Health Agency, Falls Church, VA, USA
| | - Christopher L Hunter
- J3 Medical Affairs-Clinical Support Division/Defense Health Agency, Falls Church, VA, USA
| | - Aditya Bhagwat
- J3 Medical Affairs-Clinical Support Division/Defense Health Agency, Falls Church, VA, USA
| | - John A Blue Star
- 59 Medical Operations Squadron, Wilford Hall Ambulatory Medical Center, JBSA-Lackland, San Antonio, TX, USA
| | - Jeffrey L Goodie
- Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD, USA
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Fitts JJ, Gegbe F, Aber MS, Kaitibi D, Yokie MA. Strengthening mental health services in Sierra Leone: perspectives from within the health system. Health Policy Plan 2021; 35:657-664. [PMID: 32384138 DOI: 10.1093/heapol/czaa029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/14/2022] Open
Abstract
Though mental and substance use disorders are a leading cause of disability worldwide, mental health systems are vastly under-resourced in most low- and middle-income countries and the majority of people with serious mental health needs receives no formal treatment. Despite international calls for the integration of mental health into routine care, availability of outpatient mental health services and integration of mental health into the broader healthcare system remain weak in many countries. Efforts to strengthen mental healthcare systems must be informed by the local context, with attention to key health system components. The current study is a qualitative analysis of stakeholder perspectives on mental health system strengthening in one low-income country, Sierra Leone. It utilizes locally grounded knowledge from frontline healthcare providers to identify constraints and opportunities for strengthening mental health care within each component of the health system. In-depth semi-structured interviews were conducted with 43 participants including doctors, nurses, community health workers, mental health advocates, mental health specialists, and traditional healers recruited from the Bo, Moyamba and Western Area Urban Districts. Interview transcripts were content-coded in NVivo using both a priori and emergent codes and aggregated into broader themes, utilizing the World Health Organization Health Systems Framework. Participants described an extremely limited system of mental health care, with constraints and obstacles within each health system component. Participants identified potential strategies to help overcome these constraints. Findings reinforce the importance of factors outside of the healthcare system that shape the implementation of mental health initiatives, including pervasive stigma towards mental illness, local conceptualizations of mental illness and an emphasis on traditional treatment approaches. Implications for mental health initiatives in Sierra Leone and other low-income countries include a need for investment in primary care clinics to support integrated mental health services and the importance of engaging communities to promote the utilization of mental health services.
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Affiliation(s)
- Jessica J Fitts
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel St., Champaign, IL 61820, USA
| | - Fatmata Gegbe
- Department of Nursing, School of Community Health Sciences, Njala University, Kowama Location, Sierra Leone
| | - Mark S Aber
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel St., Champaign, IL 61820, USA
| | - Daniel Kaitibi
- Department of Physics and Computer Sciences, Njala University, PMB Freetown, Sierra Leone
| | - Musa Aziz Yokie
- Department of Physics and Computer Sciences, Njala University, PMB Freetown, Sierra Leone
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Hooley C, Amano T, Markovitz L, Yaeger L, Proctor E. Assessing Implementation Strategy Reporting in the Mental Health Literature: A Narrative Review. Adm Policy Ment Health 2020; 47:19-35. [PMID: 31482489 DOI: 10.1007/s10488-019-00965-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inadequate implementation strategy reporting restricts research synthesis and replicability. We explored the implementation strategy reporting quality of a sample of mental health articles using Proctor et al.'s (Implement Sci 8:139, 2013) reporting recommendations. We conducted a narrative review to generate the sample of articles and assigned a reporting quality score to each article. The mean article reporting score was 54% (range 17-100%). The most reported domains were: name (100%), action (82%), target (80%), and actor (67%). The least reported domains included definition (6%), temporality (26%), justification (34%), and outcome (37%). We discuss limitations and provide recommendations to improve reporting.
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10
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Meffert SM, Neylan TC, McCulloch CE, Blum K, Cohen CR, Bukusi EA, Verdeli H, Markowitz JC, Kahn JG, Bukusi D, Thirumurthy H, Rota G, Rota R, Oketch G, Opiyo E, Ongeri L. Interpersonal psychotherapy delivered by nonspecialists for depression and posttraumatic stress disorder among Kenyan HIV-positive women affected by gender-based violence: Randomized controlled trial. PLoS Med 2021; 18:e1003468. [PMID: 33428625 PMCID: PMC7799784 DOI: 10.1371/journal.pmed.1003468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/15/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND HIV-positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world's majority of HIV-positive women live and prevalence of GBV is high. METHODS AND FINDINGS We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV-positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months. Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03). Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (-6.9 [-12.2, -1.5], p = 0.01), and nonsignificantly reduced work absenteeism (-3.35 [-6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (-2.79 [-5.42, -0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed. CONCLUSIONS IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV-positive women's mental health, functioning, and GBV (IPV) exposure, compared to controls. TRIAL REGISTRATION Clinical Trials Identifier NCT02320799.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - Charles E. McCulloch
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, California, United States of America
| | - Kelly Blum
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, UCSF, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Helen Verdeli
- Teachers College, Columbia University, New York, New York, United States of America
| | - John C. Markowitz
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, and Global Health Economics Consortium, UCSF, San Francisco, California, United States of America
| | - David Bukusi
- Department of Psychiatry, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Ray Rota
- University of Nairobi, Nairobi, Kenya
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Kumar M, Huang KY, Othieno C, Wamalwa D, Hoagwood K, Unutzer J, Saxena S, Petersen I, Njuguna S, Amugune B, Gachuno O, Ssewamala F, McKay M. Implementing combined WHO mhGAP and adapted group interpersonal psychotherapy to address depression and mental health needs of pregnant adolescents in Kenyan primary health care settings (INSPIRE): a study protocol for pilot feasibility trial of the integrated intervention in LMIC settings. Pilot Feasibility Stud 2020; 6:136. [PMID: 32974045 PMCID: PMC7507720 DOI: 10.1186/s40814-020-00652-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Addressing adolescent pregnancies associated health burden demands new ways of organizing maternal and child mental health services to meet multiple needs of this group. There is a need to strengthen integration of sustainable evidence-based mental health interventions in primary health care settings for pregnant adolescents. The proposed study is guided by implementation science frameworks with key objective of implementing a pilot trial testing a full IPT-G version along with IPT-G mini version under the mhGAP/IPT-G service framework and to study feasibility of the integrated mhGAP/IPT-G adolescent peripartum depression care delivery model and estimate if a low cost and compressed version of IPT-G intervention would result in similar size of effect on mental health and family functioning as the Full IPT-G. There are two sub- studies embedded which are: 1) To identify multi-level system implementation barriers and strategies guided by the Consolidated Framework for Implementation Research (CFIR) to enhance perinatal mhGAP-depression care and evidence-based intervention integration (i.e., group interpersonal psychotherapy; IPT-G) for pregnant adolescents in primary care contexts; 2) To use findings from aim 1 and observational data from Maternal and Child Health (MCH) clinics that run within primary health care facilities to develop a mental health implementation workflow plan that has buy-in from key stakeholders, as well as to develop a modified protocol and implementation training manual for building health facility staff's capacity in implementing the integrated mhGAP/IPT-G depression care. METHODS For the primary objective of studying feasibility of the integrated mhGAP/IPT-G depression care in MCH service context for adolescent perinatal depression, we will recruit 90 pregnant adolescents to a three-arm pilot intervention (unmasked) trial study (IPT-G Full, IPT-G Mini, and wait-list control in the context of mhGAP care). Pregnant adolescents ages 13-18, in their 1st-2nd trimester with a depression score of 13 and above on EPDS would be recruited. Proctor's implementation evaluation model will be used. Feasibility and acceptability of the intervention implementation and size of effects on mental health and family functioning will be estimated using mixed method data collection from caregivers of adolescents, adolescents, and health care providers. In the two sub-studies, stakeholders representing diverse perspectives will be recruited and focus group discussions data will be gathered. For aim 2, to build capacity for mhGAP-approach of adolescent depression care and research, the implementation-capacity training manual will be applied to train 20 providers, 12 IPT-G implementers/health workers and 16 Kenyan researchers. Acceptability and appropriateness of the training approach will be assessed. Additional feedback related to co-located service delivery model, task-shifting and task-sharing approach of IPT-G delivery will be gathered for further manual improvement. DISCUSSION This intervention and service design are in line with policy priority of Government of Kenya, Kenya Vision 2030, World Health Organization, and UN Sustainable Development Goals that focus on improving capacity of mental health service systems to reduce maternal, child, adolescent health and mental health disparities in LMICs. Successfully carrying out this study in Kenya will provide an evidence-based intervention service development and implementation model for adolescents in other Sub-Saharan African (SSA) countries. The study is funded by FIC/NIH under K43 grant.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Keng-Yen Huang
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, USA
| | - Jurgen Unutzer
- Department of Psychiatry, University of Washington, Seattle, USA
| | - Shekhar Saxena
- Department of Global Health and Population, Chan School of Public Health, Harvard University, Boston, USA
| | - Inge Petersen
- Department of Psychology, University of Kwa-Zulu Natal, Durban, South Africa
| | - Simon Njuguna
- Department of Mental Health, Ministry of Health, Nairobi, Kenya
| | | | - Onesmus Gachuno
- Department of Obstertrics and Gynacology, University of Nairobi, Nairobi, Kenya
| | - Fred Ssewamala
- Brown School at Washington University in St.Louis, St. Louis, USA
| | - Mary McKay
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
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Salamanca-Buentello F, Seeman MV, Daar AS, Upshur REG. The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world. PLoS One 2020; 15:e0237853. [PMID: 32834012 PMCID: PMC7446846 DOI: 10.1371/journal.pone.0237853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 08/04/2020] [Indexed: 01/14/2023] Open
Abstract
Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi- and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low- and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing long-term funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to reduce the burden of these disorders by encouraging their timely and context-sensitive prevention and management.
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Affiliation(s)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Abdallah S. Daar
- Departments of Clinical Public Health and Surgery, University of Toronto, Toronto, Ontario, Canada
- Stellenbosch Institute for Advanced Study, Stellenbosch, Western Cape, South Africa
| | - Ross E. G. Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld - Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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Wasil AR, Venturo-Conerly KE, Shinde S, Patel V, Jones PJ. Applying network analysis to understand depression and substance use in Indian adolescents. J Affect Disord 2020; 265:278-286. [PMID: 32090752 DOI: 10.1016/j.jad.2020.01.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/14/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Network analysis has been used to better understand relationships between depressive symptoms. Existing work has rarely examined networks of adolescents or individuals in non-western countries. METHODS We used data from 13,035 adolescents (52.5% male; Mage=13.8) from Bihar, a low-resource state in India. Depression was measured using the Patient Health Questionnaire-9, and substance use was measured using a questionnaire adapted from the World Health Organization. We modeled a network of depressive symptoms and a network examining connections between depressive symptoms and substance use. RESULTS The most commonly reported depressive symptoms were sleep problems, poor appetite, and low energy. In the depression network, feeling like a failure and sad mood were the most central symptoms, and somatic symptoms clustered together. To our surprise, depressive symptoms were only weakly associated with substance use. LIMITATIONS Our study uses cross-sectional data, which are not sufficient to draw causal inferences about the relationships between symptoms. Additionally, we used an exploratory data-driven approach, and we did not pose a priori hypotheses about the relationships between symptoms. DISCUSSION Our findings suggest that feelings like a failure and sad mood are highly central symptoms in Indian adolescents; future research may examine if these symptoms are strong targets for intervention. Sad mood has commonly been identified as a central symptom of depression in western samples, while feeling like a failure has not. We offer avenues for future research, illustrating how network analysis may enhance our ability to understand, prevent, and treat psychopathology in LMICs.
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Affiliation(s)
- Akash R Wasil
- Department of Psychology, Harvard University, United States; Department of Psychology, University of Pennsylvania, United States
| | | | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, United States; Sangath, Goa, India
| | - Payton J Jones
- Department of Psychology, Harvard University, United States
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Levy R, Mathai M, Chatterjee P, Ongeri L, Njuguna S, Onyango D, Akena D, Rota G, Otieno A, Neylan TC, Lukwata H, Kahn JG, Cohen CR, Bukusi D, Aarons GA, Burger R, Blum K, Nahum-Shani I, McCulloch CE, Meffert SM. Implementation research for public sector mental health care scale-up (SMART-DAPPER): a sequential multiple, assignment randomized trial (SMART) of non-specialist-delivered psychotherapy and/or medication for major depressive disorder and posttraumatic stress disorder (DAPPER) integrated with outpatient care clinics at a county hospital in Kenya. BMC Psychiatry 2019; 19:424. [PMID: 31883526 PMCID: PMC6935499 DOI: 10.1186/s12888-019-2395-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. METHODS/DESIGN We will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale -up. DISCUSSION The results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information - a critical gap for addressing a leading global cause of disability. TRIAL REGISTRATION ClinicalTrials.gov NCT03466346, registered March 15, 2018.
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MESH Headings
- Adult
- Ambulatory Care/methods
- Ambulatory Care/trends
- Ambulatory Care Facilities/trends
- Antidepressive Agents, Second-Generation/administration & dosage
- Combined Modality Therapy/methods
- Combined Modality Therapy/trends
- Delivery of Health Care, Integrated/methods
- Delivery of Health Care, Integrated/trends
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/therapy
- Female
- Fluoxetine/administration & dosage
- Hospitals, County/trends
- Humans
- Kenya/epidemiology
- Male
- Mental Health Services/trends
- Psychotherapy/methods
- Public Sector/trends
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/therapy
- Treatment Outcome
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Affiliation(s)
- Rachel Levy
- Medical School, University of California, San Francisco, CA, USA
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Purba Chatterjee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Linnet Ongeri
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Simon Njuguna
- Director of Mental Health, Kenyan Ministry of Health, Nairobi, Kenya
| | | | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | | | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA
| | - Hafsa Lukwata
- Division of Mental Health and Control of Substance Abuse, Ministry of Health -, Kampala, Uganda
| | - James G Kahn
- Department of Epidemiology and Biostatistics, Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, UC Global Health Institute, San Francisco, CA, USA
| | - David Bukusi
- Department of Psychiatry, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Rachel Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Kelly Blum
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles E McCulloch
- Division of Mental Health and Control of Substance Abuse, Ministry of Health -, Kampala, Uganda
| | - Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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Hooley C, Amano T, Markovitz L, Yaeger L, Proctor E. Assessing Implementation Strategy Reporting in the Mental Health Literature: A Narrative Review. Adm Policy Ment Health 2020; 47:19-35. [PMID: 31482489 DOI: 10.1007/s10488-019-00965-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Inadequate implementation strategy reporting restricts research synthesis and replicability. We explored the implementation strategy reporting quality of a sample of mental health articles using Proctor et al.'s (Implement Sci 8:139, 2013) reporting recommendations. We conducted a narrative review to generate the sample of articles and assigned a reporting quality score to each article. The mean article reporting score was 54% (range 17-100%). The most reported domains were: name (100%), action (82%), target (80%), and actor (67%). The least reported domains included definition (6%), temporality (26%), justification (34%), and outcome (37%). We discuss limitations and provide recommendations to improve reporting.
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16
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Kemp CG, Petersen I, Bhana A, Rao D. Supervision of Task-Shared Mental Health Care in Low-Resource Settings: A Commentary on Programmatic Experience. Glob Health Sci Pract 2019; 7:150-159. [PMID: 31249017 PMCID: PMC6641815 DOI: 10.9745/ghsp-d-18-00337] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher G Kemp
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Inge Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Arvin Bhana
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.,South African Medical Research Council, Health Systems Research Unit, Durban, South Africa
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Spoelstra SL, Schueller M, Sikorskii A. Testing an implementation strategy bundle on adoption and sustainability of evidence to optimize physical function in community-dwelling disabled and older adults in a Medicaid waiver: a multi-site pragmatic hybrid type III protocol. Implement Sci 2019; 14:60. [PMID: 31196137 PMCID: PMC6567613 DOI: 10.1186/s13012-019-0907-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background In partnership with a state Medicaid home and community-based waiver program, this study tests implementation strategies for adoption and sustainability of an evidence-based intervention to support disabled and older adults who have difficulty with physical function and daily living tasks. A multi-level implementation strategy bundle will be directed at relationship, coalition, and team building; readiness to implement, leadership, and clinician attitude toward evidence assessments; intervention and facilitation training; interdisciplinary coordination; facilitation; and audit and feedback to support practice change. Methods Knowledge-to-Action model underpins this 2-arm, 3-year pragmatic mixed method randomized hybrid type III trial in 18 waiver program sites in Michigan. Data will be collected on sites, 775 clinicians (registered nurses, occupational therapists, social workers), and 15,000 disabled and older adults. Consolidated Framework for Implementation Research guides examination of site, clinician, and beneficiary characteristics; clinician attitude and self-efficacy; leadership and readiness to implement; and intervention impact on beneficiary outcomes. Sites will be randomized to either usual waiver care with internal facilitation of the bundle of implementation strategies or usual waiver care with both internal and external facilitation of the bundle. Primary outcomes are site-level adoption and sustainability over 12 months, and intervention effects on these outcomes are hypothesized to be mediated by clinicians’ attitude and self-efficacy. At the beneficiary level, by addressing the individual’s capabilities and home environment, the intervention is hypothesized to improve secondary outcomes of activities of daily living, pain, depression, falls, emergency department visits, and hospitalizations. Baseline site readiness and leadership and stages of implementation at 6 months will be explored as potential moderators. Linear mixed effects models will be used to test intervention effects on primary outcomes, with bias-correcting analytic strategy in mediation analyses. Generalized linear mixed effects modeling will be employed for the analysis of intervention effects on secondary outcomes. Discussion Synthesizing findings within and across the sites, we will specify how leadership, readiness for change, and level of facilitation enhance capacity for adoption and sustainability of an evidence-based intervention in an under-resourced Medicaid setting that cares for disabled and older adults. Trial registration ClinitalTrials.gov, NCT03634033. Registered 16 August 2018. Electronic supplementary material The online version of this article (10.1186/s13012-019-0907-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA.
| | - Monica Schueller
- Kirkhof College of Nursing, Grand Valley State University, 301 Michigan St, Room C352, Grand Rapids, MI, 49504, USA
| | - Alla Sikorskii
- Departments of Psychiatry and Statistics and Probability, Michigan State University, East Lansing, USA
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Kumar M, Kuria MW, Othieno CJ, Falkenström F. Improving psychotherapies offered in public hospitals in Nairobi, Kenya: extending practice-based research model for LMICs. Int J Ment Health Syst 2018; 12:76. [PMID: 30555529 PMCID: PMC6288907 DOI: 10.1186/s13033-018-0254-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/24/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychotherapy and mental health services in Nairobi's public hospitals are increasing. Rather than prematurely imposing psychotherapy protocols developed in Western countries to Kenya, we argue that first studying psychological interventions as they are practiced may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems in a lower and middle income country like Kenya. METHOD We present preliminary findings from a process-outcome study involving 345 patients from two public institutions, Kenyatta National and Mathare National Hospitals. We asked our patients to fill out a brief personal information questionnaire, Clinical Outcomes in Routine Evaluation-Outcome Measure (Evans et al. in Br J Psychiatry 180:51-60, 2002, and the Session Alliance Inventory (Falkenström et al. in Psychol Assess 27:169-183, 2015) after each session. We present descriptives for CORE-OM, patient-therapist concordance on the SAI, and using longitudinal mixed-effects model, test change in CORE-OM over time with various therapy and patient factors as predictors in regression analyses. RESULTS The majority of patients who attended the outpatient care clinics were young males. Our regression analysis suggested that patients with depression reported higher initial distress levels (2.75 CORE-OM scores, se = 1.11, z = 2.48, p = 0.013, 95% CI 0.57-4.93) than patients with addictions, anxiety, or psychosis. Older clients improved slower (0.08 CORE-OM scores slower improvement per session per year older age; se = 0.03, z = 3.02 p = 0.003, 95% CI 0.03, 0.14). Female patients reported higher initial distress than men (2.62 CORE-OM scores, se = 1.00, z = 2.61, p = 0.009, 95% CI 0.65, 4.58). However, interns had patients who reported significantly higher initial distress (3.24 CORE-OM points, se = 0.90, z = 3.60, p < 0.001, 95% CI 1.48, 5.00), and improved more over time (- 1.20 CORE-OM scores per session, se = 0.51, z = - 2.35, p = 0.019, 95% CI - 2.20, - 0.20) than patients seeing mental health practitioners. The results showed that at average alliance, CORE-OM decreased by 1.74 points per session (se = 0.21, p < 0.001). For each point higher on the SAI at session 2, the CORE-OM decreased by an additional 0.58 points per session (se = 0.25, p = 0.02). DISCUSSION Our objective was to study psychotherapies as they are practiced in naturalistic settings. The overall significant finding is that our participants report improvement in their functioning mental health condition and distress reduced as psychotherapy progressed. There were many more male than female participants in our sample; younger patients improved more than older ones; and while interns had patients with higher distress, their patients improved better than those patients attended by professionals. CONCLUSIONS These are preliminary observations to consider for a larger sample follow-up study. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
- Research Department of Clinical Health and Educational Psychology, University College London, Gower Street, London, WC1E 6BT UK
| | - Mary Wangari Kuria
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Caleb Joseph Othieno
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Hendriks T, Warren MA, Schotanus-Dijkstra M, Hassankhan A, Graafsma T, Bohlmeijer E, de Jong J. How WEIRD are positive psychology interventions? A bibliometric analysis of randomized controlled trials on the science of well-being. The Journal of Positive Psychology 2018. [DOI: 10.1080/17439760.2018.1484941] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Tom Hendriks
- Department of Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Meg A Warren
- Department of Psychology, Western Washington University, Bellingham, WA, USA
| | - Marijke Schotanus-Dijkstra
- Department of Psychology, Health and Technology, University of Twente, Centre for eHealth and Wellbeing Research (CEWR), Enschede, The Netherlands
| | - Aabidien Hassankhan
- Department of Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Tobi Graafsma
- Institute of Graduate Studies and Studies (IGSR), Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Centre for eHealth and Wellbeing Research (CEWR), Enschede, The Netherlands
| | - Joop de Jong
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands
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20
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Mason WA, Cogua-Lopez J, Fleming CB, Scheier LM. Challenges Facing Evidence-Based Prevention: Incorporating an Abductive Theory of Method. Eval Health Prof 2018; 41:155-182. [PMID: 29719989 DOI: 10.1177/0163278718772879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current systems used to determine whether prevention programs are "evidence-based" rely on the logic of deductive reasoning. This reliance has fostered implementation of strategies with explicitly stated evaluation criteria used to gauge program validity and suitability for dissemination. Frequently, investigators resort to the randomized controlled trial (RCT) combined with null hypothesis significance testing (NHST) as a means to rule out competing hypotheses and determine whether an intervention works. The RCT design has achieved success across numerous disciplines but is not without limitations. We outline several issues that question allegiance to the RCT, NHST, and the hypothetico-deductive method of scientific inquiry. We also discuss three challenges to the status of program evaluation including reproducibility, generalizability, and credibility of findings. As an alternative, we posit that extending current program evaluation criteria with principles drawn from an abductive theory of method (ATOM) can strengthen our ability to address these challenges and advance studies of drug prevention. Abductive reasoning involves working from observed phenomena to the generation of alternative explanations for the phenomena and comparing the alternatives to select the best possible explanation. We conclude that an ATOM can help increase the influence and impact of evidence-based prevention for population benefit.
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Affiliation(s)
- W Alex Mason
- 1 National Research Institute for Child and Family Studies, Boys Town, NE, USA
| | - Jasney Cogua-Lopez
- 1 National Research Institute for Child and Family Studies, Boys Town, NE, USA
| | - Charles B Fleming
- 2 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Ongeri L, McCulloch C, Neylan T, Bukusi E, Macfarlane S, Othieno C, Ngugi A, Meffert S. Suicidality and associated risk factors in outpatients attending a general medical facility in rural Kenya. J Affect Disord 2018; 225:413-421. [PMID: 28850856 PMCID: PMC5663198 DOI: 10.1016/j.jad.2017.08.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Low-and-Middle-Income-Countries (LMICs) account for 75% of global suicides. While primary care populations in high-income countries (HIC) typically have higher prevalence of suicidal behavior relative to general populations, few studies have explored suicidal behavior among general medical outpatients in LMICs. This study addresses the research gap by characterizing potential risk factors for suicidal ideation in a large general medical outpatient setting in rural Kenya. METHODS A cross-sectional study of adult general medical outpatients attending a rural sub-county hospital in Kaloleni, Kenya. Primary outcomes included major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and suicidal behavior measured by the Mini International Neuropsychiatric Interview (MINI 5.0). We use binary logistic regression to model suicidality, mental disorders, intimate partner violence, and lifetime abuse. RESULTS 394 outpatients completed the assessment. The prevalence of SI over the past month was 20%. 18% of those with suicidal ideation over the past month also attempted suicide in the past month. Participants who met criteria for MDD (suicidality item removed) were 19 times [CI: 4.56, 79.05] more likely to report suicidal ideation compared to those without MDD (adjusted odds ratio 12.15 [CI: 2.66, 55.49]). LIMITATIONS This was a cross sectional study design with convenience sampling and hence vulnerable to selection and recall bias. CONCLUSION The prevalence of SI and its strong association with actual suicide attempt in this population, make an urgent public health case for intervention. These data identify MDD as a highly significant correlate of SI.
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Affiliation(s)
- L. Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya,Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Corresponding author at: Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. (L. Ongeri)
| | - C.E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA,Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - T.C. Neylan
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, USA
| | - E. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Global Health Sciences, University of California San Francisco, California, USA
| | - S.B. Macfarlane
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of Nairobi, Kenya
| | - C. Othieno
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Centre for Population Health Sciences, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya
| | - A.K. Ngugi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, USA
| | - S.M. Meffert
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, USA
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22
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Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, Neria Y, Bradford JME, Oquendo MA, Arbuckle MR. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep 2017; 19:28. [PMID: 28425023 PMCID: PMC5553319 DOI: 10.1007/s11920-017-0780-z] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. RECENT FINDINGS Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.
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Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA.
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - James M Shultz
- Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, FL, 33160, USA
| | - Liat Helpman
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jennifer J Mootz
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Karen A Johnson
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jean-Marie E Bradford
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 200, Philadelphia, PA, 19104-3309, USA
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
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23
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Wolfenden L, Williams CM, Wiggers J, Nathan N, Yoong SL. Improving the translation of health promotion interventions using effectiveness-implementation hybrid designs in program evaluations. Health Promot J Austr 2016; 27:204-207. [PMID: 29241482 DOI: 10.1071/he16056] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022] Open
Abstract
Bridging the gap between research-based evidence and public health policy and practice is a considerable challenge to public health improvement this century, requiring a rethinking of conventional approaches to health research production and use. Traditionally the process of research translation has been viewed as linear and unidirectional, from epidemiological research to identify health problems and determinants, to efficacy and effectiveness trials and studies of strategies to maximise the implementation and dissemination of evidence-based interventions in practice. A criticism of this approach is the considerable time it takes to achieve translation of health research into practice. Hybrid evaluation designs provide one means of accelerating the research translation process by simultaneously collecting information regarding intervention impacts and implementation and dissemination strategy. However, few health promotion research trials employ such designs and often fail to report information to enable assessment of the feasibility and potential impact of implementation and dissemination strategies. In addition to intervention effects, policy makers and practitioners also want to know the impact of implementation strategies. This commentary will define the three categories of effectiveness-implementation hybrid designs, describe their application in health promotion evaluation, and discuss the potential implications of more systematic use of such designs for the translation of health promotion and evaluation.So what?Greater use of effectiveness-implementation hybrid designs may accelerate research translation by providing more practice- and policy-relevant information to end-users, more quickly.
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Affiliation(s)
- Luke Wolfenden
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | | | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Nicole Nathan
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Sze Lin Yoong
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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24
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Opiyo E, Ongeri L, Rota G, Verdeli H, Neylan T, Meffert S. Collaborative Interpersonal Psychotherapy for HIV-Positive Women in Kenya: A Case Study From the Mental Health, HIV and Domestic Violence (MIND) Study. J Clin Psychol 2016; 72:779-83. [PMID: 27463639 PMCID: PMC6788292 DOI: 10.1002/jclp.22359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We examine the efficacy of nonspecialists delivering interpersonal psychotherapy (IPT) to HIV-positive (HIV+) women. We describe a case in which local personnel without prior mental health training delivered IPT for the treatment of depression and posttraumatic stress disorder in an HIV+ woman who reported experiencing gender-based violence and was enrolled in HIV care at the Family AIDS, Care, Education and Services program in Kisumu, Kenya.
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Affiliation(s)
| | | | - Grace Rota
- Family AIDS, Care Education and Services
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